Cause-of-death query in validation of death certification by expert panel; effects on mortality statistics in Finland, 1995

Lahti, R.A; Penttilä, Antti

doi:10.1016/s0379-0738(02)00418-8

Cited by 56 publications

(44 citation statements)

References 8 publications

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“…A recent meta-analysis (36) of the discrepancy between clinical and autopsy diagnoses estimated that 30% of the diagnoses listed on the death certificates are incorrect. Furthermore, in Denmark the causes of death are not regularly validated (29), as opposed to, for example, Finland where a validation report estimated that of 7% questionable death certificates, half were reassigned to a different ICD code (37). Thus, the correctness of the causes of death is crucial for mortality statistics and health surveillance but also for research purposes.…”

Section: Discussionmentioning

confidence: 99%

Total and Cause-Specific Mortality by Elevated Transferrin Saturation and Hemochromatosis Genotype in Individuals With Diabetes: Two General Population Studies

et al. 2014

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OBJECTIVEMortality is increased in patients with hereditary hemochromatosis, in individuals from the general population with increased transferrin saturation (TS), and also in patients with type 1 diabetes and increased TS from a highly specialized diabetes clinic. Thus, we have recommended targeted screening for TS in specialized diabetes clinics. Whether mortality is also increased in individuals from the general population with diabetes and increased TS is unknown. RESEARCH DESIGN AND METHODSIn two Danish population studies (N = 84,865), we examined mortality according to baseline levels of TS and hemochromatosis genotype (HFE) G → A substitution at nucleotide 845 in codon 282 (C282Y/C282Y) in individuals with diabetes (type 1, N = 118; type 2, N = 3,228; total, N = 3,346). RESULTSThe cumulative survival rate was reduced in individuals with diabetes with TS ‡50% vs. <50% (log-rank; P < 0.0001), with median survival ages of 66 and 79 years, respectively. The hazard ratio (HR) for TS ‡50% vs. <50% was 2.0 (95% CI 1.3-2.8; P = 0.0004) for total mortality overall (and similar for men and women separately); 2.6 (1.3-5.4; P = 0.008) for neoplasms; and 3.4 (2.0-6.0; P = 0.00002) for endocrinological causes. A stepwise increased risk of total mortality was observed for stepwise increasing TS (log-rank test, P = 0.0001), with an HR for TS ‡70% vs. TS <20% of 4.8 (2.0-12; P = 0.0006). The HR for total mortality in individuals with diabetes for C282Y/C282Y versus wild type/wild type was 3.3 (1.04-10; P = 0.04), and for C282Y/C282Y and TS ‡50% versus wild type/wild type and TS <50% was 6.0 (1.5-24; P = 0.01). Six percent of these premature deaths can possibly be avoided by early screening for TS or HFE genotype. CONCLUSIONSIndividuals with diabetes, ascertained in the general population, with increased TS or HFE genotype have a twofold to sixfold increased risk of premature death.

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Section: Discussionmentioning

confidence: 99%

Total and Cause-Specific Mortality by Elevated Transferrin Saturation and Hemochromatosis Genotype in Individuals With Diabetes: Two General Population Studies

et al. 2014

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“…Only a minor proportion of death certificates (1-2%) requires such measures in Finland. 12 For the present analysis, 4 intervention-related, 1 probable and 2 possible prostate cancer deaths according to the review board were combined with 120 cases definitely attributed to prostate cancer. Four pending cases were excluded from the analyses.…”

