National chronic respiratory disease mortality study: I. Prevalence and severity at death of chronic respiratory diseases in the united states, 1963

Abstract

The certifiers of 3193 U.S. deaths, aged 35–74, were queried by mail on the presence and severity of several chronic respiratory diseases (excluding tuberculosis, lung cancer and occupational pneumoconioses), in order to evaluate published vital statistics which indicate a marked increase since 1950 in the U.S. death rate from these diseases. The prevalence at death of the chronic respiratory diseases was found to be more than nine tunes greater than its underlying cause death rate. It was also found that U.S. death certifiers in 1963 listed on the death certificates only half of the severe chronic respiratory disease present at death, suggesting that vital statistics based on death certificates may seriously underestimate the contribution of chronic respiratory diseases to U.S. deaths. Such epidemiologic observations on the chronic respiratory diseases as their rapidly increasing U.S. mortality rate, their relatively small contribution to mortality in the U.S. when compared to the U.K., and their relatively high mortality rates in several states could be statistical artifacts arising from variation in habits of death certification.