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PubMed1998

Linking death reports from the Malaysian Family Life Survey-2 with birth and death certificates.

The Malaysian Family Life Survey--2 (MFLS-2) was a population-based survey conducted in Peninsular Malaysia in 1988-89. Through detailed birth histories, it attempted to collect information on all pregnancies and their outcomes from ever-married women, as well as socioeconomic and health services-utilization data that might have affected mortality. The survey did not, however, collect information on the causes of infant death. The two objectives of this study were to assess the feasibility of linking all reported deaths among live births of women interviewed in the MFLS-2 to the birth and death certificates kept by the National Registration Department, and to determine the causes of death from the successfully matched death certificates. This information could be used in the development of specific health programs to decrease infant and child mortality. In this study, the success rates for linking survey data to birth and death certificates were 34.5% and 31.8% respectively. Methodological problems faced during the study are discussed, as are the strengths and limitations of record linking as a means of increasing the utility of birth histories for studying the causes of death. Ways to improve linkage rates of survey data with the national birth and death registration are also suggested.

Birth Certificates↗
PubMedDate not supplied

Experiences with linked birth and infant death certificates from the NIMS project.

The National Infant Mortality Surveillance (NIMS) project aggregated data provided by 53 vital statistics reporting areas--50 States, New York City, the District of Columbia, and Puerto Rico (subsequently called States)--from their files of linked birth and death certificates and compared individual States' total infant mortality experiences for the 1980 birth cohort by age at death, race, birth weight, and plurality. Therefore, it was essential to achieve maximum uniformity among the separate data sets and to specify when this uniformity could not be obtained. In working with these multiple sources, we identified five key issues that relate to data from linked birth and death certificates: Variations in definitions of variables are often embedded in data that have been gathered from several independent sources. (For NIMS, the sources were 53 reporting areas and the National Center for Health Statistics.) Variations in States' linking procedures--these are based on an individual State's primary purpose for linking the data--affect the completeness and comparability of the 1980 resident birth cohorts used for NIMS. Variations in the recording of some pregnancy outcomes as fetal deaths or live births are known to be a problem in vital statistics data that particularly affects data for events among infants weighing less than 500 g at birth. Ambiguities occur frequently in unknowns or zero values. For NIMS this effect was most pronounced for the pregnancy history variables. Examination of the values reported for unknown or zero categories helps in uncovering problems with and improving quality of data. (e) Analysis from a new perspective may reveal unexpected data problems. These problems tend to surface only during a reexamination of underlying data that is prompted by unusual findings.Continued alertness to these issues may improve further the quality of data in files of linked birth and death certificates and assure the integrity of analysis based on these data.

Birth Certificates↗
PubMed1987

Death certificate-based occupational mortality surveillance in the United States.

Surveillance of cause-specific mortality patterns by occupation and industry through the use of death certificate records is a simple and relatively inexpensive approach to the generation of leads as to potential occupational disease problems. Researchers from the National Institute for Occupational Safety and Health (NIOSH) have been working with the National Center for Health Statistics, other federal agencies, and state health departments on a number of programs to foster the development of standardized, routine coding of occupation and industry entries on death certificates by state health departments. Thirty-one states and the District of Columbia are now doing such coding. These data are being analyzed currently by investigators at NIOSH and at individual state health departments for the purpose of hypothesis generation on occupation-disease relationships. The proportionate mortality ratio method is the predominant method being used, as appropriate denominator data are not generally available. This type of surveillance is particularly useful for the study of occupation and industry groups for which it is difficult to assemble cohorts, such as groups that are predominantly non-union and in small workplaces. Limitations of this surveillance include its inappropriateness for monitoring those occupational diseases which are not often fatal, and the limited scope and accuracy of death certificate information.

Death Certificates↗
PubMed1992

Use of death certificates in epidemiological studies, including occupational hazards: discordance with clinical and autopsy findings.

