Tuberculosis surveillance using death certificate data,New York City, 1992.

OBJECTIVE. To determine the accuracy and frequency of reporting tuberculosis as either the contributing or underlying cause of death on death certificates in New York City during 1992. METHODS. Death certificates from 1992 that listed tuberculosis were matched with the New York City tuberculosis registry. For those persons who had tuberculosis listed as a cause of death, but who were not listed in the registry, medical records were reviewed. The frequency of reporting tuberculosis on death certificates in patients who died with active tuberculosis was evaluated in the second part of this study. Death certificates of patients with active tuberculosis (persons who died within six months of starting anti-tuberculosis medications) in 1992 were reviewed. RESULTS. Tuberculosis was listed on 635 death certificates; 377 (59%) were confirmed cases based on registry data. Reviews of medical records were possible for 230 (89%) of the remaining 258 patients and confirmed only two additional tuberculosis cases. Of 310 persons who died with active tuberculosis in 1992 (second part of the study), only 104 (34%) had tuberculosis listed on their death certificates. CONCLUSIONS. In New York City, a diagnosis of tuberculosis on death certificates is an inaccurate measure of tuberculosis burden.     

Validity of demographic characteristics on the death certificate.

In a sample of the United States population from the Census Bureau's current Population Surveys, we compared demographic characteristics with those recorded on the death certificate for the 43,000 decedents in the samples followed from 1979 to 1985. Overall percentage agreements were: Sex 99.5, Race 99.4, Place of birth 99.4, Hispanic origin 98.7, and Veteran status 95.2. Relatively fewer American Indians and Asian/Pacific Islanders had death certificates that agreed with the baseline race (73.6% and 82.4%, respectively). The direction of disagreement suggests that current estimates of mortality rates for American Indians and Asian/Pacific Islanders are underestimated.     

Colorectal cancer deaths as determined by expert committee and from death certificate: a comparison. The Minnesota Study.

For deaths during the first 13 years of follow-up of the Minnesota Colon Cancer Control Study, an expert committee using numerous medical documents, and a nosologist using only the death certificate independently determined whether colorectal cancer caused the death and, if not, whether the disease was present at death. Deaths due to colorectal cancer numbered 318 according to the nosologist and 323 according to the committee, a discrepancy of 1.5%, which is similar in magnitude to that in three previous studies. The nosologist and committee agreed that colorectal cancer caused the death in each of 290 individual cases; they disagreed widely on the number of deaths from other causes but with colorectal cancer. If it is important to know only the gross number of deaths from colorectal cancer, then the death certificate alone appears to be sufficiently accurate; if it is important to know the cause of death of individual subjects or the number dying from other causes but with colorectal cancer, then the expert committee method provides more accurate information.     

Determining injury at work on the California death certificate.

OBJECTIVES: This study examined decisions of California Country Coroner's offices in determining injury at work and identified factors influencing this decision. METHODS: Surveys were sent to California County Coroner's offices (response rate = 93%). The survey included 23 vignettes that required the respondent to determine whether the fatality involved an injury at work. The Rasch method was used to determine internal consistency in endorsing vignettes and to determine overall endorsability of vignettes based on underlying factors. RESULTS: Respondents showed internal consistency but much disagreement in their endorsement of vignettes. Decedents who were performing paid work or were on their work site during working hours were almost unanimously endorsed as having incurred an injury at work. Non-payment, travel/transportation, suicide, and nontraditional work sites and work hours led to disagreement and uncertainty among respondents. CONCLUSIONS: Coroners have different methods of determining injury at work on the death certificate, and available guidelines do not define many of the ambiguous situations encountered by coroners.     

影响上海市死因监测工作质量的原因分析及对策

居民的病伤死亡原因资料不仅可以直接反映一个国家或地区人民的健康水平,而且可以在一定程度上反映一个国家或地区的社会经济、文化教育及卫生保健的情况。死亡的定义非常明确,加之死亡资料容易获得,投入的人力、物力、经费少,得到的信息多。因此,死亡信息已成为许多国家最可靠的卫生数据。死亡资料还在多个领域得到应用,如：①经济学（保险行业）：疾病与经济关系,一种疾病发生至死亡导致的直接、间接的经济估价;②环境医学：空气、水质与疾病的死亡关系;③气象学：寒潮、高温与疾病的死亡关系;④社会医学：因伤害死亡对国家、社会、家庭造成的影响等。除了完整获得死亡资料外,正确确定死亡原因对于保证死亡资料的准确性也是非常重要的。正确进行死因判断取决于两个方面：准确报告死亡原因和对死亡原因进行恰当的统一分类。这两个方面需要得到两个部门的支持,首先是进行死因报告的各级各类医疗机构和社区卫生服务中心,其次是负责死因复查、死因编码的各级疾病预防控制中心。     

Leukemia among Nebraska farmers: a death certificate study.

The risk of leukemia among farmers was studied using records of death certificates from Nebraska, 1957--1974. Comparison of occupation, as recorded on the death certificate, for 1084 leukemia deaths and 2168 deaths from other causes, matched for age at death, year of death, county of residence, race, and sex, revealed an elevated risk of leukemia among farmers (odds ratio = 1.25). The risk was greatest among farmers born after 1900 and dying before age 66 (odds ratio = 1.83). Stratification by county of residence showed a significantly elevated risk for farmers from heavy corn producing counties.     

