Accuracy of death certificates: a population-based, complete-coverage, one-year autopsy study in East Germany

Abstract

The Goerlitz Autopsy Study is a population-based autopsy study, conducted in 1987 in the municipality of Goerlitz, population 78,484, in former East Germany. It is unique in that 1,023 (96.5 percent) of the 1,060 subjects who died in the municipality over a period of one year were investigated by full autopsy. An underlying cause was assigned to every death, using the procedures recommended by the International Classification of Diseases, Injuries and Causes of Death, ninth revision, German edition. Assignment of cause of death was done independently by the attending clinician and the pathology team who performed the autopsy. The data were analyzed through cross-classification of deaths by death certificate diagnosis and autopsy-based diagnosis. Sensitivity and positive predictive values were calculated for the death certificate diagnoses, assuming that the autopsy findings represent the correct reference set. Overall, 47 percent of diagnoses on death certificates differed from those based on autopsy and, for 30 percent of the subjects, the difference crossed a major disease category. The proportion of disagreement was higher for deaths occurring in nursing homes and among the very old, but was unrelated to gender. In the death certificates, diseases of the circulatory system and endocrine and metabolic disorders were over-represented, whereas infectious diseases, neoplasms, and respiratory, digestive, and genitourinary diseases were under-represented. Neoplasms in the death certificates are characterized by relatively high sensitivity and predictive values, even though these were still unsatisfactory, given the chronicity of the clinical course and the opportunities available for correct diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic liver disease mortality in the United States, 1990-1998

“…5 These differences suggest that, similar to findings of studies examining the accuracy of death certificates in identifying respiratory and cardiovascular diseases as causes of death, hepatitis C may be underascertained among patients dying of chronic liver disease, underreported on death certificates, or both. 3,4,[13][14][15][16] In the only study to date of which we are aware that addressed this issue by comparing mortality data with medical records, the potential magnitude of underreporting of hepatitis C on death certificates was estimated to be approximately 50%. 17 If this estimate was consistent across the country, hepatitis C should have been recorded as causing approximately 9,000 (30%) CLD deaths in 1998.…”

The East-West life expectancy gap: differences in mortality from conditions amenable to medical intervention.

“…Studies comparing international variation in death certification practices showed that individual countries in Western and Eastern Europe differ in certification and coding of underlying cause of death. [30][31][32] Thus some degree of over-and underregistration of mortality for particular amenable causes of death is likely to exist. As misclassification generates mistakes in both directions, using the aggregated measure for all selected amenable causes in the study assures less biased results.…”

The impact of the variation in death certification and coding practices on trends in mortality from ischaemic heart disease

“…In other words, the non-specific or erroneous ante mortem diagnosis, documented due to diagnostic error, inadequate or misinterpreted clinical information, result in the allocation of a code that may not reflect the true cause of death. This problem has been identified and confirmed in a number of studies comparing death certificate information with autopsy results or with the diagnosis of expert panels (Cameron & McGoogan 1981a & b;Kingsford 1995;Modelmog, Rahlenbeck & Trichopoulos 1992). Discrepancies between autopsy results and death certificates have been documented to be as high as 30% (Cameron & McGoogan 1981a & b).…”

“…During the last two decades many researchers have pointed out that the changes in death certification practices, disease classification and coding practices are an important factor affecting mortality statistics (Jordan & Bass 1993;Kingsford 1995;Kircher, Nelson & Burdo 1985;McKelvie 1993;Modelmog, Rahlenbeck & Trichopoulos 1992;Myers & Farquhar 1998;Nielsen, Bjornsson & Jonasson 1991;Rooney & Devis 1996;Weeramanthri & Beresford 1992;. Since IHD is the leading cause of death, it is therefore important to examine the effect of certification and classification changes on mortality trends due to IHD.…”