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April 21, 1993, Vol 269, No. 15 >
ARTICLE | April 21, 1993

Accuracy of the Death Certificate in a Population-Based Study of Asthmatic Patients FREE

Loren W. Hunt, Jr, MD; Marc D. Silverstein, MD; Charles E. Reed, MD; Edward J. O'Connell, MD; William M. O'Fallon, PhD; John W. Yunginger, MD
[+] Author Affiliations

Reprint requests to Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Dr Hunt).


JAMA. 1993;269(15):1947-1952. doi:10.1001/jama.1993.03500150059027
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References

Objective.  —To quantify the reliability of death certificate data concerning asthma.

Design.  —The complete medical records of decedents were reviewed by a physician certified in allergy and pulmonology who determined the cause of death without having access to the original death certificate. Disagreements between the death certificate and the reviewer were adjudicated by an expert panel.

Setting.  —The community of Rochester, Minn.

Patients.  —The mortality cohort included 339 deaths from a larger cohort of 5241 Rochester residents who received medical treatment for asthma between 1964 and 1983.

Main Outcome Measures.  —Kappa coefficients were used to measure agreement beyond that expected by chance between the reviewer and the death certificate. The sensitivity and specificity of the death certificate diagnosis of asthma were calculated against the standard of the reviewer/panel diagnosis.

Results.  —Death certificates reported asthma as an immediate or underlying cause of death in 22 instances (6%), whereas the reviewer/panel identified asthma in 53 cases (16%). In four cases, the death certificate listed asthma and the panel identified another cause of death. The death certificate had a sensitivity of 42% and a specificity of 99% compared with the reviewer/panel. Agreement between death certificates and the reviewer was not influenced by whether an autopsy was performed.

Conclusions.  —Death certificate diagnosis of asthma as an underlying cause of death had a low sensitivity but a high specificity. Increases in mortality due to asthma are not likely caused by false-positive diagnoses of asthma as an underlying cause of death. Asthma mortality rates, determined from death certificate data, may indeed underestimate actual asthma-related mortality.(JAMA. 1993;269:1947-1952)

