Accuracy of national mortality codes in identifying adjudicated cardiovascular deaths

Harriss, Linton; Ajani, A.; Hunt, David; Shaw, James A.; Chambers, Brian R.; Dewey, Helen M; Frayne, Judith; Beauchamp, Alison; Duve, Karen; Giles, Graham G.; Harrap, Stephen B; Magliano, Dianna J.; Liew, Danny; McNeil, John J; Peeters, Anna; Stebbing, Margaret Susanne; Wolfe, Rory; Tonkin, Andrew

doi:10.1111/j.1753-6405.2011.00739.x

Cited by 49 publications

(46 citation statements)

References 21 publications

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“…It is most likely that this reflects an increasing awareness among doctors that diabetes is a key etiological factor in the development of CVD. Our findings are supported by a study by Harriss et al (26), which adjudicated 750 deaths from an Australian longitudinal cohort and found that of 54 deaths with an underlying ICD code listed as "diabetes," almost 60% were primarily due to CVD. Our somewhat lower estimates are most likely explained by our conservative approach, whereby only those diabetes cases that were "diabetes with circulatory complication" or "uncomplicated diabetes" were recoded.…”

Section: Comparison With the Literaturesupporting

confidence: 88%

Mortality Trends Among People With Type 1 and Type 2 Diabetes in Australia: 1997–2010

et al. 2014

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OBJECTIVEWith improvements in cardiovascular disease (CVD) rates among people with diabetes, mortality rates may also be changing. However, these trends may be influenced by coding practices of CVD-related deaths on death certificates. We analyzed trends of mortality over 13 years in people with diabetes and quantified the potential misclassification of CVD mortality according to current coding methods. RESEARCH DESIGN AND METHODSA total of 1,136,617 Australians with diabetes registered on the National Diabetes Services Scheme between 1997 and 2010 were linked to the National Death Index. Excess mortality relative to the Australian population was reported as standardized mortality ratios (SMRs). Potential misclassification of CVD mortality was determined by coding CVD according to underlying cause of death (COD) and then after consideration of both the underlying and other causes listed in part I of the death certificate. RESULTSFor type 1 diabetes, the SMR decreased in males from 4.20 in 1997 to 3.08 in 2010 (P trend < 0.001) and from 3.92 to 3.46 in females (P trend < 0.01). For type 2 diabetes, the SMR decreased in males from 1.40 to 1.21 (P trend < 0.001) and from 1.56 to 1.22 in females (P trend < 0.001). CVD deaths decreased from 35.6 to 31.2% and from 31.5 to 27.2% in males and females with type 1 diabetes, respectively (P trend < 0.001 for both sexes). For type 2 diabetes, CVD decreased from 44.5 to 29.2% in males and from 45.5 to 31.6% in females (P trend < 0.001 for both sexes). Using traditional coding methods, ∼38 and 26% of CVD deaths are underestimated in type 1 diabetes and type 2 diabetes, respectively. CONCLUSIONSAll-cause and CVD mortality has decreased in diabetes. However, the total CVD mortality burden is underestimated when only underlying COD is considered. This has important ramifications for understanding mortality patterns in diabetes.

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Section: Comparison With the Literaturesupporting

confidence: 88%

Mortality Trends Among People With Type 1 and Type 2 Diabetes in Australia: 1997–2010

et al. 2014

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“…Unfortunately, we do not have data on specific causes of deaths. Nevertheless, identification of causes of death is not free of problems [17][18][19][20][21]; for example, sudden cardiac death prevalence was found to be overestimated by 47% [22] and use of all-cause mortality as an unbiased endpoint was advocated [23].…”

Section: Discussionmentioning

confidence: 99%

Sex differences in salt-sensitivity risk approximated from ambulatory blood pressure monitoring and mortality

Bursztyn

Ben‐Dov

2013

Journal of Hypertension

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“…Our study suggests the underestimation of specific causes of death that are of particular importance to individuals with diabetes, such as acute complications and CVD, when using death certificates as the only source of information. Other studies have also underscored the problem with the insufficient reliability of causes of death in type 1 diabetes when only considering death certificates (39,42,43). An important limitation of this study is that we did not have complete information on HbA 1c or smoking status, among other risk factors.…”

Section: Discussionmentioning

confidence: 99%

Long-term Mortality and End-Stage Renal Disease in a Type 1 Diabetes Population Diagnosed at Age 15–29 Years in Norway

et al. 2016

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OBJECTIVETo study long-term mortality, causes of death, and end-stage renal disease (ESRD) in people diagnosed with type 1 diabetes at age 15-29 years. RESEARCH DESIGN AND METHODSThis nationwide, population-based cohort with type 1 diabetes diagnosed during 1978-1982 (n = 719) was followed from diagnosis until death, emigration, or September 2013. Linkages to the Norwegian Cause of Death Registry and the Norwegian Renal Registry provided information on causes of death and whether ESRD was present. A clinical committee reviewed the causes of death. We calculated standardized mortality ratios (SMRs) for comparison with the background population. RESULTSDuring 30 years' follow-up, 4.6% of participants developed ESRD and 20.6% (n = 148; 106 men and 42 women) died. Cumulative mortality by years since diagnosis was 6.0% (95% CI 4.5-8.0) at 10 years, 12.2% (10.0-14.8) at 20 years, and 18.4% (15.8-21.5) at 30 years. The SMR was 4.4 (95% CI 3.7-5.1). Mean time from diagnosis of diabetes to ESRD was 23.6 years (range 14.2-33.5). Death was caused by chronic complications (32.2%), acute complications (20.5%), violent death (19.9%), or any other cause (27.4%). Death was related to alcohol in 15% of cases. SMR for alcohol-related death was 6.8 (95% CI 4.5-10.3), for cardiovascular death was 7.3 (5.4-10.0), and for violent death was 3.6 (2.3-5.3). CONCLUSIONSThe cumulative incidence of ESRD was low in this cohort with type 1 diabetes followed for 30 years. Mortality was 4.4 times that of the general population, and more than 50% of all deaths were caused by acute or chronic complications. A relatively high proportion of deaths were related to alcohol.Studies assessing causes of death in type 1 diabetes are most frequently conducted in individuals diagnosed during childhood (1-7) or without evaluating the effect of age at diagnosis (8,9). Reports on causes of death in cohorts of patients diagnosed during late adolescence or young adulthood, with long-term follow-up, are less frequent (10). This period in life is often referred to as "emerging adulthood" and is represented by several changes in life, increasing risk behaviors, and exploration of possible life directions (11). Young people move away from the care provided by their families. Transition from

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Accuracy of national mortality codes in identifying adjudicated cardiovascular deaths

Abstract: Objective: This study investigated the sensitivity and specificity of the national mortality codes in identifying cardiovascular disease (CVD) deaths and documents methods of verification.

Cited by 49 publications

References 21 publications

Mortality Trends Among People With Type 1 and Type 2 Diabetes in Australia: 1997–2010

Mortality Trends Among People With Type 1 and Type 2 Diabetes in Australia: 1997–2010

Sex differences in salt-sensitivity risk approximated from ambulatory blood pressure monitoring and mortality

Long-term Mortality and End-Stage Renal Disease in a Type 1 Diabetes Population Diagnosed at Age 15–29 Years in Norway

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