Burnand B, Feinstein A R
Department of Medicine, Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, CT 06510.
J Clin Epidemiol. 1992 Sep;45(9):929-40. doi: 10.1016/0895-4356(92)90109-z.
The ante-mortem (in vivo) and post-mortem diagnoses of coronary heart disease (CHD) were compared in necropsies at a university hospital for 1965, 1975, and 1985. The secular trends showed gradually rising proportions in both true positive and false negative ante-mortem diagnoses. Both types of change in diagnostic error would progressively lower the counted numbers of CHD in official vital statistics. With suitable statistical corrections, the occurrence rates of CHD in Connecticut became much higher and showed less dramatic trends in secular decline. The results indicate that major improvements in accuracy are needed before vital statistics data are accepted at face value and analyzed for biologic explanations of the changing numbers.
对一所大学医院1965年、1975年和1985年尸检中的冠心病生前（活体）诊断和死后诊断进行了比较。长期趋势显示，生前诊断中的真阳性和假阴性比例都在逐渐上升。这两种诊断错误类型都会使官方生命统计中冠心病的计数逐渐减少。经过适当的统计校正后，康涅狄格州冠心病的发病率变得更高，且长期下降趋势不那么明显。结果表明，在直接接受生命统计数据并对数量变化进行生物学解释分析之前，需要大幅提高诊断准确性。