REFERENCES

1 +
Sly RM.  Mortality from asthma. J Allergy Clin Immunol . 1989;;84:421-434.
2 +
Paulozzi LJ, Coleman JJ, Buist AS.  A recent increase in asthma mortality in the northwestern United States. Ann Allergy . 1986;;56:392-395.
3 +
Goodman RA, Berkelman RL.  Physicians, vital statistics, and disease reporting. JAMA . 1987;;258: 379-381.
4 +
Evans R III.  Recent observations reflecting increases in mortality from asthma. J Allergy Clin Immunol . 1987;;80:377-379.
5 +
Burney PGJ.  Asthma mortality: England and Wales. J Allergy Clin Immunol . 1987;;80:379-382.
6 +
Sears MR.  Asthma morbidity and mortality: New Zealand. J Allergy Clin Immunol . 1987;;80:383-388.
7 +
Jackson R, Sears MR, Beaglehole R, Rea HH.  International trends in asthma mortality: 1970-1985. Chest . 1988;;94:914-918.
8 +
Burney P.  Asthma deaths in England and Wales 1931-85: evidence for a true increase in asthma mortality. J Epidemiol Community Health . 1988;; 42:316-320.
9 +
Sears MR, Rea HH, deBoer G, et al.  Accuracy of certification of deaths due to asthma: a national study. Am J Epidemiol . 1986;;124:1004-1011.
10 +
British Thoracic Association.  Accuracy of death certificates in bronchial asthma. Thorax . 1984;;39: 505-509.
11 +
World Health Organization, Medical Certification and Rules for Classification. In: International Classification of Diseases: Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death; Based on the Recommendations of the Ninth Revision Conference, 1975, I . Geneva, Switzerland: World Health Organization; 1977;:699-730.
12 +
Curb JD, Babcock C, Pressel S, Tung B, Remington RD, Hawkins CM.  Nosological coding of cause of death. Am J Epidemiol . 1983;;118:122-128.
13 +
Roberts WC.  The autopsy: its decline and a suggestion for its revival. N Engl J Med . 1978;;299:332-338.
14 +
Kircher T, Nelson J, Burdo H.  The autopsy as a measure of accuracy of the death certificate. N Engl J Med . 1985;;313:1263-1269.
15 +
Yunginger JW, Reed CE, O'Connell EJ, Melton LJ, O'Fallon WM, Silverstein MD.  A community-based study of the epidemiology of asthma, I: incidence rates, 1964-84. Am Rev Respir Dis . 1992;;146:888-894.
16 +
Kurland LT, Molgaard CA.  The patient record in epidemiology. Sci Am . 1981;;245:54-63.
17 +
National Center for Health Statistics, US Public Health Service, US Dept of Health and Human Services. Physicians' Handbook on Medical Certification of Death . Hyattsville, Md: US Dept of Health and Human Services; 1987;.
18 +
Landis JR, Koch GG.  The measurement of observer agreement for categorical data. Biometrics . 1977;;33:159-174.
19 +
Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981;.
20 +
Ormerod LP, Stableforth DE.  Asthma mortality in Birmingham 1975-7: 53 deaths. BMJ . 1980;; 280:687-690.
21 +
Barger LW, Osborne ML, Buist AS.  Further analysis of the increase in asthma death rates: investigation of the false negative reporting rate for Oregon in 1982. Am Rev Respir Dis . 1988;;137:A147.
22 +
Sirken MG, Rosenberg HM, Chevarley FM, Curtin LR.  The quality of cause-of-death statistics. Am J Public Health . 1987;;77:137-139.
23 +
Nemetz PN, Ballard DJ, Beard CM, et al.  An anatomy of the autopsy, Olmsted County, 1935 through 1985. Mayo Clin Proc . 1989;;64:1055-1064.
24 +
Carter JR.  The problematic death certificate. N Engl J Med . 1985;;313:1285-1286.
25 +
Kircher T, Anderson RE.  Cause of death: proper completion of the death certificate. JAMA . 1987;; 258:349-352.
26 +
Zumwalt RE, Ritter MR.  Incorrect death certification: an invitation to obfuscation. Postgrad Med . 1987;;81:245-247, 250, 253-254.
27 +
Cameron HM, McGoogan E.  A prospective study of 1152 hospital autopsies, I: inaccuracies in death certification. J Pathol . 1981;;133:273-283.
28 +
Moriyama IM.  Development of the present concept of cause of death. Am J Public Health . 1956;; 46:436-441.
29 +
Modelmog D, Rahlenbeck S, Trichopoulos D.  Accuracy of death certificates: a population-based, complete coverage, one year autopsy study in East Germany. Cancer Causes Control . 1992;;3:541-546.
30 +
Leitch DGM, O'Connor SJ, Keller RF.  Variation in death certification of ischemic heart disease in Australia and New Zealand. Aust N Z J Med . 1987;; 17:309-315.
31 +
Schade B.  Reliability and validity of the classification of death in general practice. Scand J Prim Health Care . 1987;;5:109-112.
32 +
Janssen TA.  Importance of tabulating multiple causes of death. Am J Public Health . 1940;;30:871-879.
33 +
Lindahl BIB.  The causal sequence on death certificates: errors affecting the reliability of mortality statistics for rheumatoid arthritis. J Chronic Dis . 1985;;38:47-57.
34 +
Israel RA, Rosenberg HM, Curtin LR.  Analytical potential for multiple cause-of-death data. Am J Epidemiol . 1986;;124:161-179.
35 +
Chamblee RF, Evans MC.  New dimensions in cause of death statistics. Am J Public Health . 1982;; 72:1265-1270.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Sly RM.  Mortality from asthma. J Allergy Clin Immunol . 1989;;84:421-434.
