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Targeting Non-obvious Errors in Death Certificates
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Mortality statistics are much used although their accuracy is often questioned. Producers of mortality statistics check for errors in death certification but current methods only capture obvious mistakes. This thesis investigates whether non-obvious errors can be found by linking death certificates to hospital discharge data.

Data: 69,818 deaths in Sweden 1995. Paper I: Analysing differences between the underlying cause of death from the death certificate (UC) and the main discharge condition from the patient’s last hospitalization (MDC). Paper II: Testing whether differences can be explained by ICD definitions of UC and MDC. Paper III: Surveying methods in 44 current studies on the accuracy of death certificates. Paper IV: Checking death certificates against case summaries for: i) 573 deaths where UC and MDC were the same or the difference could be explained; ii) 562 deaths where the difference could not be explained.

Results: In 54% of deaths the MDC differed from the UC. Almost two-thirds of the differences were medically compatible since the MDC might have developed as a complication of the UC. Of 44 recent evaluation studies, only 8 describe the methods in such detail that the study could be replicated. Incompatibility between MDC and UC indicates a four-fold risk that the death certificate is inaccurate. For some diagnostic groups, however, death certificates are often inaccurate even when the UC and MDC are compatible.

Conclusion: Producers of official mortality statistics could reduce the number of non-obvious errors in the statistics by collecting additional information on incompatible deaths and on deaths in high-risk diagnostic groups. ICD conventions contribute to the quality problem since they presuppose that all deaths are due to a single underlying cause. However, in an ageing population an increasing number of deaths are due to an accumulation of etiologically unrelated conditions.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2008. , p. 105
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 305
Keywords [en]
Social medicine, Cause of death, Death certificates, Medical records, Mortality statistics, Quality control, Medical record linkage
Keywords [sv]
Socialmedicin
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-8420ISBN: 978-91-554-7075-3 (print)OAI: oai:DiVA.org:uu-8420DiVA, id: diva2:171336
Public defence
2008-02-21, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:15
Opponent
Supervisors
Available from: 2008-01-31 Created: 2008-01-31 Last updated: 2016-05-26Bibliographically approved
List of papers
1. Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics
Open this publication in new window or tab >>Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics
2000 In: International Journal of Epidemiology, ISSN 0300-5771, Vol. 29, p. 495-502Article in journal (Refereed) Published
Identifiers
urn:nbn:se:uu:diva-96679 (URN)
Available from: 2008-01-31 Created: 2008-01-31 Last updated: 2016-04-22Bibliographically approved
2. Comparing hospital discharge records with death certificates: can the differences be explained?
Open this publication in new window or tab >>Comparing hospital discharge records with death certificates: can the differences be explained?
2002 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, Vol. 56, p. 301-308Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-96680 (URN)
Available from: 2008-01-31 Created: 2008-01-31 Last updated: 2017-03-15
3. Methodology of studies evaluating death certificate accuracy were flawed.
Open this publication in new window or tab >>Methodology of studies evaluating death certificate accuracy were flawed.
2006 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 59, no 2, p. 125-31Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND OBJECTIVE: Statistics on causes of death are important for epidemiologic research. Studies that evaluate the source data often give conflicting results, which raise questions about comparability and validity of methods. METHODS: For 44 recent evaluation studies we examined the methods employed and assessed the reproducibility. RESULTS: Thirty studies stated who reviewed the source data. Six studies reported reliability tests. Twelve studies included all causes of death, but none specified criteria for identifying the underlying cause when several, etiologically independent conditions were present. We assessed these as not reproducible. Of 32 studies that focussed on a specific condition, 21 provided diagnostic criteria such that the verification of the focal diagnosis is reproducible. Of 16 that discussed the difference between dying "with" and "from" a condition, eight described how competing causes had been handled. For these eight, the selection of a principal cause is reproducible, but in three the selection strategy conflicts with the international instructions issued by the World Health Organization. CONCLUSION: Methods and criteria are often insufficiently described. When described, they sometimes disagree with the international standard. Explicit descriptions of methods and criteria would contribute to methodologic improvement and would allow readers to assess the generalizability of the conclusions.

Keywords
Cause of Death, Death Certificates, Epidemiologic Studies, Humans, Medical Records, Quality Control
Identifiers
urn:nbn:se:uu:diva-79624 (URN)10.1016/j.jclinepi.2005.05.006 (DOI)16426947 (PubMedID)
Available from: 2006-04-11 Created: 2006-04-11 Last updated: 2017-12-14Bibliographically approved
4. Unexplained differences between hospital and mortality data indicated mistakes in death certification: An investigation of 1094 deaths in Sweden during 1995
Open this publication in new window or tab >>Unexplained differences between hospital and mortality data indicated mistakes in death certification: An investigation of 1094 deaths in Sweden during 1995
2009 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 62, no 11, p. 1202-1209Article in journal (Refereed) Published
Abstract [en]

Objective

Mortality statistics are important for epidemiological research. We examine if discrepancies between death certificate (DC) and hospital discharge condition (HDC) indicate certification errors.

Study Design and Setting

From 39,872 hospital deaths in Sweden in 1995, we randomly selected 600 “cases,” where DC and HDC were incompatible, and 600 compatible “controls,” matched on sex, age, and underlying cause of death. We obtained case summaries for 1,094 (91%) of these. Using a structured protocol, we assessed the accuracy of DCs.

Results

Regression analysis indicated diagnostic group and “case” or “control” as the variables that most affected the accuracy. Malignant neoplasm “controls” had the highest accuracy (92%), and benign and unspecified tumor “cases,” the lowest (20%). For all diagnostic groups except one, compatible “controls” had better accuracy than incompatible “cases.” The exception, chronic obstructive lung disease, had low accuracy for both “cases” (54%) and “controls” (52%).

Conclusion

Incompatibility between DC and HDC indicates a greater risk of certification errors. For some diagnostic groups, however, DCs are often inaccurate even when DC and HDC are compatible. By requesting additional information on incompatible cases and all deaths in high-risk diagnostic groups, producers of mortality statistics could improve the accuracy of the statistics.

National Category
Medical and Health Sciences
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-96682 (URN)10.1016/j.jclinepi.2009.01.010 (DOI)
Available from: 2008-01-31 Created: 2008-01-31 Last updated: 2017-12-14Bibliographically approved

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