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Sensitivity and specificity of death certificate diagnoses for dementing illnesses, 1988-1990
C A Macera1, R K Sun, K K Yeager
1Department of Epidemiology & Biostatistics, School of Public Health, University of South Carolina, Columbia 29208.
Objective:
To evaluate the extent to which mortality data, which is often used to track secular trends for specific diseases, underestimates the prevalence of dementia.
Design:
Retrospective analysis of existing data.
Setting:
Department of Mental Health inpatient facilities in South Carolina.
Subjects:
Inpatients at Department of Mental Health facilities who were listed in the South Carolina Statewide Alzheimer's Disease and Related Disorders Registry and who died between 1988 and 1990 (n = 450).
Main Outcome Measures:
Sensitivity and specificity of dementia diagnoses on death certificates compared to medical record diagnoses for inpatients with a pre-mortem dementia diagnosis.
Results:
Twenty-three percent of death certificates contained any dementia diagnosis (104/450). The sensitivity of death certificates varied by type of dementia (28 percent for Alzheimer's disease; 8 percent for multi-infarct dementia) as well as by race, sex, and age.
Conclusions:
Mortality statistics substantially underestimate the prevalence of dementing illnesses and do not fully represent the public health burden of dementia.