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  • 1. Björkenstam, Charlotte
    et al.
    Johansson, Lars Age
    Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
    Nordström, Peter
    Thiblin, Ingemar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Rättsmedicin.
    Fugelstad, Anna
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Ljung, Rickard
    Suicide or undetermined intent?: A register-based study of signs of misclassification2014Ingår i: Population Health Metrics, ISSN 1478-7954, E-ISSN 1478-7954, Vol. 12, artikel-id 11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Several studies have concluded that some deaths classified as undetermined intent are in fact suicides, and it is common in suicide research in Europe to include these deaths. Our aim was to investigate if information on background variables would be helpful in assessing if deaths classified as undetermined intent should be included in the analyses of suicides. Methods: We performed a register study of 31,883 deaths classified as suicides and 9,196 deaths classified as undetermined intent in Sweden from 1987 to 2011. We compared suicide deaths with deaths classified as undetermined intent with regard to different background variables such as sex, age, country of birth, marital status, prior inpatient care for self-inflicted harm, alcohol and drug abuse, psychiatric inpatient care, and use of psychotropics. We also performed a multivariate analysis with logistic regression. Results: Our results showed differences in most studied background factors. Higher education was more common in suicides; hospitalization for self-inflicted harm was more common among female suicides as was prior psychiatric inpatient care. Deaths in foreign-born men were classified as undetermined intent in a higher degree and hospitalization for substance abuse was more common in undetermined intents of both sexes. Roughly 50% of both suicide and deaths classified as undetermined intent had a filled prescription of psychotropics during their last six months. Our multivariate analysis showed male deaths to more likely be classified as suicide than female: OR: 1.13 (1.07-1.18). The probability of a death being classified as suicide was also increased for individuals aged 15-24, being born in Sweden, individuals who were married, and for deaths after 1987-1992. Conclusion: By analyzing Sweden's unique high-validity population-based register data, we found several differences in background variables between deaths classified as suicide and deaths classified as undetermined intent. However, we were not able to clearly distinguish these two death manners. For future research we suggest, separate analyses of the two different manners of death.

  • 2.
    Brooke, Hannah Louise
    et al.
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, POB 210, S-17177 Stockholm, Sweden..
    Talback, Mats
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, POB 210, S-17177 Stockholm, Sweden..
    Hornblad, Jesper
    Natl Board Hlth & Welf, Stockholm, Sweden..
    Johansson, Lars Age
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi.
    Ludvigsson, Jonas Filip
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Orebro Univ Hosp, Dept Paediat, Orebro, Sweden.;Univ Nottingham, Sch Med, Div Epidemiol & Publ Hlth, Nottingham, England.;Columbia Univ Coll Phys & Surg, Dept Med, New York, NY USA..
    Druid, Henrik
    Karolinska Inst, Dept Pathol & Oncol, Stockholm, Sweden..
    Feychting, Maria
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, POB 210, S-17177 Stockholm, Sweden..
    Ljung, Rickard
    Karolinska Inst, Inst Environm Med, Unit Epidemiol, POB 210, S-17177 Stockholm, Sweden..
    The Swedish cause of death register2017Ingår i: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 32, nr 9, s. 765-773Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sweden has a long tradition of recording cause of death data. The Swedish cause of death register is a high quality virtually complete register of all deaths in Sweden since 1952. Although originally created for official statistics, it is a highly important data source for medical research since it can be linked to many other national registers, which contain data on social and health factors in the Swedish population. For the appropriate use of this register, it is fundamental to understand its origins and composition. In this paper we describe the origins and composition of the Swedish cause of death register, set out the key strengths and weaknesses of the register, and present the main causes of death across age groups and over time in Sweden. This paper provides a guide and reference to individuals and organisations interested in data from the Swedish cause of death register.