Influence of age at death on accuracy of death certificate disease diagnosis: findings in 475 consecutive deaths of mesothelioma among asbestos insulation workers and asbestos factory workers.

Age at death had no appreciable influence on accuracy of death certificate diagnoses of 475 consecutive deaths of mesothelioma among asbestos insulation and asbestos factory workers, until age 75 or older.     

United states non-Hodgkin's lymphoma surveillance by occupation 1984-1989: A twenty-four state death certificate study

Death certificates from 23,890 male and female non-Hodgkin's lymphoma (NHL) cases and 119,450 noncancer controls from 24 states for the period 1984-1989 were used to generate hypotheses regarding occupational associations. Cases were frequency matched by age, race, and gender with five controls per case. Odds ratios were calculated for 231 industries and 509 occupations. Significant associations were observed for a variety of white-collar professionals (i.e., real estate agents, secretaries, bookkeepers, teachers, postal employees, business agents, engineers, chemists, and medical professionals) and blue-collar occupations (i.e., firefighters, farm managers, aircraft mechanics, electronic repairers, mining machine operators, and crane and tower operators). © 1995 Wiley-Liss, Inc.     

The surveillance of birth defects: the usefulness of the revised US standard birth certificate.

To assess the sensitivity and positive predictive value of birth defects reported on the 1989 revision of the US Standard Birth Certificate, a population of 76,862 Atlanta-area births during 1989 and 1990 was used as the basis for comparing 771 birth certificates that reported birth defects with 2428 live-born infant records in a birth defects registry that uses multiple sources of case ascertainment. Only 14% of birth defects in the registry records were reported on birth certificates. After the analysis was restricted to defects recognizable at birth, the sensitivity and positive predictive value of the birth certificates were 28% and 77%, respectively. Birth certificates underestimate birth defect rates and should be used cautiously for birth defect surveillance and epidemiological studies.     

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.     

Comparison of death certificate occupation and industry data with lifetime occupational histories obtained by interview: variations in the accuracy of death certificate entries

This study compares usual and recent occupation and industry data from lifetime work histories obtained by interview with death certificate entries for occupation and industry for 2,435 persons diagnosed with cancer. Match rates are calculated as the percent of death certificate occupation and industry entries that were confirmed by interview data and are compared for exact 3-digit 1980 U.S. Census Bureau occupation and industry codes and for groups of these codes. The overall match rate for individual usual occupation codes was 47.9% and for exact usual industry codes it was 61.8%. Significant differences between the interview data for usual occupation or industry and the death certificate entry were observed by race and gender, marital status, number of years worked, and occupation and industry groups and by age for industry. Misclassification or overreporting of occupation and industry data on the death certificate ranged from 30 to 50% in this study. Our results suggest that the utility of death certificate data for investigations into the occupational risk factors for cancer may be quite limited.     

Fetal death certificate data quality: a tale of two U.S. counties

PurposeDescribe the relative frequency and joint effect of missing and misreported fetal death certificate (FDC) data and identify variations by key characteristics.MethodsStillbirths were prospectively identified during 2006–2008 for a multisite population-based case-control study. For this study, eligible mothers of stillbirths were not incarcerated residents of DeKalb County, Georgia, or Salt Lake County, Utah, aged ≥13 years, with an identifiable FDC. We identified the frequency of missing and misreported (any departure from the study value) FDC data by county, race/ethnicity, gestational age, and whether the stillbirth was antepartum or intrapartum.ResultsData quality varied by item and was highest in Salt Lake County. Reporting was generally not associated with maternal or delivery characteristics. Reasons for poor data quality varied by item in DeKalb County: some items were frequently missing and misreported; however, others were of poor quality due to either missing or misreported data.ConclusionsFDC data suffer from missing and inaccurate data, with variations by item and county. Salt Lake County data illustrate that high quality reporting is attainable. The overall quality of reporting must be improved to support consequential epidemiologic analyses for stillbirth, and improvement efforts should be tailored to the needs of each jurisdiction.     

Non-referral of unnatural deaths to coroners and non-reporting of unnatural deaths on death certificates in Taiwan: implications of using mortality data to monitor quality and safety in healthcare.

BACKGROUND: Mortality data has often been used to monitor the quality of cardiac care. OBJECTIVE: To investigate the under-reporting of unnatural deaths in mortality data. METHOD: All patients with a main discharge diagnosis of injury (ICD-9-CM code 800-999) who died in 2003 or 2004 were identified through record linkage between hospital discharge claims data and cause of death data in Taiwan. Percentages of unnatural deaths that had been referred to the coroner and in which injury-related information was reported on the death certificate were estimated. RESULTS: Of 4086 known or suspected unnatural deaths, only 57% (2346/4086) were referred to the coroner, and in 71% (2889/4086) injury-related information was reported on the death certificate. The percentages of referral and reporting were lowest for deaths related to complications in medical and surgical care. In deaths related to fracture of the femur and the effects of a foreign body, many doctors report injury-related information on the death certificate but do not refer the certification of cause of death to the coroner. CONCLUSIONS: The sensitivity of using mortality data alone to detect known or suspected unnatural deaths varied according to the types of injury and external causes. Monitoring cause of death data linked with hospital discharge record data could provide a better system for discovering these unnatural deaths.