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Could the coronary heart disease mortality rates decline be artefactual?
1Family Medicine Department, Université de Montréal, Québec.
Insights
Coronary Heart Disease (CHD) mortality decline is likely real, not due to classification errors. Analysis suggests changes in coding practices did not significantly impact CHD death rate trends.
Area of Science:
- Cardiovascular epidemiology
- Public health statistics
- Medical classification systems
Background:
- Coronary Heart Disease (CHD) mortality rates have recently declined.
- This decline is often attributed to risk factor reduction and improved medical management.
- The potential influence of classification artifacts on these trends warrants investigation.
Purpose of the Study:
- To evaluate whether changes in disease classification or death certification practices could explain the observed decline in Coronary Heart Disease (CHD) mortality rates.
- To assess the impact of potential confounding factors on secular trends in CHD mortality.
Main Methods:
- Review of knowledge and information regarding disease classification, competing causes of death, and death certification accuracy.
- Analysis of potential effects of an aging population with multiple comorbidities.
- Examination of death certificate coding practices and their influence on mortality statistics.
Main Results:
- Factors such as death certification accuracy, completeness, and coding practices were considered as potential influences on CHD mortality trends.
- The aging population with multiple conditions was also assessed for its impact.
- No significant shifts within the cardiovascular disease category or to other categories were observed, making an artefactual explanation unlikely.
Conclusions:
- The observed decline in Coronary Heart Disease (CHD) mortality is unlikely to be an artifact of classification or coding changes.
- Improvements in risk factor management and medical care are the most probable drivers of the mortality reduction.
Abstract:
The recent decline in Coronary Heart Disease (CHD) mortality rates has been attributed to reduction in risk factors and to improved management. In this article, we review whether artefacts of classification could have played a role as well. Knowledge and information on disease, competing causes of death, death certification accuracy and completeness, advancing age of the population with multiple conditions as well as death certificate coding practice could have affected secular trends of CHD mortality rates. However, the lack of noticeable shifts within the cardiovascular category or with another category makes it difficult for the CHD decline to be artefactual.