Section: Methodsmentioning

confidence: 99%

Assessment of causes of death in a prostate cancer screening trial

Mäkinen

Karhunen

Aro

et al. 2007

Intl Journal of Cancer

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Accurate assessment of the causes of death is crucial for a conclusive evaluation of the ongoing prostate cancer screening trials. Here, we report the validity of the official causes of death as compared with an independent expert review in the Finnish prostate cancer screening trial. Because nearly 80,000 men were involved, death-cause evaluation was restricted to men diagnosed for prostate cancer. Medical charts were retrieved and the cause of death was assigned by an expert review panel for all deaths among men with prostate cancer during the study period, 1996-2003. The panel decision was compared with both death certificates and the official causes of death as assigned by Statistics Finland. Of a total of 315 deaths, the review panel attributed 127 (41%) to prostate cancer and 184 (59%) to other causes, the corresponding figures in death certificates being 124 (40%) and 187 (60%). Four cases were excluded because of insufficient information. The death-certificate data were in agreement with the panel's assessment in 305 out of 311 cases (overall agreement 97.7%, j 5 0.95). The overall agreement between the official causes of death and the panel's decision was 97.4% (304/311, j 5 0.95). The sensitivity of the certificates in identifying prostate cancer deaths was 96.1% (panel as golden standard). Correspondingly, specificity was 98.9%. The official causes of death thus provide an accurate means for evaluating disease-specific mortality in a large population-based prostatecancer screening trial in Finland. ' 2007 Wiley-Liss, Inc.Key words: prostate cancer; prostate-specific antigen; mass screening; cause of death; mortality; randomized trials Prostate cancer mortality is declining in some parts of the world, e.g., in the United States.1 Widespread debate has prevailed as to the extent to which the decrease may be a consequence of prostate-specific antigen (PSA)-based screening. The only valid means of settling the issue is through large randomized screening trials. Such trials are currently under way in both the United States (Prostate, Lung, Colorectal and Ovary screening trial, PLCO) and Europe (European Randomized Study of Prostate Cancer Screening, ERSPC), and the first mortality results are expected within a few years.2 Nevertheless the value of these ongoing trials has been questioned by suggesting that it would be almost impossible to demonstrate (or rule out) the value of PSA screening on account of possible misdiagnosis of the cause of death in elderly men with multiple comorbidities.3 Accurate assessment of the underlying cause of death is thus crucial for a conclusive evaluation of the possible benefits of prostate cancer screening. For several chronic conditions, a panel of experts has been regarded as the preferred strategy to establish cause-specific mortality for research purposes. [4][5][6] However, the use of death certificates has also been advocated to avoid labor-intensive and costly death reviews in large epidemiological studies. 7The Finnish prostate cancer screening trial is a part of ...

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“…Five empirical studies have assessed the effects of the query program, three of which covered all causes of death (Hopkins et al, 1989;Lahti et al, 2003;Hoyert et al, 2005) . Of 1033 death certificates queried Finland in 2005, 53 (5.1%) asked for specification of the nature (malignant or benign) of the neoplasm and 54 (5.1%) asked for specification of the primary site of a malignant neoplasm (Lahti et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

“…When a malignant neoplasm is stated to be the underlying cause of death, it is important to determine the primary site." Several studies have examined the possible effects of querying on cause-specific mortality (Hopkins et al, 1989;Swerdlow, 1994;Hanzkuck, 1996;Lahti et al, 2003;Hoyert et al, 2005); however, only one study assessed the possible effects of querying on site-specific cancer mortality rates (Swerdlow, 1994). One limitation of this study was that no uniform systematic program was implemented for querying.…”

Section: Introductionmentioning

confidence: 99%

Possible Effect of Implementing a National Query Program on Site-Specific Cancer Mortality Rates in Taiwan

Lin

Cheng

Peng³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 15 (2), 793-796 IntroductionExamining site-specific cancer mortality across years or regions could help to generate epidemiological hypotheses or to evaluate cancer prevention programs. Given that site-specific cancer mortality is derived from information reported on the death certificate, if medical certifiers report poor-quality cancer-related cause-of-death statements, the validity of site-specific cancer mortality rates is threatened. For example, if a medical certifier reported only "tumor of the lung" on the death certificate, the coder would classify this case as ICD-10 code D38.1 "neoplasm of uncertain or unknown behavior of the lung" instead of ICD-10 code C34 "malignant neoplasm of the lung". In other words, if a country or region has more death certificates reporting "neoplasm of uncertain nature" by medical certifiers, the quality of site-specific cancer mortality data is less assured.One remedy to solve the above-mentioned problem is to query medical certifiers for more detailed information for coding purposes (National Center for Health Statistics, 2009). Because the availability of staff and resources used for querying varies across regions, the National Center for Of the 2,571 responses, in 1,398 cases (54%) medical certifiers were still unable to determine the nature of the neoplasm. There were four neoplasm sites for which more than 50% of the responses changed the category to malignant, the gastrointestinal system (73%), urinary system (60%), stomach (55%) and rectum (53%). The liver was the cancer site that showed the largest absolute increase in the number of deaths after the query; however, the brain showed the largest relative increase, at 12%. Conclusions: Different neoplasm sites showed different magnitudes of change in nature after the query. Brain cancer mortality rates exhibited the largest increase.

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Cause-of-death query in validation of death certification by expert panel; effects on mortality statistics in Finland, 1995

Cited by 56 publications

References 8 publications

Total and Cause-Specific Mortality by Elevated Transferrin Saturation and Hemochromatosis Genotype in Individuals With Diabetes: Two General Population Studies

Total and Cause-Specific Mortality by Elevated Transferrin Saturation and Hemochromatosis Genotype in Individuals With Diabetes: Two General Population Studies

Assessment of causes of death in a prostate cancer screening trial

Possible Effect of Implementing a National Query Program on Site-Specific Cancer Mortality Rates in Taiwan

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