There has long been evidence of frequent inaccuracy of death certificates, with significant discordance between such designations and clinical and autopsy data. This exists for occupational diseases as well. The use of statistical rates based on death certificates has been seriously questioned despite their utility for total mortality. Programs to supplement death certificate data, particularly in occupational disease studies, may be helpful, and are reviewed.

Autopsy↗
PubMed1992

Death certificates in epidemiological studies, including occupational hazards: inaccuracies in occupational categories.

We compared death certificates for asbestos-associated diseases (mesothelioma, lung cancer, asbestosis) in two asbestos workers' cohorts. One (insulation workers) had current or recent employment and a strong, continuing union support system which gave them much information about the effects of asbestos exposure. The second cohort, asbestos factory workers, had no such advantage. The factory had closed almost 30 years before, and its workers had dispersed into many areas of the state and nation. Accuracy of medical diagnosis was comparable in the two groups, but occupational listings were not. Three-quarters of the insulators' death certificates told of asbestos work, while virtually none of the factory workers' certificates provided such information, even for deaths of mesothelioma and asbestosis. The data indicate that disease categories, based on medical and pathological diagnoses, at least for asbestos-associated disease, tend to be accurate. Attempts to identify groups at risk by sorting occupational categories can give variable results, good for those with current exposures, much less satisfactory for those with long-past occupational exposures.

Adolescent↗
PubMed2005

American Board of Medical Specialties and repositioning for excellence in lifelong learning: maintenance of certification.

The board certification movement was founded out of a concern for the quality of care, and today, more than 85% of all physicians licensed to practice medicine in the United States have been certified by an American Board of Medical Specialties (ABMS) member board. There is increasing evidence of a need for continuous monitoring and promotion of quality as well as for assessment and documentation that certified medical specialists are keeping up-to-date so that their continuing competence can be documented. To help, the ABMS established a program called Maintenance of Certification, a system that includes periodic examination of knowledge and the comprehensive evaluation of practice. Maintenance of Certification includes 4 major components: professional standing, including an unrestricted license to practice medicine; lifelong learning and self-assessment; demonstrated cognitive expertise; and practice performance assessment. The efforts of the Conjoint Committee on Continuing Medical Education press continuing medical education providers to facilitate self-directed learning and directed self-learning while driving lifelong learning and assessment into the clinical practices of all physicians who seek to continuously upgrade their knowledge, skills, and behaviors to provide quality medical care.

Certification↗
PubMed1995

Is the apparent rise in cancer mortality in the elderly real? Analysis of changes in certification and coding of cause of death in England and Wales, 1970-1990.

The effect of changes in recording and coding of cause of death on trends in cancer mortality in England and Wales in persons aged 45 and over during 1970-1990 is reviewed. During this period, all-cancer mortality rates increased only at ages over 75 in males and over 55 in females. Rises in cancer mortality were largely due to increases in cancer of lung, prostate and unspecified site in men, and of lung, breast and unspecified site in women. Death coding and certification artefacts were much larger in older persons. In those aged 75-84, a change in the position of recording cancer on the death certificate could potentially account for 46% of the recorded increase in prostate-cancer mortality and 28% of the increase in breast-cancer mortality. The decrease in recorded mortality from ill-defined terminal events was far greater than the increase in cancer mortality in this age group. The rise in all-cancer mortality in the elderly was partly due to an increase in lung-cancer mortality, and data artefacts explained a large proportion of the increase in the other common specified cancers in those aged 75-84. The use of routine mortality statistics to chart progress against cancer lacks validity at older ages because of imprecision in certification of cause of death.

Aged↗
PubMed2003

Certification in neurodevelopmental disabilities: the development of a new subspecialty and results of the initial examinations.

