Accuracy of Death Certificates and Assessment of Factors for Misclassification of Underlying Cause of Death
Open Access
- 1 January 2016
- journal article
- Published by Japan Epidemiological Association in Journal of Epidemiology
- Vol. 26 (4), 191-198
- https://doi.org/10.2188/jea.je20150010
Abstract
Background: Cause of death (COD) information taken from death certificates is often inaccurate and incomplete. However, the accuracy of Underlying CODs (UCODs) recorded on death certificates has not been comprehensively described when multiple diseases are present. Methods: A total of 450 consecutive autopsies performed at a geriatric hospital in Japan between February 2000 and August 2002 were studied. We evaluated the concordance rate, sensitivity, and specificity of major UCODs (cancer, heart disease, and pneumonia) reported on death certificates compared with a reference standard of pathologist assessment based on autopsy data and clinical records. Logistic regression analysis was performed to assess the effect of sex, age, comorbidity, and UCODs on misclassification. Results: The concordance rate was relatively high for cancer (81%) but low for heart disease (55%) and pneumonia (9%). The overall concordance rate was 48%. Sex and comorbidity did not affect UCOD misclassification rates, which tended to increase with patient age, although the association with age was also not significant. The strongest factor for misclassification was UCODs (P < 0.0001). Sensitivity and specificity for cancer were very high (80% and 96%, respectively), but sensitivity for heart disease and pneumonia was 60% and 46%, respectively. Specificity for each UCOD was more than 85%. Conclusions: Researchers should be aware of the accuracy of COD data from death certificates used as research resources, especially for cases of elderly patients with pneumonia.Keywords
This publication has 24 references indexed in Scilit:
- Estimation With Cox ModelsEpidemiology, 2012
- Validation Data-based Adjustments for Outcome Misclassification in Logistic RegressionEpidemiology, 2011
- Effect of Misclassified Underlying Cause of Death on Survival Estimates of Colon and Rectal CancerJNCI Journal of the National Cancer Institute, 2011
- Trends in Frequency of Reporting Improper Diabetes-related Cause-of-Death Statements on Death Certificates, 1985-2005: An Algorithm to Identify Incorrect Causal SequencesAmerican Journal of Epidemiology, 2010
- Sensitivity and Specificity of Death Certificates for DiabetesDiabetes Care, 2008
- Death Certificates Are Not Reliable: Revivification of the AutopsySouthern Medical Journal, 2006
- Developments of geriatric autopsy database and Internet-based database of Japanese single nucleotide polymorphisms for geriatric research (JG-SNP)Mechanisms of Ageing and Development, 2004
- Mortality in Medicolegal Deaths in Hyogo Prefecture (1986-88).Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene), 1991
- Accuracy of cancer death certificates and its effect on cancer mortality statistics.American Journal of Public Health, 1981
- RELATION OF CLINICAL TO NECROPSY DIAGNOSIS IN CANCER AND VALUE OF EXISTING CANCER STATISTICSJAMA, 1923