Bemerkungen zur Aussagefähigkeit der Todesursachenziffer „ischämische Herzkrankheiten”

Abstract

The rate of cause of death due to IHD ('ischaemic heart diseases') represents a terminal occurrence of the arteriosclerotic basic disease. lts extent is determined by the incidence of cardiovascular diseases, prevalence and duration of sickness. The relative frequency of falling ill as well as the reflection of the risk of falling ill and the extent of the population fallen ill are not known at all or only very insufficiently. Thus the question cannot be answered how the risk to fall ill with the coronary heart disease must be considered in view of the high mortality rate IHD of the population in the total mortality of the population. There are recognizable influences on the rate of cause of death due to IHD, such as the duration of sickness, the increasing average life expectancy and the procedure of coding death certificates and the selection of the basic disease. So the abrupt increase of the infarct mortality after the turn in the new federal states, as well as in Mecklenburg-Western Pomerania is to be attributed to the adoption to the coding procedure. The increasing trend of the mortality rate of IHD up to 1995 in Mecklenburg-Western Pomeranian infers an individual shortening of the sickness of existing coronary heart diseases among the population. After this temporary increase of infarct mortality the decrease of this figure suggests prolongation of the duration of sickness. The rate of cause of death from 'ischaemic heart diseases' also represents a terminal occurrence in life. The development of specific mortality in advanced age leads to the observation that the emphasis within the cause of death structure among those classifications of the elderly at an extremely advanced age, gradually shifts towards mortality caused by ischaemic heart disease. From the accompanying decreasing trend of mortality from acute coronary events in the younger and medium age classes a decrease in the total mortality can be concluded. Even the search for diagnosis during post mortems is reflected in the cause of death statistics, which can be evidenced on the basis of comparisons made between the figures of death from 'ischaemic heart diseases' and from 'senility, other symptoms, and imprecisely described conditions'. The difference between the original federal states and the new federal states of Eastern Germany, as also in the Federal State of Mecklenburg-Western Pomerania is obvious. Summing up, it can therefore be said, that the cause of death rate from 'ischaemic heart diseases' is only of limited significance as regards the hazards from the underlying arteriosclerotic disease of the blood vessels. lt can only be assessed in connection with the age structure of the population and the structure of all causes of death. The validity of the cause of death from 'ischaemic heart diseases' is therefore not very great in reporting practice.

Die Forderung nach Internationalisierung der deutschen Forschung am Beispiel der Zeitschrift „Das Gesundheitswesen”. Ein Beitrag zur Qualitätssicherung anwendungsbezogener Forschung

“…Kliniken und niedergelassener ¾rzte einschließlich Zahnmedizin bilden die Autoren: Baberg [93], Beer [94], Geiger [95], Hollederer [96], Huber [97], Ihle [98], Lange [99], Müller [100], Schneeweiss [101], Schubert [102], Tegtbur [103], Tretter [104], Wilm [105] und Zimmer [106].…”

Der Spandauer Gesundheitstest - Beschreibung der Studie

“…Da aber bei allen Recherchen festgehalten wurde, woher die Angaben stammen, ist eine Einschätzung der Validität möglich. Zudem ist bekannt[18][19][20][21][22][23], dass Aussagen zu Todesursachen, die nicht auf Sektionsdiagnosen beruhen, auch immer mit einer Fehlerquote behaftet sein können. Entscheidender für das Mortalitäts-Follow-up ist jedoch, dass in nahezu allen Fällen das Sterbedatum recherchiert werden konnte, da sich das Sterbealter ohnehin als härtestes Kriterium in epidemiologischen Studien erwiesen hat und damit für Longitudinaldaten eine valide Information im Sinne eines Outcomes zur Verfügung stellt.Die Möglichkeiten, den Spandauer Gesundheitstest auszuwerten sind designbedingt sehr vielfältig.…”