Survey of cause-of-death query criteria used by state vital statistics programs in the US and the efficacy of the criteria used by the Oregon Vital Statistics Program.

A survey of the 52 vital statistics registration areas in the United States revealed that at least 23 did not fulfill the minimum cause-of-death query guidelines recommended by the National Center for Health Statistics. The Oregon Center for Health Statistics is one of only a few that query certifying physicians at a comprehensive level. During August 1986-July 1987, a total of 2,453 of 23,238 death certificates were returned to the certifiers for additional information, not including those returned in a tobacco use study. More than one-half (56.1 per cent) resulted in new and more specific underlying cause-of-death data. Only 5.2 per cent of the queries were unanswered. One probable result of Oregon's program is that the state has the highest percentage of liver cirrhosis and disease deaths attributed to alcohol abuse in the United States. Nationally, 41.7 per cent of all liver disease and cirrhosis deaths in 1984 were listed as due to alcohol compared to 82.4 per cent in Oregon. The state's total liver cirrhosis and disease death rate (12.0 per 100,000 population) is only marginally higher than the United States rate (11.6). The query program also serves to locate maternal deaths that would otherwise not be reported, as well as to provide more accurate cause-of-death statistics in general.

The accuracy of industry data from death certificates for workplace homicide victims.

This study compared death certificate data on usual industry for workplace homicide victims in five urban Texas counties, with medical examiners' data on the industries where victims were working when injured. The overall positive predictive value of the death certificate data was 72 per cent. Death certificate data on usual industry underestimated the number of victims working in high-risk industries when injured, partly because of victims whose usual industry was recorded as student, housewife, or military personnel.

Incorrect death certification. An invitation to obfuscation.

The physician responsible for signing a death certificate has an obligation to complete the medical part of the form, which includes entering the cause of death. In a review of 384 death certificates signed by house staff and attending physicians at a university hospital over a one-year period, 59% contained errors in cause-of-death entries. The most common error was listing mechanisms rather than causes of death. Since death certificates are used in calculating basic mortality statistics, such a large percentage of error can lead to considerable statistical misinformation.

Reliability and validity of the classification of death in general practice.

The general practitioner in the Netherlands is solely responsible for assigning the natural causes of a patient's death when it occurs at home and for entering it on the certificate of death B, which is then forwarded to the CSO (Central Statistics Office). The CSO however, records the cause of death in the appropriate category of the ICD-9 of the WHO. The value of these data, therefore, depends upon the agreement between the general practitioner's cause of death and the CSO categories of causes of death. To assess the degree to which the CSO classification reflects the general practitioner's cause of death, form B from eight general practitioners practicing in Hoorn were compared with the classification of the CSO during a period of five years, 1979-83. There was a 65% (237/365) agreement between the classifications. Of the remaining 128 cases 68% (87/128) of the classification differences were caused by a wrongly described cause of death on the B certificate. In 32% (41/128) the classification rules of WHO made it hardly possible for the general practitioner to classify uncertain causes of death. The conclusions of this survey are that the quality of the statistics on causes of death will improve if the general practitioners are more careful with filling in the certificate of death B; the classification rules of the ICD-9 makes it possible to classify unknown causes of death; and if the certificate of death B becomes more 'user friendly'.

The black/white mortality crossover: investigation in a community-based study.

The black/white mortality crossover at about age 75, a result of lower white mortality rates at younger ages and lower black rates at the oldest ages, has been observed in U.S. vital statistics since 1900. Though a persistant observation in such data, its validity has been challenged by questions about census enumeration and age reporting on death certificates. Analyses of 20 years experience of all-cause mortality in the community-based Evans County Study using a Weibull model of age specific mortality rates showed a statistically significant black/white mortality crossover for both men (at age 73) and women (at age 85). The finding of a crossover in this longitudinally followed population is significant because the age reporting for both survivors and age at death for nonsurvivors were obtained in the study protocol and did not rely on age reporting either in census data or on the death certificate. Differences in the age and sex patterns of mortality between two populations living in the same geographic region are relevant to questions about the etiology of the major age-related chronic diseases as well as to topics of current interest in health care policy.

Qualidade das informaçöes sobre mortalidade no Municipio de Manaus, Estado do Amazonas

Estudando-se os óbitos fetais e neonatais precoces ocorridos no município de Manaus, no período de janeiro a junho de 1982, detectou-se 7 possíveis fontes de dados sobre mortalidade, das quais 6 puderam ser usadas para estudo da qualidade das informaçöes a respeito do ítem "óbito fetal" (sim e näo) da declaraçäo de óbito. O estudo permitiu observar o frequente desrespeito às normas legais sobre o registro de óbitos, além de outros fatores que interferem na qualidade das informaçöes coletadas. Quanto à informaçäo a respeito de ser ou näo óbito fetal, foi possível evidenciar que as inconsistências existentes entre as várias fontes dificultam a exata quantificaçäo da referida mortalidade. Assim sendo, as informaçöes contidas nas segundas vias das declaraçöes, näo coincidem com as das primeiras vias alteradas pelos codificadores do Núcleo de Bioestatística da Secretaria de Saúde, nem com as anotaçöes feitas em livros de ocorrências e prontuários de hospitais e maternidades, livros de registros de cartórios, livros de registro do Serviço de Controle de Febre Amarela (SUCAM) e planilhas contendo os dados transmitidos à Divisäo Nacional de Epidemiologia do Ministério da Saúde