Impact of HIV infection on mortality and accuracy of AIDS reporting on death certificates.

To assess the impact of HIV infection on mortality and the accuracy of AIDS reporting on death certificates, we analyzed data from 6704 homosexual and bisexual men in the San Francisco City Clinic cohort. Identification of AIDS cases and deaths in the cohort was determined through multiple sources, including the national AIDS surveillance registry and the National Death Index. Through 1990, 1518 deaths had been reported in the cohort and 1292 death certificates obtained. Of the 1292 death certificates, 1162 were for known AIDS cases, but 9% of the AIDS cases did not have HIV infection or AIDS noted on the death certificate. Only 0.7% of the decedents had AIDS listed as a cause of death and had not been reported to AIDS surveillance. AIDS and HIV infection was the leading cause of death in the cohort, with the highest proportionate mortality ratio (85%) and standardized mortality ratio (153 in 1987), and the largest number of years of potential life lost (32,008 years). The devastating impact of HIV infection on mortality is increasing and will require continued efforts to prevent and treat HIV infection.     

Review of death certificates to assess completeness of AIDS case reporting

To assess the level of reporting of acquired immunodeficiency syndrome (AIDS) cases, the authors reviewed death certificates for periods of 3 months during July through December 1985 in each of four cities: Washington, DC, New York City, Boston, and Chicago. Since reporting began in 1981, these cities have reported 38 percent of all AIDS cases in the United States. Death certificates were selected and matched to the AIDS surveillance registries in each city, and medical records of those not on the AIDS registry were reviewed to determine if AIDS had been diagnosed. The estimated completeness of AIDS case reporting to AIDS surveillance systems was high in all four cities (ranging from 83 percent to 100 percent). The unreported cases were similar to reported cases with respect to sex, race, risk factor, and specific diagnosis. Of the causes of death examined, AIDS, Pneumocystis carinii pneumonia, and Kaposi's sarcoma were predictive of AIDS as defined by the CDC case definition. However, 77 of 588 deaths (13 percent) attributed to 1 of these 3 causes occurred in cases that were presumptively AIDS but did not meet the diagnostic requirements to be classified as AIDS for reporting purposes. A review of death certificates provides an easy and rapid means of evaluating surveillance efforts and can be a useful adjunct to other methods of surveillance for AIDS.     

汕头地区4例散发创伤弧菌感染的实验室诊断

目的了解汕头市某院创伤弧菌（VV）感染患者的病原微生物学特征及药物敏感性。方法回顾性分析汕头市某院2013年6月—2014年6月收治的4例VV感染患者,采集患者血标本进行培养,采集患者疱液或棉拭子采集伤口分泌物接种于血平板、麦康凯平板及TCBS平板,对分离的菌株进行鉴定和药敏试验。结果4例VV感染患者,其中死亡3例,治愈1例;分别因进食腌蟹、蒸扇贝或外伤后接触海产品,而引起原发性败血症及下肢感染。患者A、B疱液,患者C伤口分泌物,患者D血培养均分离出氧化酶阳性、TCBS平板上生长呈绿色的革兰阴性菌,均鉴定为VV。VV对头孢唑林耐药或中介,对头孢替坦均为中介,1株VV对头孢吡肟耐药。结论4例VV感染患者病死率高（3/4）,疱液或伤口分泌物培养阳性率较血培养高;及时就诊、尽早开始抗菌药物治疗及积极清创有助于治疗该病。     

加强质控管理对持续改进职业健康检查质量作用的探讨

创伤弧菌是人类三大致病弧菌之一，能够通过食源性传播或者伤口感染导致发病，近年来全球发病率逐步升高。随着新一代测序技术的发展，已有上百株创伤弧菌全基因组序列在国际公共数据库公布。这些数据为创伤弧菌基因组学研究提供了重要基础，并促进了对该病原菌遗传多样性、传播和致病机制的认识。本文从基因分型、种群结构和重要毒力因子3个方面对创伤弧菌基因组学研究进展进行归纳总结，以期为创伤弧菌感染、进化和防控研究提供借鉴。     

Occupational information on death certificates: a survey of state practices.

A national survey was conducted in 1979 to determine the extent to which state and local vital registration offices coded and stored occupational information reported on death certificates. This survey found that 11 states routinely code occupation, seven routinely code industry, and six have coded occupation and/or industry on a limited basis. State and federal cooperation is needed to facilitate increased use of mortality data for environmental and occupational health research.     

Use of death certificates for mesothelioma surveillance.

Data from the Massachusetts Cancer Registry and death certificates were linked for mesothelioma cases reported to the registry from 1982 through 1987 to determine the extent to which the cause of death information that is given on the death certificate is useful in identifying mesothelioma cases for disease surveillance. Only 12 percent of all persons reported with mesothelioma who had died were detected using underlying cause of death codes for cancers of the peritoneum and pleura, which are commonly used to identify mesothelioma cases. The rate increased to 83 percent when death certificates were reviewed manually for any mention of mesothelioma. Surveillance using only the coded cause of death data currently available will result in a large underascertainment of mesothelioma cases.     

Misclassification of childhood homicide on death certificates

Suspect classification of homicide deaths of Connecticut residents under 20 years of age was noted for 29 percent of cases examined. Misclassification was attributed to incomplete or erroneous information recorded on the death certificates, rather than errors in the designation of ICD-9 homicide codes. The results have important implications in the interpretation of vital statistics when homicide is listed as the cause of death and underscore the value of record linkage systems.     

Identification of cases of sudden infant death syndrome from death certificates.

