Károlyi G, Károlyi P
Institute of Social Medicine and History of Medicine, Semmelweis University of Medicine, Budapest, Hungary.
J Epidemiol Community Health. 1991 Sep;45(3):238-43. doi: 10.1136/jech.45.3.238.
The aim was to compare the value of four sources of data in assessing morbidity in a population: (1) data from a screening programme including follow up records, (2) death certifications by attending physicians, (3) death certifications by doctor-coroners, and (4) necropsy reports.
The study was a cohort analysis of health and mortality in a sample of agricultural workers first examined in 1964-66 when they were aged 60 years or older. Follow up examinations enabled morbidity assessment to be made and ICD diagnostic categories to be compared with data available on persons in the cohort who had died.
Hajdúszoboszló, a small town in eastern Hungary.
1412 persons (96.1% of those aged greater than or equal to 60 years) were examined in 1964-6. Those still alive and available in 1989 were examined again. Necropsy records were available for 144 persons from the cohort in 1989 and were extensively reviewed in comparison with data available from other sources.
Comparison of causes of death established at necropsy showed marked differences from those registered by attending physicians and doctor-coroners, deviations ranging from -91.6% to +74.8%; 19.4% of underlying causes of death occurred exclusively in the necropsy group. Major divergencies in diagnostic classification occurred in the three data sources, particularly for diseases of the circulatory system, where hypertensive renal disease, old myocardial infarction, acute cerebrovascular disease, and venous thrombosis were rarely documented by physicians/coroners. When necropsy data were used the number of diagnostic categories increased strikingly over the other sources of information. Necropsy records revealed quantitatively similar information on morbidity to follow up examination though there were qualitative differences, necropsy being less likely to document diagnoses of endocrine disorders, mental and neurological diseases, digestive disorders, and musculosketal disorders.
Necropsy records contain much valuable material not available from other sources, exceeding by ninefold the amount of information reported at present. A way should be found to make use of this large data pool.
旨在比较四种数据来源在评估人群发病率方面的价值：（1）来自筛查项目并包含随访记录的数据；（2）主治医生开具的死亡证明；（3）法医开具的死亡证明；（4）尸检报告。
该研究是对一组农业工人的健康和死亡率进行队列分析，这些工人于1964 - 1966年首次接受检查，当时他们年龄在60岁及以上。后续检查使得能够进行发病率评估，并将国际疾病分类（ICD）诊断类别与队列中已死亡人员的现有数据进行比较。
匈牙利东部的一个小镇豪伊杜索博斯洛。
1964 - 1966年对1412人（年龄大于或等于60岁者的96.1%）进行了检查。1989年仍在世且可联系到的人再次接受了检查。1989年从该队列中获取了144人的尸检记录，并与其他来源的数据进行了广泛比较。
尸检确定的死亡原因与主治医生和法医登记的死亡原因相比存在显著差异，偏差范围从 - 91.6%到 + 74.8%；19.4%的根本死亡原因仅出现在尸检组中。三种数据来源在诊断分类上存在重大差异，特别是对于循环系统疾病，医生/法医很少记录高血压肾病、陈旧性心肌梗死、急性脑血管疾病和静脉血栓形成。当使用尸检数据时，诊断类别数量比其他信息来源显著增加。尸检记录显示，尽管在定性方面存在差异，但在发病率方面与随访检查提供的信息在数量上相似，尸检记录内分泌疾病诊断、精神和神经疾病诊断、消化系统疾病诊断以及肌肉骨骼疾病诊断的可能性较小。
尸检记录包含许多其他来源无法获得的有价值材料，信息量比目前报告的多九倍。应该找到利用这个庞大数据库的方法。
