Diagnostic validity of fatal cerebral strokes and coronary deaths in mortality statistics: an autopsy study
Open Access
- 18 December 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in European Journal of Epidemiology
- Vol. 26 (3), 221-228
- https://doi.org/10.1007/s10654-010-9535-4
Abstract
Mortality statistics represent important endpoints in epidemiological studies. The diagnostic validity of cerebral stroke and ischemic heart disease recorded as the underlying cause of death in Norwegian mortality statistics was assessed by using mortality data of participants in the Bergen Clinical Blood Pressure Study in Norway and autopsy records from the Gade Institute in Bergen. In the 41 years of the study (1965–2005) 4,387 subjects had died and 1,140 (26%) had undergone a post mortem examination; 548 (12%) died from cerebral stroke and 1,120 (24%) from ischemic heart disease according to the mortality statistics, compared to 113 (10%) strokes and 323 (28%) coronary events registered in the autopsy records. The sensitivity and positive predictive value of fatal cerebral strokes in the mortality statistics were 0.75, 95% confidence interval (CI) [0.66, 0.83] and 0.86 [0.77, 0.92], respectively, whereas those of coronary deaths were 0.87 [0.84, 0.91] and 0.85 [0.81, 0.89] respectively. Cohen’s Kappa coefficients were 0.78 [0.72, 0.84] for stroke and 0.80 [0.76, 0.84] for coronary deaths. In addition to female gender and increasing age at death, cerebral stroke was a negative predictor of an autopsy being carried out (odds ratio (OR) 0.69, 95% CI [0.54, 0.87]), whereas death from coronary heart disease was not (OR 1.14, 95% CI [0.97, 1,33]), both adjusted for gender and age at death. There was substantial agreement between mortality statistics and autopsy findings for both fatal strokes and coronary deaths. Selection for post mortem examinations was associated with age, gender and cause of death.Keywords
This publication has 19 references indexed in Scilit:
- Increased mortality in the slim elderly: a 42 years follow-up study in a general populationEuropean Journal of Epidemiology, 2009
- Norwegian population surveys on respiratory health in adults: objectives, design, methods, quality controls and response ratesThe Clinical Respiratory Journal, 2008
- Comparison between clinical and autopsy diagnoses in a cardiology hospitalHeart, 2007
- Death Certificates Are Not Reliable: Revivification of the AutopsySouthern Medical Journal, 2006
- Trends of accuracy of clinical diagnoses of the basic cause of death in a university hospitalJournal of Clinical Pathology, 2004
- Validity of Cerebrovascular Mortality RatesAngiology, 1991
- Death certification: increased clinical confidence in diagnosis and lack of interest in confirmation by necropsy is not justified.Journal of Clinical Pathology, 1989
- Changes in frequency of cerebrovascular diseases in Oslo, Norway, 1958-1977. An autopsy study.Stroke, 1981
- Clinical and post‐mortem assessment of the cause of deathThe Journal of Pathology, 1977
- A Coefficient of Agreement for Nominal ScalesEducational and Psychological Measurement, 1960