Changes in reporting for unintentional injury deaths, United States of America.

Peishan Ning,Haitao Chu,Motao Zhu,David C Schwebel,Guoqing Hu

doi:10.2471/blt.18.215327

Abstract

ObjectiveTo quantify how changes in reporting of specific causes of death and of selecting underlying cause from among multiple causes of death contribute to trends in mortality from unintentional injury in Americans aged 65 years or older.MethodsWe extracted age-standardized unintentional injury mortality data in the United States Centers for Disease Control and Prevention online databases from 1999 to 2016. We used an attribution method to calculate two indicators: the proportion of mortality with specific codes out of all mortality; and the proportion of mortality with underlying cause of death selected from multiple causes of death. We conducted a linear regression to examine the changes over time in these proportions and in reported and age-adjusted mortality.FindingsFrom 1999 through 2016, the proportion of cause-specific unintentional injury mortality in this age group increased from 74% in 1999 (136.9 out of 185.0 per 100 000 population) to 85% in 2016 (143.0 out of 169.1 per 100 000 population) based on multiple causes of death codes. The proportions of mortality with underlying cause of death selected out of multiple causes of death rose in all specific causes of unintentional injury except motor vehicle crash. Age-standardized mortality attributed to reporting changes increased steadily between 1999 and 2016. The increases for overall unintentional injury, fall, motor vehicle crash, suffocation, poisoning and fire or hot object were 24.2, 13.5, 2.1, 2.3, 1.6 and 0.4 deaths per 100 000 persons, respectively.ConclusionChanges in data reporting affect trends in overall and specific unintentional injury mortality over time for older Americans.

Highlights

Proper interpretation of reported injury mortality rates and their changes over time are important for assessing the effects of sociodemographic factors on injury risk, developing injury control and prevention efforts, and prioritizing policy interventions
The correctness and specificity of multiple causes of death is primarily determined by clinical diagnosis and the skill of staff members who are responsible for completing death certificates
Mortality data from the death certificates are either entered by the physician certifying a death, coded by the States and provided to National Center for Health Statistics (NCHS) through the Vital Statistics Cooperative Program; or they are coded by NCHS from copies of the original death certificate provided to NCHS by the State registration offices.[2,14]

Summary

Introduction

Proper interpretation of reported injury mortality rates and their changes over time are important for assessing the effects of sociodemographic factors on injury risk, developing injury control and prevention efforts, and prioritizing policy interventions. Two factors important for quality reporting are the correctness and specificity of the data on multiple causes of death and the correct selection of the underlying cause of death from the multiple causes of death.[1,2] The correctness and specificity of multiple causes of death is primarily determined by clinical diagnosis and the skill of staff members who are responsible for completing death certificates. This includes both their skill in proper recording of each cause of death and in proper ranking of the sequence of multiple causes of death.[1,2] Selection of the underlying cause of death from multiple causes of death is typically made according to the sequence of multiple causes of death on the death certificate, with the first cause in the sequence usually chosen.[2]

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