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Competing causes of death: a death certificate study
J P Mackenbach1, A E Kunst, H Lautenbach
1Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
Journal of Clinical Epidemiology
|November 22, 1997
Summary
Competing causes of death are common, especially with respiratory diseases. Eliminating cancer may lead to less biased life expectancy gains than eliminating cardiovascular or respiratory diseases.
Area of Science:
- Epidemiology
- Public Health
- Gerontology
Background:
- Empirical data on the interrelationships between causes of death is limited.
- Competing causes of death are of significant interest in mortality research.
- This study estimates the prevalence of competing causes of death at the time of death from specific underlying causes.
Purpose of the Study:
- To estimate the prevalence of competing causes of death.
- To analyze the relationship between underlying causes of death and the presence of competing causes.
- To assess the impact of competing causes on life expectancy estimations.
Main Methods:
- Utilized death certificate data from a stratified sample of 5975 deaths in the Netherlands (1990).
- Identified diseases that could become a new underlying cause if the initial cause were eliminated.
- Employed Poisson regression analysis for age- and sex-adjusted prevalence variations.
Main Results:
- An average of 46.2 competing causes were identified per 100 deaths.
- Frequent competing causes included senile dementia, diabetes mellitus, and ischemic heart disease.
- Prevalence was higher for respiratory disease deaths (RR=1.42) and lower for neoplasms (RR=0.54).
Conclusions:
- The prevalence of competing causes varies significantly by underlying cause of death.
- Underestimation of coexisting diseases on death certificates is a potential limitation.
- Life expectancy gains estimated after eliminating neoplasms are less biased by competing causes than those for cardiovascular or respiratory diseases.
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