Abstract
ObjectiveThe aim of this study was to evaluate the validity of cause of death stated in death certificates in Tehran using outcome measures of the Tehran Lipid and Glucose Study (TLGS), an ongoing prospective cohort study.MethodsThe cohort was established in 1999 in a population of 15005 people, 3 years old and over, living in Tehran; 3551 individuals were added to this population three years later. As part of cohort's outcome measures, deaths occurring in the cohort are investigated by a panel of medical specialists (Cohort Outcome Panel-COP) and underlying cause of death is determined for each death. The cause of death assigned in a deceased's original death certificate was evaluated against the cause of death determined by COP and sensitivity and positive predictive values (PPV) were determined. In addition, determinants of assigning accurate underlying cause of death were determined using logistic regression model.ResultA total of 231 death certificates were evaluated. The original death certificates over reported deaths due to neoplasms and underreported death due to circulatory system and transport accidents. Neoplasms with sensitivity of 0.91 and PPV of 0.71 were the most valid category. The disease of circulatory system showed moderate degree of validity with sensitivity of 0.67 and PPV of 0.78. The result of logistic regression indicated if the death certificate is issued by a general practitioner, there is 2.3 (95% CI 1.1, 5.1) times chance of being misclassified compared with when it is issued by a specialist. If the deceased is more than 60 years, the chance of misclassification would be 2.5 times (95% CI of 1.1, 5.9) compared with when the deceased is less than 60 years.
Highlights
Mortality data have been one of the oldest information available to the health authorities and have been utilized to monitor the health of different communities since early 17th century when the first death registration was established in England and Wales [1]
The present study examines the validity of underlying cause of death as stated in death certificate for group of deceased who were registered members of a prospective cohort that were monitored for several exposures and outcomes in a urban population in Tehran, Iran
Our study showed that neoplasms were over reported and death due to circulatory system and transport accidents underreported in the death certificate issued in the population of Tehran, indicating different degrees of accuracy for different causal categories
Summary
Mortality data have been one of the oldest information available to the health authorities and have been utilized to monitor the health of different communities since early 17th century when the first death registration was established in England and Wales [1]. The degree of misclassification is influenced by several factors including; the true underlying cause of death, the mechanism that judgment on cause of death is based on (clinical information, autopsy report, or just simple inquiry from the of kin of the deceased), the age at which death occurs, and lack of a standard procedures and quality controls in management of death certificate at community level [3,4,5,6,7]. Studies of assessing validity and accuracy of cause of death in different communities have employed several methodology among them the sensitivity analysis of issued cause of death against a gold standard such as autopsy reports or reassessment of underling cause by either re-abstracting of medical information of the deceased or application of standardized structured questionnaire in the form of verbal autopsy [10,11]. The present study examines the validity of underlying cause of death as stated in death certificate for group of deceased who were registered members of a prospective cohort that were monitored for several exposures and outcomes (both morbidity and mortality) in a urban population in Tehran, Iran
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