2 +
Paulozzi LJ, Coleman JJ, Buist AS.  A recent increase in asthma mortality in the northwestern United States. Ann Allergy . 1986;;56:392-395.
3 +
Goodman RA, Berkelman RL.  Physicians, vital statistics, and disease reporting. JAMA . 1987;;258: 379-381.
4 +
Evans R III.  Recent observations reflecting increases in mortality from asthma. J Allergy Clin Immunol . 1987;;80:377-379.
5 +
Burney PGJ.  Asthma mortality: England and Wales. J Allergy Clin Immunol . 1987;;80:379-382.
6 +
Sears MR.  Asthma morbidity and mortality: New Zealand. J Allergy Clin Immunol . 1987;;80:383-388.
7 +
Jackson R, Sears MR, Beaglehole R, Rea HH.  International trends in asthma mortality: 1970-1985. Chest . 1988;;94:914-918.
8 +
Burney P.  Asthma deaths in England and Wales 1931-85: evidence for a true increase in asthma mortality. J Epidemiol Community Health . 1988;; 42:316-320.
9 +
Sears MR, Rea HH, deBoer G, et al.  Accuracy of certification of deaths due to asthma: a national study. Am J Epidemiol . 1986;;124:1004-1011.
10 +
British Thoracic Association.  Accuracy of death certificates in bronchial asthma. Thorax . 1984;;39: 505-509.
11 +
World Health Organization, Medical Certification and Rules for Classification. In: International Classification of Diseases: Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death; Based on the Recommendations of the Ninth Revision Conference, 1975, I . Geneva, Switzerland: World Health Organization; 1977;:699-730.
12 +
Curb JD, Babcock C, Pressel S, Tung B, Remington RD, Hawkins CM.  Nosological coding of cause of death. Am J Epidemiol . 1983;;118:122-128.
13 +
Roberts WC.  The autopsy: its decline and a suggestion for its revival. N Engl J Med . 1978;;299:332-338.
14 +
Kircher T, Nelson J, Burdo H.  The autopsy as a measure of accuracy of the death certificate. N Engl J Med . 1985;;313:1263-1269.
15 +
Yunginger JW, Reed CE, O'Connell EJ, Melton LJ, O'Fallon WM, Silverstein MD.  A community-based study of the epidemiology of asthma, I: incidence rates, 1964-84. Am Rev Respir Dis . 1992;;146:888-894.
16 +
Kurland LT, Molgaard CA.  The patient record in epidemiology. Sci Am . 1981;;245:54-63.
17 +
National Center for Health Statistics, US Public Health Service, US Dept of Health and Human Services. Physicians' Handbook on Medical Certification of Death . Hyattsville, Md: US Dept of Health and Human Services; 1987;.
18 +
Landis JR, Koch GG.  The measurement of observer agreement for categorical data. Biometrics . 1977;;33:159-174.
19 +
Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons Inc; 1981;.
20 +
Ormerod LP, Stableforth DE.  Asthma mortality in Birmingham 1975-7: 53 deaths. BMJ . 1980;; 280:687-690.
21 +
Barger LW, Osborne ML, Buist AS.  Further analysis of the increase in asthma death rates: investigation of the false negative reporting rate for Oregon in 1982. Am Rev Respir Dis . 1988;;137:A147.
22 +
Sirken MG, Rosenberg HM, Chevarley FM, Curtin LR.  The quality of cause-of-death statistics. Am J Public Health . 1987;;77:137-139.
23 +
Nemetz PN, Ballard DJ, Beard CM, et al.  An anatomy of the autopsy, Olmsted County, 1935 through 1985. Mayo Clin Proc . 1989;;64:1055-1064.
24 +
Carter JR.  The problematic death certificate. N Engl J Med . 1985;;313:1285-1286.
25 +
Kircher T, Anderson RE.  Cause of death: proper completion of the death certificate. JAMA . 1987;; 258:349-352.
26 +
Zumwalt RE, Ritter MR.  Incorrect death certification: an invitation to obfuscation. Postgrad Med . 1987;;81:245-247, 250, 253-254.
27 +
Cameron HM, McGoogan E.  A prospective study of 1152 hospital autopsies, I: inaccuracies in death certification. J Pathol . 1981;;133:273-283.
28 +
Moriyama IM.  Development of the present concept of cause of death. Am J Public Health . 1956;; 46:436-441.
29 +
Modelmog D, Rahlenbeck S, Trichopoulos D.  Accuracy of death certificates: a population-based, complete coverage, one year autopsy study in East Germany. Cancer Causes Control . 1992;;3:541-546.
30 +
Leitch DGM, O'Connor SJ, Keller RF.  Variation in death certification of ischemic heart disease in Australia and New Zealand. Aust N Z J Med . 1987;; 17:309-315.
31 +
Schade B.  Reliability and validity of the classification of death in general practice. Scand J Prim Health Care . 1987;;5:109-112.
32 +
Janssen TA.  Importance of tabulating multiple causes of death. Am J Public Health . 1940;;30:871-879.
33 +
Lindahl BIB.  The causal sequence on death certificates: errors affecting the reliability of mortality statistics for rheumatoid arthritis. J Chronic Dis . 1985;;38:47-57.
34 +
Israel RA, Rosenberg HM, Curtin LR.  Analytical potential for multiple cause-of-death data. Am J Epidemiol . 1986;;124:161-179.
35 +
Chamblee RF, Evans MC.  New dimensions in cause of death statistics. Am J Public Health . 1982;; 72:1265-1270.

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