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Assessing the Accuracy of Reporting of Hypertension on Death Certificates in Australia
Tim Adair1, Hang Li1, Chalapati Rao2
1Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia.
Insights
Hypertension is underreported on Australian death certificates, even for individuals with severe high blood pressure or a prior diagnosis. This study highlights a significant gap in accurately documenting hypertension mortality.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Health
Background:
- Accurate reporting of hypertension on death certificates is crucial for understanding mortality trends.
- Existing evidence on the accuracy of hypertension reporting on death certificates is insufficient.
- Death certificates are primary sources for cause-of-death data.
Purpose of the Study:
- To assess the accuracy of hypertension reporting on death certificates in Australia.
- To evaluate reporting accuracy based on measured blood pressure levels and prior hypertension diagnoses.
Main Methods:
- Linked blood pressure data from National Health Surveys (2014-2015, 2017-2018) with death registration data (July 2015-December 2021).
- Calculated the percentage of decedents with hypertension reported on death certificates.
- Stratified analysis by blood pressure levels, medication use, and prior diagnosis.
Main Results:
- Hypertension was reported on death certificates for only 20.2% of decedents with very high to severe blood pressure (≥160/100 mm Hg).
- Reporting rates were 14.5% for high blood pressure and 17.8% for those with a prior hypertension diagnosis.
- Even with very high blood pressure and a prior diagnosis, hypertension was reported in only 27.9% of deaths.
Conclusions:
- Hypertension mortality is underreported in Australia, affecting a minority of deaths even in severe cases.
- A significant gap exists between measured/diagnosed hypertension and its reporting on death certificates.
- Improved death certificate accuracy is needed to reflect the true burden of hypertension mortality.
Background:
There is insufficient evidence of how accurately hypertension is reported on death certificates, which are the primary evidence of causes of death. This study assesses the accuracy of reporting of hypertension on death certificates of decedents in Australia who previously had their blood pressure measured.
Methods:
Blood pressure data from the 2014-2015 and 2017-2018 National Health Surveys were linked to death registration data from July 2015 to December 2021 (average 3.3 years from survey to death). The percentage of decedents with hypertension reported on the death certificate was calculated according to blood pressure level and previous diagnosis of hypertension.
Results:
Hypertension was reported on the death certificate of 20.2% (95% confidence interval 12.1%-28.3%) of decedents who had very high to severe blood pressure (160/100 mm Hg and above), 14.5% (10.3%-18.8%) who had high blood pressure (140 to <160 / 90 to <100 mm Hg), 14.1% (10.8%-17.4%) who had normal to high blood pressure (<140/90 mm Hg) and who took hypertension medication, and 17.8% (13.6%-22.0%) who had been diagnosed with hypertension. Where the decedent had very high to severe blood pressure, hypertension was reported for 27.9% (14.1%-41.8%) of deaths if they had been diagnosed with hypertension, and 21.7% (9.6%-33.7%) where another cardiovascular disease was reported on the death certificate.
Conclusions:
Hypertension mortality in Australia is only reported for a minority of deaths of people with high or very high to severe blood pressure; this is also found for those with a prior diagnosis of hypertension.
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