  • 3.
    Eriksson, A
    et al.
    Research Unit Skellefteå, Internal Medicine, Department of Public Health and Clinical Medicine, Umeå University, .
    Stenlund, H
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå.
    Ahlm, K
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå.
    Boman, K
    Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, .
    Bygren, LO
    Department of Biosciences and Nutrition, Preventive Nutrition, Karolinska Institutet, Stockholm.
    Johansson, Lars Age
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin. Centre for Epidemiology, Swedish National Board of Health and Welfare, Stockholm, Sweden .
    Olofsson, BO
    Department of Public Health and Clinical Medicine, Internal Medicine, Umeå University, Umeå.
    Wall, S
    2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå.
    Weinehall, L
    2Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå.
    Accuracy of death certificates of cardiovascular disease in a community intervention in Sweden2013Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, nr 8, s. 883-889Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim was to investigate the possibility to evaluate the mortality pattern in a community intervention programme against cardiovascular disease by official death certificates.

    Methods: For all deceased in the intervention area (Norsjö), the accuracy of the official death certificates were compared with matched controls in the rest of Västerbotten. The official causes of death were compared with new certificates, based on the last clinical record, issued by three of the authors, and coded by one of the authors, all four accordingly blinded.

    Results: The degree of agreement between the official underlying causes of death in “cardiovascular disease” (CVD) and the re-evaluated certificates was not found to differ between Norsjö and the rest of Västerbotten. The agreement was 87% and 88% at chapter level, respectively, but only 55% and 55% at 4-digit level, respectively. The reclassification resulted in a 1% decrease of “cardiovascular deaths” in both Norsjö and the rest of Västerbotten.

    Conclusions: The disagreements in the reclassification of cause of death were equal but large in both directions. The official death certificates should be used with caution to evaluate CVD in small community intervention programmes, and restricted to the chapter level and total populations.

  • 4. Fugelstad, Anna
    et al.
    Johansson, Lars Age
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Thiblin, Ingemar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Rättsmedicin.
    Faktisk ökning av antalet narkotikadödsfall mörkas2016Ingår i: Dagens Nyheter, Vol. April, nr 12Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 5.
    Fugelstad, Anna
    et al.
    Karolinska Inst, Dept Clin Neurosci, Gotgatan 83E, SE-I1662 Stockholm, Sweden.
    Thiblin, Ingemar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Rättsmedicin.
    Johansson, Lars Age
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicinsk epidemiologi.
    Ågren, Gunnar
    Former Natl Inst Publ Hlth, Gotgatan 83E, SE-17662 Stockholm, Sweden.
    Sidorchuk, Anna
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Opioid-related deaths and previous care for drug use and pain relief in Sweden2019Ingår i: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 201, s. 253-259Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: In 2006-2014, the rate of drug-related deaths, typically opioid poisonings, more than doubled in Sweden. Opioid prescriptions for pain control or opioid agonist therapy also increased. In this retrospective study, we compared death rates between individuals whose first recorded contact with prescribed opioids was for pain control and individuals that had received substance use disorder (SUD) treatment before their first recorded opioid prescription.

    Methods: We included 2834 forensically examined individuals (ages 15-64 years) that died of poisoning in Sweden in 2006-2014. For each death we acquired data on previous opioid prescriptions and SUD treatments. We compared three study groups: pain control (n = 788); a SUD treatment group (n = 1629); and a group with no prescription for pain control or SUD treatment (n = 417).

    Results: Overall fatal poisonings increased from 2.77 to 7.79 (per 100,000 individuals) from 2006 to 2014 (relative 181% increase). Fatal poisoning increased from 2006 to 2014 by 269% in the pain control group (0.64 to 2.36 per 100,000) and by 238% in the SUD treatment group (1.35 to 4.57 per 100,000). Heroin-related deaths remained constant; consequently, the increase was likely attributable to prescription opioids.

    Conclusion: A rapid increase in deaths attributable mainly to prescription opioids for pain control, was reported previously in the United States. Our study indicated that increased access to prescription opioids might contribute to higher death rates also in Sweden among patients seeking pain control and individuals with an established SUD; however, deaths related to prescription opioids mainly occurred among those with SUDs.