The American Board of Psychiatry and Neurology, in collaboration with the American Board of Pediatrics, administered the first Subspecialty Certification Examination in Neurodevelopmental Disabilities to 190 candidates on April 3, 2001, and the second to 80 candidates on April 9, 2002. This report describes the history of the certifying examination including the process of its development and the results of the first and second examination administrations. The purpose of the Certification Examination in Neurodevelopmental Disabilities is to assess knowledge of qualified candidates in the subspecialty. A committee comprised of child neurologists and pediatricians developed this examination. Of the 190 pediatricians (n = 169) and child neurologists (n = 21) who completed the examination in 2001, 157 (83%) passed the examination. The second group of examinees included 68 pediatricians and 12 child neurologists, and the pass rate was 70%. The 213 candidates certified to date have received ten-year time-limited certificates that may be renewed by recertification process beginning in 2010. After the "grandfathering period," candidates for the examination must complete ACGME-approved training programs in the subspecialty.

Certification↗
PubMed1991

Bias in congenital malformations information from the birth certificate.

An analysis of 1983 data from California birth certificates, and from the California Birth Defects Monitoring Program case registry, showed that there is a bias in reporting of congenital malformations on the birth certificate. Hospitals with many births erroneously report lower malformation rates than do hospitals with few births. The bias is partly due to the source of information; larger hospitals are more likely to get their information about malformations from the obstetrician than from the pediatrician. Since malformation data recorded on the birth certificate is both incomplete and biased, at present it is advisable to use these data for epidemiologic analyses with great caution.

Bias↗
PubMed2006

Certifying diabetes-related cause-of-death: a comparison of inappropriate certification statements in Sweden, Taiwan and the USA.

AIMS/HYPOTHESIS: The aim of this study was to assess differences in the certification practices of physicians in Sweden, Taiwan and the USA with regard to diabetes-related cause-of-death (COD) statements. METHODS: Multiple-cause-of-death data from Sweden (2000), Taiwan (2001) and the USA (2001) were used for this study. All deaths with mention of diabetes anywhere on the death certificate were extracted for analysis. Two types of inappropriate COD statements were: (1) reporting two or more diagnoses per line; and (2) entering an incorrect causal sequence among reported diagnoses. RESULTS: Of those deaths in which diabetes was reported in Part I of the death certificate, American physicians (19%) were less likely to report two or more diagnoses per line than physicians in Sweden (46%) and Taiwan (56%). On the other hand, Swedish physicians (5%) were less likely to report incorrect causal sequences than were their counterparts in Taiwan (21%) and the USA (28%). CONCLUSIONS/INTERPRETATION: These findings reveal substantial differences in diabetes-related COD statements among physicians in Sweden, Taiwan and the USA, implying that caution should be used when interpreting differences in mortality statistics between these countries.

Automation↗
PubMed1984

Accuracy and epidemiological implications of the death certificate diagnosis of pulmonary embolism.

The death certificate (DC) diagnosis of pulmonary embolism (PE) has been compared to autopsy findings in 2398 patients dying between 1966 and 1976. Accuracy of the death certificate and the effect of diagnostic misclassification errors on the association between PE and potential risk factors were analyzed in this study. Sensitivity of the DC diagnosis of PE was less than 40% and the predictive value of a positive diagnosis was less than 50%. The epidemiological associations derived using the DC diagnosis of PE were very unreliable for myocardial infarction and malignant neoplasm because errors of diagnostic misclassification were not randomly distributed. Associations with risk factors derived using massive embolism were conservative estimates of the associations derived by using any embolism found at autopsy. We conclude that the death certificate diagnosis of PE is extremely inaccurate and should be used with great caution to study the epidemiology of PE.

Adult↗
PubMed1981

Voluntary certification and the uniform guidelines on selection procedures: a potential problem for personnel managers.

