Death certificates in asthma and COPD patients (survey of statistical data in Warsaw).

UNLABELLED

Mortality statistics regarding asthma and COPD (in the older age groups) are probably lower due to the misplacement of underlying and additional causes of death in the death certificates. To check this possibility, all death certificates over one year were reviewed(20.881) in Warsaw. In 1,431 cases (6.85%) the medical diagnoses were missing. Asthma, COPD and Pulmonary Heart Disease (PHD) (excluding any other cause of PHD) were mentioned at some point in 315 cases (on one of the three items cards). 212 deaths occurred in hospital, 103 at home (22 were regarded as sudden deaths). After reviewing records from 16 hospitals and patients' local clinics, the existence of long-standing asthma and/or COPD was confirmed in all cases. Considering all the three items (underlying, secondary, direct causes) in the death certificates the mortality rates (for 100,000 all-age inhabitants) were established for asthma--4.51 for COPD--10.54, for PHD--3.23 (different from official statistics).

PRINCIPAL CONCLUSIONS

The main sources of underestimation in mortality from asthma and/or COPD (in official statistics) are: 1) disregarding the "additional" and "immediate" causes of death, 2) regarding PHD as an underlying cause of death, 3) the lack of medical diagnoses in great number of death certificates.