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Unexplained differences between hospital and mortality data indicated mistakes in death certification: An investigation of 1094 deaths in Sweden during 1995
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)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Ssocialmedicinsk epidemiologi)
2009 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 62, no 11, 1202-1209 p.Article 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.

Place, publisher, year, edition, pages
2009. Vol. 62, no 11, 1202-1209 p.
National Category
Medical and Health Sciences
Research subject
Social Medicine
Identifiers
URN: urn:nbn:se:uu:diva-96682DOI: 10.1016/j.jclinepi.2009.01.010OAI: oai:DiVA.org:uu-96682DiVA: diva2:171335
Available from: 2008-01-31 Created: 2008-01-31 Last updated: 2013-02-08Bibliographically 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.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 305
Keyword
Social medicine, Cause of death, Death certificates, Medical records, Mortality statistics, Quality control, Medical record linkage, Socialmedicin
National Category
Medical and Health Sciences
Identifiers
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
Opponent
Supervisors
Available from: 2008-01-31 Created: 2008-01-31 Last updated: 2016-05-26Bibliographically approved

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Johansson, Lars AgeWesterling, Ragnar

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