IntroductionAccurate cause-of-death reporting is required for mortality data to validly inform public health programming and evaluation. Research demonstrates overreporting of heart disease on New York City death certificates. We describe changes in reported causes of death following a New York City health department training conducted in 2009 to improve accuracy of cause-of-death reporting at 8 hospitals. The objective of our study was to assess the degree to which death certificates citing heart disease as cause of death agreed with hospital discharge data and the degree to which training improved accuracy of reporting.MethodsWe analyzed 74,373 death certificates for 2008 through 2010 that were linked with hospital discharge records for New York City inpatient deaths and calculated the proportion of discordant deaths, that is, death certificates reporting an underlying cause of heart disease with no corresponding discharge record diagnosis. We also summarized top principal diagnoses among discordant reports and calculated the proportion of inpatient deaths reporting sepsis, a condition underreported in New York City, to assess whether documentation practices changed in response to clarifications made during the intervention.ResultsCitywide discordance between death certificates and discharge data decreased from 14.9% in 2008 to 9.6% in 2010 (P < .001), driven by a decrease in discordance at intervention hospitals (20.2% in 2008 to 8.9% in 2010; P < .001). At intervention hospitals, reporting of sepsis increased from 3.7% of inpatient deaths in 2008 to 20.6% in 2010 (P < .001).ConclusionOverreporting of heart disease as cause of death declined at intervention hospitals, driving a citywide decline, and sepsis reporting practices changed in accordance with health department training. Researchers should consider the effect of overreporting and data-quality changes when analyzing New York City heart disease mortality trends. Other vital records jurisdictions should employ similar interventions to improve cause-of-death reporting and use linked discharge data to monitor data quality.

Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality.

Background: Since 2002, under the Bloomberg administration, New York City (NYC) has aggressively pursued and implemented a broad set of public health policies to reduce chronic disease. Limited research exists evaluating secular trends in cardiovascular disease (CVD) mortality against the backdrop of these policy initiatives. Hypothesis: We hypothesized that CVD mortality trends declined more rapidly during the years 2002-2011 compared with the previous decade. Methods: Using individual death certificates of NYC residents during 1990-2011, all-cause mortality rates were calculated in addition to the following cause-specific mortality rates: any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), stroke, ischemic stroke. Mortality rates were age and sex standardized to the NYC year 2000 population. Joinpoint regression identified years in which mortality trends changed after excluding 116,285 deaths (10% of all deaths) occurring in 9 NYC hospitals (due to their participation in a cause of death reporting quality improvement training in 2009, sponsored by NYC Department of Health & Mental Hygiene (DOHMH)). Results: 1,149,217 deaths occurred to NYC residents from 1990-2011, 566,181 among women and 583,036 among men. The annual percent change (APC) in all-cause mortality rates for women and men were -2.6% and -7.1% between 1994 and 1998, while rates were approximately -2.5% for both sexes from 1998-2011. CVD accounted 49.5% and 37.5% of deaths among women and men, respectively in 1990; in 2011 these proportions were 40.4% and 35.3%. Age standardized CVD mortality rates (per 100,000) for women and men were 391.0 and 357.8 in 1990 vs. 197.2 and 166.2 in 2011. Overall CVD mortality rates increased in women and men by 1.7% and 0.05% from 1990-1993 and began to decline in 1993 with APCs of -3.8% and -4.0% during 1993-2011. In contrast, the decline in atherosclerotic CVD mortality accelerated during 2002-2011 (APC=-4.7%) vs. 1990-2002 (APC=-2.4%) among men. Among women, atherosclerotic CVD rates began to decline more rapidly in 1993 (APC=-3.2%) and again in 2006 (APC=-6.6%) vs. 1990-1993 (APC=1.9%). Similar trends were evident for CAD mortality. Ischemic stroke mortality rates declined steadily from 1990-2011 in both sexes and there was no evidence of change in these trends. Results were generally consistent when all hospitals were included with the exception of rates for overall CVD mortality, which began to show more rapid decline in 2009 - immediately following DOHMH cause-of-death training efforts. Conclusion: Overall, CVD mortality rates in NYC did not accelerate during the 2002-2011 period after accounting for changes in cause of death reporting. However, atherosclerotic CVD rates did appear to change in slope (shift to declining more rapidly) during this period, with possible differences in timing between men and women.