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PubMed1994

A comparison of analyses of occupational bladder cancer: death certificate vs. population-based case-control interview data.

The authors examined the utility of death certificate data for occupational health surveillance by comparing the ability of the data to identify high-risk occupations for bladder cancer with that of a population-based case-control study. Death certificate data for white males from 23 states for 1979-1987 were analyzed using proportionate mortality ratios. The case-control study used cancer registry cases for 1977-1978. Results were compared for 21 a priori suspect occupations. A broad definition of agreement resulted in agreement for 62% of the occupations; the death certificate study identified eight of 15 occupations identified by the case-control study and neither study identified five of the categories. While death certificate data have many limitations, our results indicate that death certificate data can provide clues to some potential occupational health problems. With the advantages of inexpensive data, large sample size, and industrial coverage, more refined analyses of the data should prove useful for occupational mortality surveillance and hypothesis generation.

Case-Control Studies↗
PubMed1985

False-positive reporting of Down syndrome on Ohio and New York birth certificates.

Although correction for underreporting of congenital malformations on birth certificates is included in most studies, inaccuracy of reporting has not been widely examined. Two separate investigations were conducted on the inaccuracy of Down syndrome (DS) reporting on birth certificates; ie, false-positive cases in which an individual coded as DS did not in fact have DS. In Ohio, 824 individuals were coded as DS on their birth certificate during 1970-1981. Of these, a definitive determination as to whether or not they had DS was made on 778 by using cytogenetic data, medical records, the state's birth defects registry, school records, and by questioning physicians. Fifty-seven false-positives were found, indicating a 7.8% level of coding inaccuracy for all races and 6.9% for whites only. Nine of these arose from miscodings during data processing; 48 were misdiagnosed as DS. This can be contrasted with false-negatives also studied in Ohio, where 66.1% of DS cases were not reported on the birth certificate. No statistical differences were observed between false-positives and true DS in the distribution of sexes, in population size of county of birth, or in year of birth (although there was a declining false-positive rate over the 12 year period). The percentage of DS false-positives, however, was significantly higher for younger maternal ages (greater than or equal to 30 years) than older ones (greater than or equal to 30 years) and for nonwhites compared to whites. Further, there was a strong negative correlation between the percentage of false-positives and the degree of certainty expressed in reporting DS on the birth certificate.

Adolescent↗
PubMed2001

Temporal changes in liver cancer incidence rates in Japan: accounting for death certificate inaccuracies and improving diagnostic techniques.

Primary liver cancer (PLC) rates have risen dramatically during the past few decades in some regions, particularly in Japan, where PLC is now the third major cause of cancer death. PLC is one of the most difficult tumors to diagnose correctly, because (i) the liver is a frequent site of cancer metastasis and (ii) death from PLC is often attributed to cirrhosis or chronic hepatitis. Also, because the disease is often rapidly fatal, a large proportion of liver cancer cases are identified based on death certificates alone without confirmation by clinical records. Thus, worldwide differences in published incidence rates for this disease reflect regional or national differences in both the accuracy of death certificates and the sensitivity of diagnostic methods. By comparing death certificate causes of death with those based on pathology review, we were able to adjust 1958--1994 incidence rates for a large Japanese cohort for these errors. Although the death certificate false-positive error rate declined, the false-negative error rate remained high throughout the study. The introduction of improved liver cancer diagnostic methods in Japan in the early 1980s was associated with a sharp increase in PLC incidence. We conclude that errors in death certificate causes of death and changes in liver cancer diagnostic techniques have had an important impact on the reported incidence of this disease. Taking these factors into account, rates of hepatocellular carcinoma rose between 2.4- and 4.3-fold in our Japanese cohort from 1960 to 1985, peaked about 1993 and declined thereafter. Incidence rates of cholangiocarcinoma remained stable through 1987.

Carcinoma, Hepatocellular↗
PubMed2005

Disparities in the recording of Parkinson's disease on death certificates.

