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Nosological coding of cause of death
Insights
Nosologists showed high agreement in coding causes of death from death certificates for the Hypertension Detection and Follow-up Program. Agreement improved with broader disease categories, aiding accurate mortality data analysis.
Area of Science:
- Medical Informatics
- Public Health Surveillance
- Epidemiology
Background:
- Accurate coding of underlying cause of death is crucial for epidemiological studies and public health surveillance.
- The Hypertension Detection and Follow-up Program (HDP) collected vital data from 1973-1979, requiring reliable mortality data analysis.
Purpose of the Study:
- To assess interobserver and intraobserver variability in coding underlying cause of death using International Classification of Diseases, Adapted (ICDA) codes.
- To evaluate the reliability of cause-of-death coding for participants of the Hypertension Detection and Follow-up Program.
Main Methods:
- Three nosologists independently coded underlying causes of death from 766 death certificates of HDP participants.
- Interobserver agreement was assessed for all three nosologists and pairwise.
- Intraobserver agreement was assessed on a 20% recoded sample of death certificates.
Main Results:
- High agreement was observed: 90.2% for three-digit ICDA code agreement among all three nosologists and 99.7% for at least two out of three.
- Agreement rates improved when ICDA codes were grouped into broader categories relevant to the HDP.
- Specific disease classifications showed varying agreement: neoplasms had the highest agreement (97.8%), while myocardial infarction had the lowest (86.5%).
- Intraobserver agreement rates for three-digit ICDA codes ranged from 94.8% to 96.1%.
Conclusions:
- Nosologists demonstrated substantial agreement in coding causes of death, supporting the reliability of mortality data from the HDP.
- Utilizing broader disease categories enhances coding consistency, which is vital for large-scale epidemiological research.
- The findings validate the use of ICDA coding for analyzing mortality patterns in hypertension studies.
Abstract:
Death certificates representing 766 decedents who had participated in the Hypertension Detection and Follow-up Program (1973-1979) at one of 14 US centers were given to three nosologists for purposes of coding underlying cause of death. Analyses examined interobserver variability among the three nosologists as well as intraobserver variability for each of the three nosologists. All three nosologists agreed on a three-digit International Classification of Diseases, Adapted (ICDA) code in 90.2% of the cases and at least two out of three agreed in 99.7% of the death certificates examined. Agreement rates improved when disease codes were collapsed into broader categories utilized in the Hypertension Detection and Follow-up Program. When particular disease classifications (e.g., cerebrovascular, ischemic heart disease, myocardial infarction, and neoplasms) were examined, three out of three agreement rates were highest for neoplasms (97.8%) and lowest for myocardial infarction (86.5%). Similarly, two out of three agreement was highest for neoplasms (98.5%) and lowest for myocardial infarction (88.0%). Intranosologist agreement rates were based on a recoded 20% sample of death certificates. Agreement rates for three-digit ICDA codes ranged from 94.8% to 96.1% for the three nosologists. The agreement rates for the general disease categories ranged from 96.7% to 97.4%.