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[Validity of death certificates in the study of ischemic heart diseases]
M C Nuttens1, J L Salomez, B Tillard
1Pasteur de Lille, MONICA Lille, Institut Pasteur.
Insights
Death certificates accurately reflect ischaemic heart disease mortality. A study found death certificates to be a valid tool for tracking heart disease deaths, despite some limitations.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Context:
- International variations in ischaemic heart disease (IHD) mortality rates are significant.
- Accurate mortality data is crucial for public health initiatives and research.
- The WHO MONICA project investigates the causes of heart disease mortality.
Purpose:
- To assess the validity of death certificates for diagnosing ischaemic heart disease.
- To compare death certificate diagnoses with data from a complementary enquiry.
- To evaluate the reliability of ischaemic heart disease mortality statistics.
Summary:
- A study in Lille compared death certificates with a complementary enquiry for 330 patients (aged 25-64) who died from possible ischaemic heart disease.
- Death certificates demonstrated a sensitivity of 77.9% and specificity of 95.9% for ischaemic heart disease diagnosis.
- Concordance was unaffected by demographic or situational factors, though complementary studies were sometimes impossible due to physician unfamiliarity with the patient.
Impact:
- Confirms the validity of death certificates for epidemiological studies on ischaemic heart disease mortality.
- Highlights the importance of accurate death certification for public health surveillance.
- Provides evidence supporting the use of existing mortality data for IHD research.
Abstract:
Mortality rates for ischaemic heart disease, as estimated from death certificates, show highly significant differences between countries. In order to study the validity of mortality rates for ischaemic heart disease, the authors, involved in the MONICA project, have compared the results obtained from the conventional death certificate code with the data collected in a complementary enquiry conducted for all deaths possibly due to ischaemic heart disease. Three hundred and thirty patients, aged from 25 to 64 years, belonging to the urban community of Lille, and who died between October 1 and December 31, 1984, were included in this study. The sensitivity of the death certificate for the diagnosis of ischaemic heart disease was 77.9 percent and its specificity was 95.9 percent. The concordance rate between death certificate and complementary enquiry was not modified by age, sex, socio-professional category, family situation, place of death and doctor who signed the certificate. The complementary study proved impossible in 31.8 percent of the cases, usually because the doctor who signed the death certificate was not fully conversant with the patient's condition. Our results therefore confirm that death certificates are valid to study mortality from ischaemic heart disease.