Sensitivity and specificity of death certificate diagnoses for dementing illnesses, 1988-1990.

OBJECTIVE

To evaluate the extent to which mortality data, which is often used to track secular trends for specific diseases, underestimates the prevalence of dementia.

DESIGN

Retrospective analysis of existing data.

SETTING

Department of Mental Health inpatient facilities in South Carolina.

SUBJECTS

Inpatients at Department of Mental Health facilities who were listed in the South Carolina Statewide Alzheimer's Disease and Related Disorders Registry and who died between 1988 and 1990 (n = 450).

MAIN OUTCOME MEASURES

Sensitivity and specificity of dementia diagnoses on death certificates compared to medical record diagnoses for inpatients with a pre-mortem dementia diagnosis.

RESULTS

Twenty-three percent of death certificates contained any dementia diagnosis (104/450). The sensitivity of death certificates varied by type of dementia (28 percent for Alzheimer's disease; 8 percent for multi-infarct dementia) as well as by race, sex, and age.

CONCLUSIONS

Mortality statistics substantially underestimate the prevalence of dementing illnesses and do not fully represent the public health burden of dementia.