  • 6.
    Hernes, Eivor
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Johansson, Lars Age
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Fosså, SD
    Pedersen, Anne Gro
    Glattre, E
    High prostate cancer mortality in Norway evaluated by automated classification of medical entities2008Ingår i: European Journal of Cancer Prevention, ISSN 0959-8278, E-ISSN 1473-5709, Vol. Aug, nr 4, s. 331-335Artikel i tidskrift (Refereegranskat)
  • 7.
    Johansson, Lars Age
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Comparing hospital discharge records with death certificates: can the differences be explained?2002Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. April, nr 4, s. 301-308Artikel i tidskrift (Refereegranskat)
  • 8.
    Johansson, Lars Age
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Targeting Non-obvious Errors in Death Certificates2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

    Delarbeten
    1. Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics
    Öppna denna publikation i ny flik eller fönster >>Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics
    2000 Ingår i: International Journal of Epidemiology, ISSN 0300-5771, Vol. 29, s. 495-502Artikel i tidskrift (Refereegranskat) Published
    Identifikatorer
    urn:nbn:se:uu:diva-96679 (URN)
    Tillgänglig från: 2008-01-31 Skapad: 2008-01-31 Senast uppdaterad: 2016-04-22Bibliografiskt granskad
    2. Comparing hospital discharge records with death certificates: can the differences be explained?
    Öppna denna publikation i ny flik eller fönster >>Comparing hospital discharge records with death certificates: can the differences be explained?
    2002 (Engelska)Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, Vol. 56, s. 301-308Artikel i tidskrift (Refereegranskat) Published
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-96680 (URN)
    Tillgänglig från: 2008-01-31 Skapad: 2008-01-31 Senast uppdaterad: 2017-03-15
    3. Methodology of studies evaluating death certificate accuracy were flawed.
    Öppna denna publikation i ny flik eller fönster >>Methodology of studies evaluating death certificate accuracy were flawed.
    2006 (Engelska)Ingår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 59, nr 2, s. 125-31Artikel i tidskrift (Refereegranskat) 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.

    Nyckelord
    Cause of Death, Death Certificates, Epidemiologic Studies, Humans, Medical Records, Quality Control
    Identifikatorer
    urn:nbn:se:uu:diva-79624 (URN)10.1016/j.jclinepi.2005.05.006 (DOI)16426947 (PubMedID)
    Tillgänglig från: 2006-04-11 Skapad: 2006-04-11 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    4. Unexplained differences between hospital and mortality data indicated mistakes in death certification: An investigation of 1094 deaths in Sweden during 1995
    Öppna denna publikation i ny flik eller fönster >>Unexplained differences between hospital and mortality data indicated mistakes in death certification: An investigation of 1094 deaths in Sweden during 1995
    2009 (Engelska)Ingår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 62, nr 11, s. 1202-1209Artikel i tidskrift (Refereegranskat) 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.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Socialmedicin
    Identifikatorer
    urn:nbn:se:uu:diva-96682 (URN)10.1016/j.jclinepi.2009.01.010 (DOI)
    Tillgänglig från: 2008-01-31 Skapad: 2008-01-31 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
  • 9.
    Johansson, Lars Age
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Björkenstam, Charlotte
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Westerling, Ragnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Unexplained differences between hospital and mortality data indicated mistakes in death certification: An investigation of 1094 deaths in Sweden during 19952009Ingår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 62, nr 11, s. 1202-1209Artikel i tidskrift (Refereegranskat)
    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.

  • 10.
    Johansson, Lars Age
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    George Massad, Salwa
    Accuracy of Palestine mortality statistics: Audit study of the quality and completeness of death notification forms2014Rapport (Övrigt vetenskapligt)
  • 11.
    Johansson, Lars Age
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Korpi, Helena
    Pedersen, Anne Gro
    NOMESCO report on mortality statistics for the Nordic/Baltic countries.2010Rapport (Övrigt vetenskapligt)
  • 12.
    Johansson, Lars Age
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Westerling, Ragnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics2000Ingår i: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. Jun, nr 3, s. 495-502-Artikel i tidskrift (Refereegranskat)
  • 13.
    Johansson, Lars Age
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Westerling, Ragnar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin.
    Rosenberg, Harry M.
    Methodology of studies evaluating death certificate accuracy were flawed.2006Ingår i: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 59, nr 2, s. 125-31Artikel i tidskrift (Refereegranskat)
    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.