Employers in health care sometimes rely upon various standardized testing procedures in selecting, promoting, and training personnel. Within the health professions, voluntary certification programs have developed to permit individuals to demonstrate competence and become recognized as qualified practitioners. This article addresses the problems which can occur, but are not widely recognized, when employers use voluntary certification examinations in the selection process. The impact of the federal government's "Uniform Guidelines on Employee Selection Procedures" upon voluntary certification activities is uncertain at best, and frightening, at worst. While the Guidelines require employers to use only validated examinations where adverse impact upon protected minority groups exists, they do not effectively address the use of professional certifying examinations and fail to provide guidance for either certifying agencies or employers. This leaves great potential for conflict, since circumstances in which employment is terminated, an employee denied promotion, or even denied opportunities for entry into positions based on an employer's use of voluntary certifying examinations, are increasing daily. How does an employer validate a national certifying examination that he does not administer? How does the certifying agency protect itself from allegations of discrimination or anti-trust violations based on actions of an employer with whom the agency has no contact? This article offers no answers to these troublesome questions. However, it may help eliminate another problem noted by the author--widespread ignorance of the seriousness of these circumstances for employers and certifying agencies. From first-hand experience and research into the development of the Uniform Guidelines, the author points out many of the difficulties which await those who rely on non-validated examinations or choose to ignore the government's edict that examinations used in selection must have a demonstrated relationship to the job. Finally, the article proposes solutions to the dilemma faced by certifying organizations and suggests that, by becoming more aware of the Uniform Guidelines, employers and testing groups have the opportunity to protect themselves before a problem occurs.

Certification↗
PubMed1992

Frequency of recording of diabetes on U.S. death certificates: analysis of the 1986 National Mortality Followback Survey.

We used data from the 1986 National Mortality Followback Survey to estimate the frequency of recording of diabetes on death certificates and to determine factors associated with recording of diabetes among decedents aged 25 years and older who died in the U.S. in 1986. Among 2766 decedents for whom a history of diabetes was provided by a personal informant, diabetes was recorded on an estimated 38.2% of death certificates and was listed as the underlying cause of death on an estimated 9.6%. The frequency of recording of diabetes was strongly related to age and duration of diabetes--among those aged 25-44 years who had had diabetes for 15 or more years, the frequency of recording was 71.9%. When other listed causes of death included conditions that may have been related to diabetes, such as cardiovascular disease, diabetes was recorded between 45 and 70% of the time, depending on the other causes. Diabetes is usually not recorded on death certificates, and the likelihood of recording is related to decedent characteristics, particularly age, duration of diabetes, and co-morbidity.

Adult↗
PubMed1995

Preventable factors and death certification in death due to asthma.

A 2 yr District-wide study was carried out to assess whether there were preventable factors in the management of patients dying from asthma, and also to assess the accuracy of death certification of asthma. Eighteen deaths occurred in which asthma was the certified cause of death. In 10, asthma was the actual cause of death. Due to inaccuracies of death certification, death was due to other causes in seven cases. In the remaining case it was not possible to differentiate between asthma and chronic obstructive airways disease. Among the 10 deaths from asthma the condition was considered to be mild in three. In three, death occurred too rapidly for help to have been available. Preventable factors were present in four cases. In three, either the patient, the doctor or both failed to appreciate the severity of the condition and the need for urgent help or hospitalization. The fourth patient had failed to seek any medical care. Many lives might be saved if patients and doctors treated severe breathlessness due to asthma with the same sense of urgency that chest pain suspicious of myocardial infarction is treated. Education is needed to improve both the clinical and post mortem accuracy of death certification. Both this and the management of asthma should be the subject of ongoing local audits.

Adult↗
PubMed2004

Impact of interventionalist volume, experience, and board certification on coronary angioplasty outcomes in the era of stenting.