A method is proposed for identification of cases of sudden infant death syndrome (SIDS) from information available on death certificates. Deaths at ages between 7 days and 2 years, referred to a coroner, having certain specified causes of death codes, identified 160 of 169 cases of SIDS confirmed as such by a pathologist. The sensitivity of the method was 94% and the specificity was 97%.     

Causes of death in Minamata disease: analysis of death certificates

Summary The causes of death in Minamata disease were analyzed and compared with those of control subjects. Of the 1422 Minamata disease patients in the Kumamoto Prefecture, 378 had died by the end of 1980. Of these 378, the first death occurred in 1954 with a peak incidence in 1956 when Minamata disease was officially reported for the first time. The number of deaths increased rapidly after 1972 with a second peak in 1976. The male: female ratio was 1.8: 1 and the mean age-at-death was 67.2 years (SD = ± 18.65). The mean age-at-death was younger in the cases of the initial outbreak than in those recently. There were, on the average, 2.8 causes of death per person. Of these cases, 157 (41.5%) had Minamata disease indicated on the death certificate, though 64 (16.9%) had Minamata disease coded as the underlying cause. Minamata disease and the noninflammatory diseases of the central nervous system (CNS) were the main underlying causes of death between 1954 and 1969, while, in the multiple cause data, pneumonia and non-ischemic heart disease were the most prevalent. Cerebrovascular diseases (18.0%) were the main underlying causes of death followed by malignant neoplasms (14.7%), cardiovascular diseases (14.1%) and Minamata disease (14.1%) in 1970 or later, while cardiovascular diseases (18.6%), Minamata disease (14.5%), cerebrovascular diseases (10.4%) and malignant neoplasms (7.1%) were the major multiple causes of death. As compared with the control, the proportions of deaths due to noninflammatory diseases of CNS and pneumonia were higher in the initial outbreak. Although the difference in the causes of death was less apparent recently, malignant neoplasms and hypertensive diseases tended to be lower. These results suggest that there is a need for a long-term follow-up of Minamata disease patients. The data also show the potential value of multiple causes of death coding in analyses of mortality.     

Exploring the use of death certificates as a component of an occupational health surveillance system.

An effort has been made to explore a case-finding surveillance system for occupationally-related disease using death records. A sentinel health event, here lung cancer in young males, was selected to seek unusual associations with occupations as listed on the death records. Fishermen appeared to be over-represented and population studies cited suggest lung cancer in this occupation deserves further exploration. Further efforts of this type could test the usefulness of an occupational health surveillance system based on the death certificate.     

Unspecified injuries on death certificates: a source of bias in injury research.

Protective gear (for example, helmets and bulletproof vests) shields certain body regions from damaging energy. Failure to specify on death certificates the body region and nature of fatal injuries compromises the utility of mortality data for epidemiologic or prevention research. Of fatally injured California motorcyclists, 41% had no specific injuries listed on their death certificates in 1988. To examine the implications of this problem, the authors abstracted 186 coroner's or medical examiner's reports from four California counties with over 60% nonspecific injuries and one county with few such injuries. These data were merged with computerized death certificate files and with the Fatal Accident Reporting System. Among the 99 cases with nonspecific injury codes, 68% had head injuries, 63% had chest injuries, 58% had abdominal injuries, and 58% had extremity injuries. Reporting sensitivity in the four problem counties varied from 36% for head injury to less than 5% for abdominal, spinal, and extremity injury. The association between head injury and failure to wear a helmet was statistically significant using the coroner's diagnoses (p = 0.02), but not using death certificate diagnoses (p = 0.17). The value of mortality data to injury researchers would be enhanced by better reporting of the nature of injury on death certificates.     

Quality of death certificates in Valencia, Spain.

Certificates of 1,454 deaths occurring over 11 months were retrieved from the Civil Register in Valencia, Spain. Relevant medical information was systematically gathered from hospital records, questionnaires, and Coroner reports. We compared the underlying cause of death (UCD) from the original death certificate, and a reference cause of death (RCD) determined by a panel of experts based on all available information. Overall, 80.2 percent of the certificates were concordant for disease category, but there was a great disparity among some specific disease categories.     

Causes of death in Huntington disease as reported on death certificates

Huntington disease (HD) is a late onset autosomal dominant neurological disorder. Two hundred fifty-three death certificates of HD-affected individuals from four midwestern states were examined to determine the completeness of reporting HD on the death certificates. Overall, 66% of death certificates indicated HD as a primary or contributory cause of death. There was significantly better reporting on more recent death certificates, but even since 1979, 16% did not report HD. The implications to those researching HD family histories and to the accuracy of mortality rates are discussed.     

Why race is differentially classified on U.S. birth and infant death certificates: an examination of two hypotheses

Among U.S. infants who die within a year of birth, classification of race on birth and death certificates may differ. I investigate two hypotheses: (1) The race of infants of different-race parents is more likely to be differentially classified at birth and death than the race of infants of same-race parents. (2) States with a greater proportion of infant deaths of a given race are less likely to differentially classify infants of that race on birth and death certificates than states with a smaller proportion of infant deaths of that race. Using the Linked Birth/Infant Death data tape for 1983-1985, I assessed the first hypothesis by comparing rates of differential classification for infants with different-race parents and same-race parents. To assess the second hypothesis, I examined the correlations between the proportion of infant deaths of each race in each state and the proportion of infants of that race consistently classified. Differential racial classification on birth and death certificates was more than 31 times as likely with different-race than with same-race parents. The second hypothesis was confirmed for white, black, American Indian, and Japanese infants. As the U.S. population becomes more heterogeneous, attention to these methodologic issues becomes increasingly critical for the measurement and redress of differential racial health status.