No abstract

This paper describes a multistage process to improve the completeness and time-/cost-effectiveness of ascertaining deaths in large employee cohorts. The process uses the vital status data service of the Social Security Administration (SSA) to identify people who can be confirmed as living, in order to reduce the number of records submitted for a National Death Index (NDI) search. The accuracy of SSA results is verified by submitting a sample of known-living and known-deceased people. For the NDI search results, an algorithm based on a discrete combination of matching variables is applied to distinguish NDI records as true, false, or questionable matches to reduce the number of death certificate requests to state offices. Subsequent decision making is based on manual reviews at various stages. In a cohort of over 200,000 employees, an SSA vital status search reduced the size of the NDI death record search by 85%. The algorithm sorted thousands of NDI records into 15 distinct strata and reduced the number of death certificate requests by 76%. The authors believe that the matching process is enhanced by obtaining paper copies of death certificates from the states, because death certificates often provide additional information and aid in determining true matches to company employees.

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Limiting ascertainment to pleura and peritoneum ICD codes underestimates mesothelioma deaths. Reviewing all ICD codes that could contain mesothelioma is the only effective method for complete capture of mesothelioma diagnoses.

This comprehensive study indicates an overall favorable mortality profile for this workforce. For a few elevations, the study helps guide decisions about future surveillance, focused studies, and other follow-up actions.