  • 14. Lamarche-Vadel, Agathe
    et al.
    Pavillon, Gérard
    Aouba, Albertine
    Johansson, Lars Age
    Swedish National Board of Health and Welfare, Center for Epidemiology, Stockholm, Sweden .
    Meyer, Laurence
    Jougla, Eric
    Rey, Grégoire
    Automated comparison of last hospital main diagnosis and underlying cause of death ICD10 codes, France, 2008-20092014Ingår i: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 14, s. 44-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: In the age of big data in healthcare, automated comparison of medical diagnoses in large scale databases is a key issue. Our objectives were: 1) to formally define and identify cases of independence between last hospitalization main diagnosis (MD) and death registry underlying cause of death (UCD) for deceased subjects hospitalized in their last year of life; 2) to study their distribution according to socio-demographic and medico-administrative variables; 3) to discuss the interest of this method in the specific context of hospital quality of care assessment.

    METHODS: 1) Elaboration of an algorithm comparing MD and UCD, relying on Iris, a coding system based on international standards. 2) Application to 421,460 beneficiaries of the general health insurance regime (which covers 70% of French population) hospitalized and deceased in 2008-2009.

    RESULTS: 1) Independence, was defined as MD and UCD belonging to different trains of events leading to death 2) Among the deaths analyzed automatically (91.7%), 8.5% of in-hospital deaths and 19.5% of out-of-hospital deaths were classified as independent. Independence was more frequent in elder patients, as well as when the discharge-death time interval grew (14.3% when death occurred within 30 days after discharge and 27.7% within 6 to 12 months) and for UCDs other than neoplasms.

    CONCLUSION: Our algorithm can identify cases where death can be considered independent from the pathology treated in hospital. Excluding these deaths from the ones allocated to the hospitalization process could contribute to improve post-hospital mortality indicators. More generally, this method has the potential of being developed and used for other diagnoses comparisons across time periods or databases.

  • 15.
    Massad, Salwa
    et al.
    Palestinian Natl Inst Publ Hlth, Res Unit, Ramallah, Palestine.
    Dalloul, Hadil
    Palestinian Natl Inst Publ Hlth, Res Unit, Ramallah, Palestine.
    Ramlawi, Asad
    Minist Hlth, Res Unit, Deputy Minister Off, Ramallah, Palestine.
    Rayyan, Izzat
    Palestinian Natl Inst Publ Hlth, Res Unit, Ramallah, Palestine.
    Salman, Rand
    Palestinian Natl Inst Publ Hlth, Res Unit, Ramallah, Palestine.
    Johansson, Lars Age
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Accuracy of mortality statistics in Palestine: a retrospective cohort study2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 4, artikel-id e026640Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To examine the accuracy of mortality statistics in Palestine, to identify gaps and to provide evidence-based recommendations to improve mortality statistics in Palestine. Study design and setting A retrospective death registry-based study that examined a stratified random sample of death notification forms (DNFs) of patients who died in hospitals in Palestine was reported in 2012. We randomly selected 600 deceased from the Cause of Death Registry: 400 from the West Bank and 200 from the Gaza Strip. Analysis was based on the randomly selected deaths that we were able to retrieve the medical records for; 371 deaths in the West Bank and 199 deaths in the Gaza Strip. Results Data in the Palestinian Health Information Centre (PHIC) registry had a low degree of accuracy: less than half of the underlying causes stated the correct cause of death. In general, deaths due to malignant neoplasms were more accurately reported on DNFs than other causes of death, and metabolic diseases (including diabetes) were the most problematic. Issues with coding and classification at the PHIC were most apparent for perinatal conditions and congenital anomalies. Conclusion Procedures for coding and classification at the PHIC deviate considerably from the international norms defined in the International Statistical Classification of Diseases and Related Health Problems (ICD) and account to a considerable extent for the discrepancies between the cause of death determined on the medical data on the death extracted from the deceased patient's hospital records and the cause of death coded by the PHIC. We recommend the introduction of international coding software for coding and classification, and a review to improve data handling in hospitals, especially those with electronic patient records.

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