Although little is known regarding potential socioeconomic or racial bias in the recording of Parkinson's disease (PD) on death certificates, studies of incidence, prevalence, and the etiology of PD frequently rely on this type of data. A national population-based survey was linked to death certificate data to investigate the concordance of PD reported on death certificates for persons reporting PD during life. Logistic regression was used to identify independent factors associated with differential reporting of PD at death. Among decedents with PD reported during life, 54.8% had PD recorded on the death certificate. Nearly 70% of persons in higher income categories had PD recorded at death compared to 35.4% for those earning $10,000 or less. Age and gender adjusted odds of having PD recorded at death was 2.3 (1.1-3.9), for those with an annual income of $35,000 or more. Income differences remain significant in multivariable models after controlling for age, gender, race, census region, family size, rural residence, and number of chronic medical conditions. In conclusion, this study found socioeconomic bias in the reporting of PD at death. This bias is large enough to confound death certificate-based investigations of incidence, prevalence, and risk factors that differ across socioeconomic strata.

Aged↗
PubMed1992

Accuracy of death certificates: a population-based, complete-coverage, one-year autopsy study in East Germany.

The Goerlitz Autopsy Study is a population-based autopsy study, conducted in 1987 in the municipality of Goerlitz, population 78,484, in former East Germany. It is unique in that 1,023 (96.5 percent) of the 1,060 subjects who died in the municipality over a period of one year were investigated by full autopsy. An underlying cause was assigned to every death, using the procedures recommended by the International Classification of Diseases, Injuries and Causes of Death, ninth revision, German edition. Assignment of cause of death was done independently by the attending clinician and the pathology team who performed the autopsy. The data were analyzed through cross-classification of deaths by death certificate diagnosis and autopsy-based diagnosis. Sensitivity and positive predictive values were calculated for the death certificate diagnoses, assuming that the autopsy findings represent the correct reference set. Overall, 47 percent of diagnoses on death certificates differed from those based on autopsy and, for 30 percent of the subjects, the difference crossed a major disease category. The proportion of disagreement was higher for deaths occurring in nursing homes and among the very old, but was unrelated to gender. In the death certificates, diseases of the circulatory system and endocrine and metabolic disorders were over-represented, whereas infectious diseases, neoplasms, and respiratory, digestive, and genitourinary diseases were under-represented. Neoplasms in the death certificates are characterized by relatively high sensitivity and predictive values, even though these were still unsatisfactory, given the chronicity of the clinical course and the opportunities available for correct diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2001

Development of clenbuterol reference materials: lyophilized bovine eye samples free of clenbuterol (CRM 673) and containing clenbuterol (CRM 674). Part 2: certification.

The certification by inter-laboratory testing of two candidate reference materials (RMs) for the mass concentration of the anabolic agent clenbuterol in bovine eye material is described: RM 674 with ca 10 microg clenbuterol per kg of eye matrix and RM 673 clenbuterol-free eye matrix as the negative control (<0.50 microg kg(-1)). Both candidate RMs were certified by eleven EU laboratories, and sixty-six accepted replicate measurements were included in the "Certification Study". The precision of the measurement process was assessed by calculation of the standard variation determined within each laboratory during the certification step. The study was performed according to the "Guidelines for the production and certification of BCR reference materials" and to "ISO guide 31, 33, and 35". The certified clenbuterol mass concentration for clenbuterol-free eye material CRM 673 (calculated on the basis of clenbuterol as the free base) was <0.50 microg kg(-1). The corresponding concentration for clenbuterol-containing eye material CRM 674 was 9.42 +/- 0.88 microg kg(-1). These certified values are very close to the desired target concentration of <0.5 microg kg(-1) and ca 10 microg kg(-1). This study has demonstrated that successful certification of clenbuterol-containing and clenbuterol-free bovine eye materials is possible.

Analysis of Variance↗
PubMed1987

Standardized physician preparation of death certificates.

One method for determining cause of death in a clinical trial is to use standard nosological coding of death certificates. In order to look at an alternative approach, the Hypertension Detection and Follow-up Program (HDFP) assessed underlying causes of death through the use of three physicians. These physicians were trained and standardized in the proper recording of cause of death on death certificates. Each physician completed a death certificate for each of the 768 deaths in the HDFP, utilizing all available information, including HDFP records, plus any additional hospital and autopsy records. The new standardized death certificates were then transmitted to a panel of three nosologists who coded the cause of death. The physician preparation procedure was compared with a procedure wherein a panel of three nosologists coded the original death certificate for the underlying cause of death. The procedures agreed on the three-digit International Classification of Disease, Adapted code in 60.1% of the cases. The agreement rate improved to 72.5% when disease codes were collapsed into broad disease categories utilized in the HDFP.

Adult↗
PubMed2005

Reliability of Indiana birth certificate data compared to medical records.

