Ducimetière P, Jougla E, Haas B, Montaye M, Ruidavets J-B, Amouyel P, Arveiler D, Ferrières J, Bingham A
INSERM Unité 258--IFR69, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif Cedex, France.
Rev Epidemiol Sante Publique. 2006 Oct;54(5):453-61. doi: 10.1016/s0398-7620(06)76743-8.
Since 1985, two sources of information currently yield coronary disease frequency indicators among the French population: the national cause of death statistics set up by the CépiDC (INSERM), on the one hand, and three registries recording myocardial infarction and coronary deaths as defined by the WHO MONICA Project in three regions (Bas-Rhin, Communauté Urbaine de Lille, Haute-Garonne) on the other hand. Particularly, an inquiry for each possibly coronary death allows the registries to conclude positively (with or without a myocardial infarction), negatively or that no conclusion can be drawn because of insufficient data. The aim of the present work is to analyze concordance between coronary deaths issuing from the two sources according to their definition, while taking into account, or not, multiple causes listed on the death certificates.
and methods: In total, 4,664 deaths occurring in 2000 in the 35-64 year-old population of the three regions identified by the CépiDc were paired with the 812 deaths analyzed by the registries. The MONICA classification was compared with that of the CépiDC which used the ICD 10th Revision of the initial cause or after taking into account multiple causes. In each case, the concordance between the final classifications (coronary deaths or not) and the mortality ratio obtained from the two sources were computed.
and conclusions: Eight hundred and six deaths could be paired: 310 with a coronary cause according to the registries, 420 of presumed coronary cause but with insufficient data and 76 of non coronary origin. Whereas the total number of coronary deaths was similar for the two sources, their concordance was relatively low (kappa=0.61). However, when the deaths with insufficient data were included in the MONICA definition, concordance decreased and a large underestimation (59%) of the coronary mortality is given by the national statistics as compared to the registries. Taking into account multiple causes of death and not only the initial cause permitted partly to reduce this underestimation (42%) and to increase concordance (kappa from 0.46 to 0.51). These findings have important consequences for international comparisons concerning coronary disease. Indeed, the MONICA Project showed that the frequency of deaths with insufficient data was especially elevated in France leading to an underestimation of the coronary death rates provided by the national statistics in comparison with other countries, particularly in Europe.
自1985年以来，目前有两个信息来源可提供法国人群中冠心病发病频率指标：一方面是由法国国家医学研究与卫生经济研究所（INSERM）设立的全国死因统计数据，另一方面是在三个地区（下莱茵省、里尔城市共同体、上加龙省）记录世界卫生组织MONICA项目所定义的心肌梗死和冠心病死亡情况的三个登记处。具体而言，对每一例可能的冠心病死亡进行调查，使登记处能够得出肯定结论（无论是否伴有心肌梗死）、否定结论，或者因数据不足无法得出结论。本研究的目的是根据两种来源对冠心病死亡的定义分析它们之间的一致性，同时考虑或不考虑死亡证明上列出的多种死因。
总共将法国国家医学研究与卫生经济研究所（CépiDc）确定的三个地区2000年35至64岁人群中发生的4664例死亡与登记处分析的812例死亡进行配对。将MONICA分类与法国国家医学研究与卫生经济研究所（CépiDC）的分类进行比较，后者使用国际疾病分类第10版的初始病因或考虑多种病因后的分类。在每种情况下，计算最终分类（是否为冠心病死亡）之间的一致性以及从两种来源获得的死亡率。
806例死亡可以配对：根据登记处的数据，310例为冠心病病因，420例为疑似冠心病病因但数据不足，76例为非冠心病病因。虽然两种来源的冠心病死亡总数相似，但其一致性相对较低（kappa值 = 0.61）。然而，当将数据不足的死亡纳入MONICA定义时，一致性下降，与登记处相比，国家统计数据对冠心病死亡率的低估幅度很大（59%）。考虑多种死因而非仅初始病因，部分减少了这种低估（42%）并提高了一致性（kappa值从0.46提高到0.51）。这些发现对冠心病的国际比较具有重要影响。事实上，MONICA项目表明，法国数据不足的死亡频率尤其高，导致与其他国家（特别是欧洲国家）相比，国家统计数据对冠心病死亡率的低估。
