Accuracy of Certification of Deaths Due to Asthma

Abstract

In a two-year study of asthma mortality in New Zealand conducted between August 1981 and July 1983, the certified cause of death and its subsequent statistical coding was compared with the opinion of a panel of respiratory physicians who had made detailed enquiry into the medical history and circumstances surrounding the death of each patient. When the panel's opinion was taken as the reference standard, the national health statistics overestimated asthma mortality for all age groups by 26.0%. For patients aged 15-64 years, the net overestimate was 12.9%, no greater than that found in a similar study in this age group in the United Kingdom. Failure of certifying doctors and coroners to follow appropriate procedures for identification of the primary condition leading to death, or misdiagnosis of other lung disease as asthma, accounted for most inaccuracies in certification. In patients under age 35 years, certification and statistical coding of asthma death was considered accurate in 97.8% of all cases, but accuracy declined with increasing age. The high New Zealand asthma mortality rate, especially in young people, could not be explained by inaccuracies in death certification or statistical coding.

Asthma mortality in Danish children and young adults, 1973-1994: epidemiology and validity of death certificates

“…This corresponds with previous descriptions in comparable studies [5,8,9,17]. Unexpectedly, the authors identified 3% false negative asthma deaths wrongly coded to another cause, and 9% false negative asthma deaths coded under adjacent respiratory codes.…”

“…The authors were surprised when the current data were compared with other published investigations into the same age group [5,9]. There was no indication of an overestimation of asthma death in the present study.…”

“…The clinical criteria for diagnosing asthma may have changed with time. It is generally accepted that for patients aged <35 yrs the accuracy of the asthma diagnosis on death certificates is clear [8,9]. However, even in this age group and especially among children, the extent of false negative certification of asthma as underlying cause of death (i.e., asthma deaths wrongly certified as due to other causes) is less well studied [10±12].…”

Mortalidade relacionada à asma, Brasil, 2000: um estudo usando causas múltiplas de morte

“…As DOs com menção de asma não apresentam dificuldades para a transformação das causas de morte em códigos da CID-10. Verifica-se que o trabalho do codificador é acurado e não se constitui em fonte de erro que comprometa a qualidade das estatísticas de mortalidade 25,26,27,28 . A tarefa subseqüente da identificação da causa básica de morte por meio da aplicação das regras sobre mortalidade da OMS 7 é realizada automaticamente e de modo uniforme, fato que elimina a decisão subjetiva da seleção manual e acompanha padrões internacionais 20,21,28 .…”

“…A tarefa subseqüente da identificação da causa básica de morte por meio da aplicação das regras sobre mortalidade da OMS 7 é realizada automaticamente e de modo uniforme, fato que elimina a decisão subjetiva da seleção manual e acompanha padrões internacionais 20,21,28 . Conclui-se que o problema maior ocorre na etapa anterior, qual seja, a do preenchimento da DO pelos médicos 26,27 . Nessa etapa se concentra o maior número de estudos.…”