PURPOSE: The purpose of this study was to measure the reliability of data reported on Indiana electronic birth certificates. Knowing the accuracy of birth certificate data is crucial when identifying community health needs and evaluating birth outcomes interventions. METHODS: This study compared 1996 electronic birth certificate data on a random sample of 1050 Indiana hospital births to data abstracted from the hospital medical records for the same patients. Kappa scores, Pearson r correlation values, sensitivity, specificity, and positive predictive values of the birth certificate data were used to measure agreement. RESULTS: Parents' demographic variables had the best agreement, followed by birth outcome variables. Delivery type, cesarean indications, pregnancy history, prenatal care and mother's risk variables were found to have moderate agreement. Agreement was poor for variables measuring labor and delivery complications, obstetric procedures, concurrent illnesses, pregnancy complications, congenital anomalies, and abnormal conditions. CONCLUSIONS: The results of this study clearly show that some important descriptive and outcome data are reliable while infrequent events are generally not. The results indicate a need to improve the quality of data reported on birth certificates.

Adult↗
PubMed2004

Death Certification and New Zealand Health Information Service (NZHIS) statistics for diabetes mellitus: an under-recognised health problem.

The main aims were to determine how much diabetes is under-recorded on death certificates, the influence of demographic variables and to what extent New Zealand Health Information Service (NZHIS) coding is able to compensate for deficiencies. A retrospective review of 600 death certificates (during 1999) from the Mortality Review Database in Christchurch Hospitals was carried out. Clinical data, laboratory results, coroner's reports, hospital clinical coding and NZHIS coding were collated and analysed. One hundred and four cases (17%) had clinically documented diabetes, of which only 47 (45%) had diabetes recorded on either the death certificate or the coroner's report. Diabetes was recognised in NZHIS coding in 45 (43%) of cases and in 94 (90%) cases in hospital clinical coding. Diabetes was more likely to be recorded on the death certificate in males and in subjects treated with insulin (P<0.05). Of the 496 subjects without documented diabetes, 159 (32%) had a highest random plasma glucose >11.1 mmol/l. Documented diabetes is thus under-reported on more than 50% of death certificates and this is not compensated by NZHIS coding. In addition, there is likely to be a significant number of cases with undiagnosed diabetes. This may adversely affect the reliability of mortality statistics.

Adolescent↗
PubMed2005

[ISO 9001-2000 certification for refractive laser treatment].

PURPOSE: To obtain ISO 9001-2000 certification for laser corneal refractive treatment, never before sought in Europe. MATERIAL AND METHODS: The consulting firm Veritas led the certification process with the clinic's staff manager. This ISO norm is dedicated to the implementation of a quality management system. We assessed and optimized all necessary resources, evaluating customer satisfaction using patient and referring-physician surveys. We started quality rounds including surgeons, nurses, and technicians. Based on this preparation, we redefined and explained all processes including staff responsibilities and necessary resources in the quality manual. The procedure lasted 14 months with substantial involvement on the part of the management. RESULTS: Unconditional ISO 9001-2000 certification was granted by the independent audit firm, BVQI, in december 2003 for refractive laser treatment. CONCLUSION: The 2000 version of the new ISO 9001-2000 seeks to meet the demand for improving health care delivery in this field, most particularly by establishing a clear procedural orientation. Such certification enhances team work, stabilizes methodologies, and reinforces cohesion and self-audit. Patients notice that the center follows a consistent quality policy and are assured that the clinic respects rules and regulations. Certification is an advantageous alternative when accreditation cannot be considered. Our article discusses the steps taken in upper management, quality management, procedural guidance, as well as customer and staff counselling. It also discusses the project's cost/benefit ratio for the organization.

Certification↗
PubMed2002

[Principal requirements in medical training for certification of deaths in Spain].

