Methodology of studies evaluating death certificate accuracy were flawed

Johansson, Lars; Westerling, Ragnar; Rosenberg, H. M.

doi:10.1016/j.jclinepi.2005.05.006

Cited by 33 publications

(24 citation statements)

References 48 publications

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“…The medical record review of deaths that occurred in 2008 was conducted in accordance with the principles set out by Johanssen et al [14] to ensure the transparency and reproducibility of medical record review studies. However, this work varied from previous applications of this technique as the small population and health service arrangements meant that an independent review in-country was not possible, thus introducing an additional step of extracting data from the medical record rather than having a physician review the record directly.…”

Section: Discussionmentioning

confidence: 99%

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Causes of death in Tonga: quality of certification and implications for statistics

Carter

Hufanga

Rao

et al. 2012

Popul Health Metrics

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BackgroundDetailed cause of death data by age group and sex are critical to identify key public health issues and target interventions appropriately. In this study the quality of local routinely collected cause of death data from medical certification is reviewed, and a cause of death profile for Tonga based on amended data is presented.MethodsMedical certificates of death for all deaths in Tonga for 2001 to 2008 and medical records for all deaths in the main island Tongatapu for 2008 were sought from the national hospital. Cause of death data for 2008 were reviewed for quality through (a) a review of current tabulation procedures and (b) a medical record review. Data from each medical record were extracted and provided to an independent medical doctor to assign cause of death, with underlying cause from the medical record tabulated against underlying cause from the medical certificate. Significant associations in reporting patterns were evaluated and final cause of death for each case in 2008 was assigned based on the best quality information from the medical certificate or medical record. Cause of death data from 2001 to 2007 were revised based on findings from the evaluation of certification of the 2008 data and added to the dataset. Proportional mortality was calculated and applied to age- and sex-specific mortality for all causes from 2001 to 2008. Cause of death was tabulated by age group and sex, and age-standardized (all ages) mortality rates for each sex by cause were calculated.ResultsReported tabulations of cause of death in Tonga are of immediate cause, with ischemic heart disease and diabetes underrepresented. In the majority of cases the reported (immediate) cause fell within the same broad category as the underlying cause of death from the medical certificate. Underlying cause of death from the medical certificate, attributed to neoplasms, diabetes, and cardiovascular disease were assigned to other underlying causes by the medical record review in 70% to 77% of deaths. Of the 28 (6.5%) deaths attributed to nonspecific or unknown causes on the medical certificate, 17 were able to be attributed elsewhere following review of the medical record. Final cause of death tabulations for 2001 to 2008 demonstrate that noncommunicable diseases are leading adult mortality, and age-standardized rates for cardiovascular diseases, neoplasms, and diabetes increased significantly between 2001 to 2004 and 2005 to 2008. Cause of death data for 2001 to 2008 show increasing cause-specific mortality (deaths per 100,000) from 2001-2004 to 2005-2008 from cardiovascular (194-382 to 423-644 in 2005-2008 for males and 108-227 to 194-321 for females) and other noncommunicable diseases that cannot be accounted for by changes in the age structure of the population. Mortality from diabetes for 2005 to 2008 is estimated at 94 to 222 deaths per 100,000 population for males and 98 to 190 for females (based on the range of plausible all-cause mortality estimates) compared with 2008 estimates from the global burden of disease study of...

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Section: Discussionmentioning

confidence: 99%

“…Previous medical record review studies [14-16] have started from the presumption of a reference standard, where one source (the medical record) is assumed to be more accurate than the other (the medical certificate). However, such an assumption was not valid in this study.…”

Section: Methodsmentioning

confidence: 99%

Causes of death in Tonga: quality of certification and implications for statistics

Carter

Hufanga

Rao

et al. 2012

Popul Health Metrics

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“…It is however reasonable to assume that a large proportion of deaths classified as 'illdefined' by the 3C committee are indeed classified as cardiovascular diseases in the national mortality register because conditions such as hypertension or diabetes are mentioned in death certificates. In a recent review of studies evaluating death certificate accuracy, Johansson et al [16] emphasized that identifying the underlying cause of death is a complex process. International recommendations about this process, which are applied by national mortality registers, favour the selection of causes of death that are precise and considered as meaningful for public health purposes.…”

Section: Discussionmentioning

confidence: 99%

Do we really know the cause of death of the very old? Comparison between official mortality statistics and cohort study classification

et al. 2009

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Causes of death of 625 subjects who died during the 4-year follow-up of a large population-based elderly cohort (Three-City study) were independently classified by the study adjudication committee and the national mortality register. The former used all available data about the cause of death (hospital records, medical data obtained from family physicians or specialists, and proxy interviews) and the latter used internationally standardized recommendations for processing death certificate data. Comparison showed a moderate overall agreement for underlying cause of death between the study adjudication committee and the national register (kappa = 0.51). Differences were found especially for cardiovascular diseases (20.6% of deaths from the study committee vs. 32.5% from the national register) and ill-defined causes of death (22.7 vs. 4%). The proportion of disagreement increased in participants dying at age >85 compared to those dying at age < or =70 (adjusted odds ratio = 2.46, 95% confidence interval = 1.10-5.49). It was also higher when the study committee used hospital record data for defining cause of death, compared to adjudication based on data obtained from proxy (adjusted odds ratio = 1.85, 95% CI = 1.09-3.14). These findings raise questions about the validity of national mortality registers in very old persons. Disease-specific causes of death, especially vascular diseases, could be overestimated in this age group.

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“…In an article by Johansson et al [22], the methodologies of various studies evaluating death certificates were compared and discussed. In our study, the essential criteria for such an evaluation suggested in that study were met.…”

Section: Discussionmentioning

confidence: 99%

Validation study of cause of death statistics in Cape Town, South Africa, found poor agreement

Burger

Groenewald

Bradshaw

et al. 2012

Journal of Clinical Epidemiology

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Methodology of studies evaluating death certificate accuracy were flawed

Cited by 33 publications

References 48 publications

Causes of death in Tonga: quality of certification and implications for statistics

Causes of death in Tonga: quality of certification and implications for statistics

Do we really know the cause of death of the very old? Comparison between official mortality statistics and cohort study classification

Validation study of cause of death statistics in Cape Town, South Africa, found poor agreement

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