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Death by mental retardation? The influence of ambiguity on death certificate coding error for adults with
1Department of Sociology and Criminology & Law, University of Florida, Gainesville, Florida, USA.
Background:
Although the coding of mental retardation as underlying cause of death has been recognised by previous researchers as erroneous, factors influencing this inaccuracy have not been sufficiently analysed. This study explores the effects of diagnostic ambiguity on risk of mental retardation being coded as underlying cause of death on US death certificates from 2004.
Methods:
Utilising all US death certificates from 2004 that included a cause of death code for mental retardation, logistic regression analysis provided estimates of the likelihood of having mental retardation erroneously coded as the underlying cause of death. Estimators used to measure ambiguity included the number of multiple causes of death, the place of death, and ICD-10 diagnostic Chapter codes.
Results:
A total of 2278 US death certificates from 2004 included a cause of death code for mental retardation. Of these death certificates, 20% erroneously coded mental retardation as the underlying cause of death. Reflecting the negative impact of diagnostic ambiguity on death certificate coding accuracy, mental retardation was more likely to be coded as underlying cause of death for decedents who: (1) had a death certificate that provided less information on co-morbid disease processes; (2) died in an outpatient or emergency room setting; or (3) had either abnormal symptomatology or death by injury, accident or other external cause.
Conclusions:
Findings from this study, as well as prior research, demonstrate that attempts to understand mortality trends for this population must attend to frequent underlying cause of death coding errors which threaten accuracy of cause of death data. Furthermore, inquiry is warranted into the impetus behind US death certificate coding policy that continues to allow the erroneous coding of 'death by mental retardation'.
Insights
Coding errors for intellectual disability (mental retardation) as a cause of death are common. Diagnostic ambiguity increases the risk of this inaccuracy on US death certificates, impacting mortality data.
Area of Science:
- Public Health
- Epidemiology
- Medical Informatics
Background:
- Previous research identified coding intellectual disability as an underlying cause of death as erroneous.
- Factors contributing to this coding inaccuracy require further analysis.
Purpose of the Study:
- To explore the impact of diagnostic ambiguity on the likelihood of intellectual disability being coded as the underlying cause of death on US death certificates from 2004.
Main Methods:
- Logistic regression analysis of US death certificates from 2004 containing a cause of death code for intellectual disability.
- Analysis of estimators for ambiguity, including multiple causes of death, place of death, and ICD-10 diagnostic chapter codes.
Main Results:
- 20% of death certificates coded intellectual disability as the underlying cause of death.
- Intellectual disability was more likely to be erroneously coded as the underlying cause of death when death certificates provided less information on co-morbidities, when death occurred in outpatient or emergency room settings, or in cases of abnormal symptomatology or external causes of death.
Conclusions:
- Frequent underlying cause of death coding errors for intellectual disability threaten the accuracy of mortality data for this population.
- Further investigation into US death certificate coding policies that permit erroneous coding of 'death by intellectual disability' is warranted.
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