OBJECTIVE: To know the training need priorities in Spanish physicians in death certification. DESIGN: Study of needs by consensus technique Delphi. SETTING: Health care and medical-legal institutions in Spain. PARTICIPANTS: Physicians who ask for information in death certification, after reading an article in a medical magazine (n=38), and agree to participate (n=33). METHODS: Priorities were established by means of a list of items, based on teaching experience and professional advice. The scores obtained for each priority were hierarchized, and the participants professional profiles were described. An analysis of hierarchical clusters was done to determine profiles of training. RESULTS: The median age of the participants was 42 years, with 18 years experience in general/family, emergency or forensic medicine, which usually certified in median 8 death a year (rank from 0 to 50). The maximum training priorities were how to register a death and which doctor should make out the official documents. Intermediate priorities included the role of doctors in violent or accidental deaths. In the main three grouping needs were, in one, include certification as a degree subject and learn how different documents are made out; although in the others two, were how to register a death, which physician make out the documents, and when it should certify the family doctor and when the coroner. CONCLUSIONS: The priorities in certification training are how to register a death and who should make out the documents, pointing out that the shortcoming continues in medical training in death certification.

Adult↗
PubMedDate not supplied

[Trends in cervix cancer mortality in Catalonia, 1975-1992: analysis of death certificates and cancer registry of Girona].

INTRODUCTION: Uterine cancer not otherwise specified (NOS) is often recorded in death certificates as cause of death. The purpose of the study is to recode all death certificates mentioning gynecological cancers in the area of Girona, Spain and to compare trends in cervical cancer mortality before and after recodification. METHODS: Death certificates issued between 1985 and 1989 in the province of Girona (population 500,000) mentioning gynecological cancer were identified. Medical records and the files of the local Cancer Registry were reviewed to assess the accuracy of the diagnosis and to recode the appropriate site of the primary. The resulting distributions were then applied to the mortality statistics of Catalonia (population 6,000,000 including Girona) and mortality trends were analyzed. RESULTS: Uterus NOS were reclassified as follows: cervix uteri 24%, corpus 29%, ovary 13%, other 14%. In 20% of the cases the code remained as uterus NOS. When this distribution was applied to the Catalan mortality statistics for 1975-1992, a downward trend was observed for cervical cancer at all age groups. CONCLUSIONS: About one third of uterus NOS in death certificates corresponded to cervix and one third to corpus. Mortality trends are severely affected by the proportion of certificates coded as uterus NOS. There is no indication of an increase in cervical cancer mortality among young women in Catalonia.

Adult↗
PubMed2001

Validation of death certificate diagnosis for coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study.

The validity of the death certificate in identifying coronary heart disease deaths was evaluated using data from the community surveillance component of the Atherosclerosis Risk in Communities Study (ARIC). Deaths in the four ARIC communities of Forsyth Co., NC; Jackson, MS; Minneapolis, MN; and Washington Co., MD were selected based on underlying cause of death codes as determined by the rules of the ninth revision of the International Classification of Diseases (ICD-9). Information about the deaths was gathered through informant interviews, physician or coroner questionnaires, and medical record abstraction, and was used to validate the cause of death. Sensitivity, specificity, and positive predictive value of the death certificate classification of CHD death (ICD-9 codes 410-414 and 429.2) were estimated by comparison with the validated cause of death based on physician review of all available information. Results from 9 years of surveillance included a positive predictive value 0.67 (95% CI 0.66-0.68), sensitivity of 0.81 (95% CI 0.79-0.83), and a false-positive rate (1-specificity) of 0.28 (95% CI 0.26-0.30). Comparing CHD deaths as defined by the death certificate with validated CHD deaths indicated that the death certificate overestimated CHD mortality by approximately 20% in the ARIC communities. Within subgroups, death certificate overestimation was reduced with advancing age (up to age 74), was consistent over time, was not dependent on gender, and exhibited considerable variation among communities.

Abstracting and Indexing↗
PubMed2001

Factors associated with errors in death certificate completion. A national study in Taiwan.

To identify characteristics of certifying physicians and the deceased that are associated with errors in death certificate completion in Taiwan, we retrospectively reviewed 4123 systematically sampled death certificates issued in 1994. Multivariate analyses were used to assess the associations of various characteristics of the certifying physicians and the deceased with four types of error. Of the 4123 death certificates reviewed, 2525 (61%) were completed correctly. In 289 (7%), only the mechanism(s) of death was given (Major Error 1); in 146 (4%), multiple causal sequences were given in part I (Major Error 2); in 800 (19%), a single causal sequence was given but was not specific enough (Minor Error 1); and in 363 (9%), a single causal sequence was given but the order was incorrect (Minor Error 2). Multiple logistic regression analyses revealed that the probability of error in death certification increased as the age of the deceased increased, the age of the certifier decreased, and the level of the hospital decreased. These findings suggest that training in death certificate completion should focus on younger certifiers and those working at lower level teaching hospitals and nonteaching hospitals. Given the high rate of Minor Error 1, physicians should be reminded to state information as specifically as possible to render cause-of-death statistics more informative.

