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Methodology of studies evaluating death certificate accuracy were flawed.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
2006 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, Vol. 59, no 2, 125-31 p.Article 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.

Place, publisher, year, edition, pages
2006. Vol. 59, no 2, 125-31 p.
Keyword [en]
Cause of Death, Death Certificates, Epidemiologic Studies, Humans, Medical Records, Quality Control
URN: urn:nbn:se:uu:diva-79624DOI: 10.1016/j.jclinepi.2005.05.006PubMedID: 16426947OAI: oai:DiVA.org:uu-79624DiVA: diva2:107537
Available from: 2006-04-11 Created: 2006-04-11 Last updated: 2016-05-26Bibliographically approved
In thesis
1. Targeting Non-obvious Errors in Death Certificates
Open this publication in new window or tab >>Targeting Non-obvious Errors in Death Certificates
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. 105 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 305
Social medicine, Cause of death, Death certificates, Medical records, Mortality statistics, Quality control, Medical record linkage, Socialmedicin
National Category
Medical and Health Sciences
urn:nbn:se:uu:diva-8420 (URN)978-91-554-7075-3 (ISBN)
Public defence
2008-02-21, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 13:15
Available from: 2008-01-31 Created: 2008-01-31 Last updated: 2016-05-26Bibliographically approved

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