Related Experiment Videos
Multiple-cause coding of death from myocardial infarction: population-based study of trends in death certificate data
Michael J Goldacre1, Stephen E Roberts, Myfanwy Griffith
1Unit of Health-Care Epidemiology, Department of Public Health, Institute of Health Science, University of Oxford, Old Road, Oxford OX3 7LF. michael.goldacre@dphpc.ox.ac.uk
Insights
Multiple-cause coding of deaths for myocardial infarction is a robust measure. The underlying cause of death accurately reflects mortality rates, even with coding rule changes.
Area of Science:
- Cardiovascular epidemiology
- Public health surveillance
- Mortality statistics
Background:
- Limited data exist on long-term mortality trends using multiple-cause coding.
- The contribution of multiple-cause coding to interpreting myocardial infarction mortality rates is unclear.
Purpose of the Study:
- To evaluate the utility of multiple-cause coding for myocardial infarction mortality.
- To assess the robustness of underlying cause coding for myocardial infarction.
Main Methods:
- Analysis of all causes of death from death certificates.
- Study period: 1979-1998 in the former Oxford health service region.
- Examination of the ratio of 'mentions' to 'underlying cause' for myocardial infarction.
Main Results:
- Myocardial infarction was the underlying cause in 93.6% of relevant death certificates.
- The ratio of mentions to underlying cause remained consistent over time, despite falling mortality rates.
- Coding rule changes had minimal impact on this ratio, which was similar across genders and age groups.
Conclusions:
- Underlying cause of death coding is a reliable and comprehensive indicator for myocardial infarction.
- Multiple-cause coding provides a robust measure for tracking myocardial infarction mortality trends.
Background:
Data on long-term trends in mortality are generally unavailable for multiple-cause coding of deaths. We wanted to know whether multiple-cause coding of deaths for myocardial infarction contributes much to the interpretation of death certificate data on mortality rates for this condition.
Methods:
We analysed all causes of death on death certificates in the former Oxford health service region from 1979 to 1998.
Results:
Of 69,333 death certificates that included myocardial infarction as a cause of death, it was the underlying cause of death in 93.6 per cent. The ratio of 'mentions' to 'underlying cause' was broadly similar over the study period, during which time there were substantial falls in mortality rates. There were significant changes to the ratios, associated with timing of changes to coding rules; but their effects were small. The ratio of mentions to underlying cause was similar in men and women and in different age groups.
Conclusion:
The underlying cause of death was a robust and almost complete measure of certified deaths for myocardial infarction.