Adult↗
PubMed1998

Estimating the proportion of unnecessary Cesarean sections in Ohio using birth certificate data.

The main objective of the study is to present a method that estimates the proportion of unnecessary Cesarean sections (C-sections) using birth certificate data. This population-based cross-sectional study uses two major databases--Ohio birth certificates and Medicaid eligibility files--and includes singleton infants born during the period July 1991 through June 1993 (n = 262,013). A total of 57 variables indicative of adverse events, including maternal medical risk factors, complications of labor and delivery, and congenital anomalies that are available on the birth certificate, are examined to estimate the rate of unnecessary C-sections. The results obtained through this method indicate that nearly 40% of the repeat C-sections had no documented abnormalities on the birth certificate to justify a C-section. Because studies using medical records have yielded similar results, we believe that using birth certificate data may be a reliable method to measure and monitor the rate of unnecessary C-sections.

Adult↗
PubMed1997

Vibrio vulnificus infection reporting on death certificates: the invisible impact of an often fatal infection.

This study assessed accuracy of (a) recording Vibrio vulnificus infection on death certificates and (b) International Classification of Disease (ICD)-9 codes for V. vulnificus. Patients with microbiologically confirmed V. vulnificus infection were identified as part of co-ordinated surveillance in four USA Gulf Coast states between 1989 and 1993. Of 60 deaths, 51 death certificates were reviewed and V. vulnificus was recorded as the immediate cause of death on 11 (22%). There was no ICD-9 code for V. vulnificus infection, thus no patients had an ICD-9 code indicating V. vulnificus infection. Of 23 certificates where V. vulnificus was recorded on the death certificate, only 5 (22%) were coded for Gram-negative, septicaemia. This study highlights the importance of teaching physicians how to provide epidemiologically meaningful data on death certificates and the need for accurate ICD mortality codes.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

Comparison of the diagnosis of leukaemia from death certificates, cancer registration and histological reports - implications for occupational case-control studies.

It is essential in occupational case-control studies of rare diseases for ascertainment to be as complete as possible, together with an accurately defined diagnosis. A nested case-control study from a large cohort of UK oil distribution workers followed up since 1950 was carried out to investigate the association between leukaemia, in particular acute myeloid leukaemia, and exposure to benzene. Ninety-one cases occurring before 1993 were identified from death certificates or cancer registrations (available from 1971). Histopathology departments were contacted to obtain material that might confirm the diagnosis of leukaemia and this was received for 39 (43%) cases. The majority of the cases (88) were identified primarily from death certificates, with a cancer registration also being received for 56 (90%) of the 62 deaths occurring after 1971. Discrepancies in the diagnoses from these two sources were found for 12 cases, five being acute myeloid leukaemia. For the majority, the diagnosis on the death certificate was more specific than that on the cancer registration. Histology reports were received for nine of the discrepancies, all confirming the death certificate diagnosis. Although leukaemia appears to be regularly registered as a cancer, records may not be routinely updated when new clinical information becomes available. It is recommended that death certificates, cancer registrations and histology reports are obtained routinely by cancer registries to maximize both numbers of cases and diagnostic accuracy for epidemiological studies.

Case-Control Studies↗
PubMedDate not supplied

A cost/benefit study of paratuberculosis certification in French cattle herds.

Paratuberculosis has received increasing attention in France because of the important losses this disease may provoke. The use of certification schemes has proven its effectiveness for the protection of healthy herds against diseases transmitted mainly by trade. The economic justification of such schemes in the particular case of paratuberculosis is studied, for French cattle herds, using a cost/benefit approach. The basic economical hypotheses and estimates have been proposed and carefully examined by a working group composed of paratuberculosis experts and field specialists. By adopting the point of view of a breeder that buys animals, we first estimated the benefits resulting from the non-introduction of the disease. They were then compared with the costs resulting from the fact that the vendor reports its own certification costs on the price of the animals he sells. Two average herds (the mean French beef herd and the mean French dairy herd), and two certification levels were studied. The results show that, currently, the use of the certification is not very economically profitable in French cattle herds. This conclusion, however should be reappraised if the certification costs decrease, for example with the commercialization of diagnostic tests on mixtures.

Animals↗