Abstract
IntroductionPoor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts. Overreporting of heart disease has been documented in New York City (NYC) and nationwide. Our objective was to evaluate the immediate and longer-term effects of a cause-of-death (COD) educational program that NYC’s health department conducted at 8 hospitals on heart disease reporting and on average conditions per certificate, which are indicators of the quality of COD reporting.MethodsFrom June 2009 through January 2010, we intervened at 8 hospitals that overreported heart disease deaths in 2008. We shared hospital-specific data on COD reporting, held conference calls with key hospital staff, and conducted in-service training. For deaths reported from January 2009 through June 2011, we compared the proportion of heart disease deaths and average number of conditions per death certificate before and after the intervention at both intervention and nonintervention hospitals.ResultsAt intervention hospitals, the proportion of death certificates that reported heart disease as the cause of death decreased from 68.8% preintervention to 32.4% postintervention (P < .001). Individual hospital proportions ranged from 58.9% to 79.5% preintervention and 25.9% to 45.0% postintervention. At intervention hospitals the average number of conditions per death certificate increased from 2.4 conditions preintervention to 3.4 conditions postintervention (P < .001) and remained at 3.4 conditions a year later. At nonintervention hospitals, these measures remained relatively consistent across the intervention and postintervention period.ConclusionThis NYC health department’s hospital-level intervention led to durable changes in COD reporting.
Highlights
Poor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts
The number of deaths ranged from 297 to 1,197 for a total of 4,597; the proportion of heart disease deaths ranged from 60.4% to 78.1%, averaging 68.2%; and the average number of conditions reported per death certificate ranged from 1.7 to 2.7, averaging 2.4 (Table 1)
At intervention hospitals the proportion of heart disease deaths decreased from 68.8% preintervention to 32.4% postintervention (P < .01)
Summary
Poor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts. Overreporting of heart disease has been documented in New York City (NYC) and nationwide. Inaccurate reporting of cause of death (COD) on death certificates limits the validity and usefulness of mortality indicators for policy, research, and applied public health decisions [1,2]. Validation studies and audits have found that heart disease is overreported as a COD [3,4,5,6,7]. A comparison of certificates of in-hospital deaths with medical charts for deaths in 2003 in New York City (NYC) showed 91% overreporting of heart disease. A previous study of 4 other regions found that 20% of certificates of in-hospital death incorrectly documented heart disease as the underlying COD [6]. Because NYC’s heart disease risk factors are not greater than those of the rest of nation [8], overreporting likely partially explains NYC’s high heart disease death rates [9,10]
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