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Comparing hospital discharge records with death certificates: can the differences be explained?
Lars Age Johansson1, R Westerling
1Statistics Sweden, Johan Enbergs v 48A, 6tr, SE-171 61 Solna, Sweden. lars.age.johansson@sos.se
Journal of Epidemiology and Community Health
|March 16, 2002
Summary
Discrepancies between death certificates and hospital records are common. Most differences in causes of death can be explained by International Classification of Diseases (ICD) selection procedures, but some remain unexplained, potentially impacting mortality data quality.
Area of Science:
- Epidemiology
- Public Health
- Medical Informatics
Background:
- Mortality statistics are crucial for epidemiological research.
- Discrepancies exist between death certificates and hospital discharge records.
- Understanding these differences is key to ensuring data accuracy.
Purpose of the Study:
- To investigate if ICD selection procedures explain discrepancies between death certificate causes of death and hospital discharge records.
- To assess the impact of additional hospital data on cause of death selection.
- To discuss implications for mortality data quality.
Main Methods:
- Linked Swedish death certificates (1995) with hospital discharge records for 69,818 individuals hospitalized in their final year.
- Utilized ACME software to analyze the compatibility between underlying cause of death and final main condition.
- Examined the influence of hospital discharge data not present on death certificates.
Main Results:
- A 54% difference was observed between the underlying cause of death and the main condition at the Basic Tabulation List level.
- One-third of these differences were not attributable to ICD selection procedures.
- Inclusion of hospital discharge data altered the underlying cause of death in 11% of cases, notably for medical misadventures and accidental falls.
Conclusions:
- The majority of discrepancies between death certificates and hospital records stem from ICD selection procedures.
- Further research is necessary to determine if unexplained differences signal lower mortality data quality.
- Ensuring accurate cause-of-death assignment is vital for reliable epidemiological studies.
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