It has been suggested that percutaneous coronary intervention (PCI) by high-volume operators may be associated with better outcomes. However, the relation between operator and outcome is confounded by hospital caseloads of PCI, with busier hospitals generally having better outcomes. We assessed the effect of operator characteristics (volume of PCI, years in practice, and board certification status) on contemporary outcomes of PCI in a busy center with high-volume operators. Between 1999 and 2001, 12,293 PCIs were performed at our center by 28 interventionalists. Patients' clinical risk was assessed with the previously validated Beaumont PCI Risk Score. Operators were classified as producing low, medium, or high volume (tertiles of annual PCI volume < or =92, 93 to 140, or >140, respectively), as less, medium, or great experience (tertiles of years in practice < or =8, 9 to 14, or >14 years, respectively), and board certified (68%) or not. In-hospital death rate and a composite end point (death, coronary artery bypass graft surgery, myocardial infarction, or stroke) occurred in 0.99% and 2.59% of patients, respectively. Operator volume, experience, and board certification showed no univariate or multivariate relation with the study end points. The Beaumont PCI Risk Score showed a strong independent relation with in-hospital death rate (adjusted odds ratio 1.37, 95% confidence interval 1.31 to 1.43, p <0.0001) and composite end point (odds ratio 1.19, 95% confidence interval 1.16 to 1.22, p <0.0001). We conclude that, in contemporary PCI practice at a large center with high-volume operators, in-hospital outcomes are not affected by operator volume, experience, or board certification. Rather, patients' clinical risk score is the overriding determinant of clinical outcomes. Our findings emphasize the power of a well-organized high-volume system to minimize the impact of operator factors on outcomes of PCI.

Aged↗
PubMed2006

The validity of the certification of manner of death by Ontario coroners.

PURPOSE: The aim of the study is to examine the validity of manner of death (MOD) certification of unnatural adult deaths by Ontario coroners. METHODS: A census of 306 active coroners practicing in Ontario was performed, with data collection occurring in 2002. Mailed self-administered questionnaires contained 14 fictitious clinicopathologic scenarios and questions regarding demographic information of the coroner. Crude and adjusted odds ratios of correct MOD certification were calculated by using responses of two deputy chief coroners as the gold standard. RESULTS: Nearly 74% of coroners responded to the survey. Deaths from hanging, drowning, and carbon monoxide had better odds of being certified correctly; whereas deaths from heroin, over-the-counter medication, and injuries from a descent had decreased odds of being certified correctly. Scenarios including a prior suicide attempt or a note had greater odds of correct MOD certification than those with only depression. Accidental deaths were underreported when injury resulted in a "natural" lethal complication and when there was a delay between injury and death. CONCLUSIONS: In detailing which deaths are likely to be misclassified and how they may be misclassified, this study will allow future research to more accurately assess suicidal and accidental deaths.

Cause of Death↗
PubMed2005

Trichinae certification in the United States pork industry.

Control of Trichinella infection in U.S. pork has traditionally been accomplished by inspection of individual carcasses at slaughter or by post-slaughter processing to inactivate parasites. We propose that an alternative to individual carcass testing or processing can be used when pigs are raised in production systems where risk of exposure to Trichinella spiralis has been mitigated. Declines in prevalence of this parasite in U.S. domestic swine during the last 30 years, coupled with improvements in pork production systems, now allow Trichinella control to be shifted to the farm through implementation of specific pork production practices. Knowledge of risk factors for exposure of swine to T. spiralis was used to develop an objective audit of risk that can be applied to pork production sites. In a pilot study, 461 production site audits were performed by trained veterinary practitioners. The on-farm audit included aspects of farm management, bio-security, feed and feed storage, rodent control programs and general hygiene. Of the 461 production site audits, 450 audits (97.6%) indicated compliance with the required good production practices. These sites are eligible for certification under the U.S. Trichinae Certification Program and will be audited regularly to maintain that status. The described trichinae certification mechanism will establish a process for ensuring the Trichinella safety of swine, and ultimately food products derived from swine, at the production level.

Animal Husbandry↗
PubMed1997

Use and accuracy of state death certificates for classification of sudden cardiac deaths in high-risk populations.

In a large cohort of patients with known or suspected coronary disease, we evaluated the characteristics of 407 patients who died after hospital discharge and tested whether the state death certificate can be used to classify deaths as sudden cardiac versus nonsudden. Compared with a paramedic classification system based on heart rhythm, the death certificate-based classification resulted in a sensitivity that ranged from 78% to 85% and a specificity that ranged from 25% to 58%. We conclude that the death certificate can be used to identify cases of sudden cardiac death in patients at high risk; however, there is a substantial rate of false-positive sudden death classification.

Aged↗