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United States mortality from ill-defined causes, 1968-1988: potential effects on heart disease mortality trends
D L Armstrong1, S B Wing, H A Tyroler
1Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill 27599-7400, USA.
Insights
Ill-defined deaths, often due to coronary heart disease (CHD), masked racial disparities. Declining ill-defined mortality in African Americans improved CHD trend accuracy, impacting public health evaluations.
Area of Science:
- Public Health
- Epidemiology
- Mortality Statistics
Background:
- Deaths coded as 'Symptoms, Signs, and ill-defined Conditions' lack specific cause information.
- Coronary heart disease (CHD) is a leading cause of death, often implicated in ill-defined death classifications.
Purpose of the Study:
- To analyze the impact of ill-defined deaths on coronary heart disease (CHD) mortality disparities between African Americans and whites.
- To assess how temporal changes in ill-defined mortality affect CHD trend analyses and public health intervention evaluations.
Main Methods:
- Utilized vital statistics and census data (1968-1988) for US adults aged 35-74.
- Calculated age-adjusted rates for ill-defined deaths, unrevised CHD deaths, and revised CHD deaths (including ill-defined).
- Conducted trend analyses for ill-defined and CHD mortality.
Main Results:
- African American/white ratios for ill-defined mortality decreased significantly from 1968 to 1988.
- Revised CHD rates revealed greater excess mortality among African Americans compared to unrevised rates.
- Declines in revised CHD mortality steepened for men and decelerated for women after 1978.
Conclusions:
- Ill-defined mortality significantly underestimated racial disparities in CHD mortality.
- Changes in ill-defined death coding may have influenced observed CHD mortality trends, impacting public health assessments.
Background:
Deaths are coded to the International Classification of Diseases (ICD) category, 'Symptoms, Signs, and ill-defined Conditions' when there is insufficient information for cause of death determination. Due to difficulties of diagnosis of coronary heart disease (CHD) death and since CHD is the leading cause of death among US adults, CHD is the most likely cause of ill-defined deaths.
Methods:
Vital statistics and census data were used to create annual age-adjusted ill-defined rates, unrevised CHD rates, and CHD rates revised to include ill-defined deaths for US African Americans and whites, ages 35-74 years, during 1968-1988. Ill-defined and CHD mortality trend analyses were conducted.
Results:
In 1968, African American/white ratios of ill-defined mortality were 5 among men and 7 among women; following steep declines in ill-defined mortality among African Americans, ratios were 3 among men and 2 among women in 1988. In 1968, approximately 3% and 1% of all deaths among African Americans and whites, respectively, were certified to ill-defined causes; in 1988, approximately 1.5% of deaths among African Americans were coded ill-defined, with no change among whites. Revised CHD rates showed substantially higher excess CHD mortality among African Americans than whites compared to unrevised CHD rates. Declines in revised CHD mortality steepened throughout the study period among men, and among women began to decelerate after 1978.
Conclusions:
Ill-defined mortality was of sufficient magnitude to potentially contribute to substantial underestimation of racial disparities in CHD mortality. Also, temporal changes in ill-defined mortality may have affected CHD trends which are used to evaluate the efficacy of public health interventions.