Ives Diane G, Samuel Paulraj, Psaty Bruce M, Kuller Lewis H
Department of Epidemiology, Center for Aging and Population Health, University of Pittsburgh, Pennsylvania 15213, USA.
J Am Geriatr Soc. 2009 Jan;57(1):133-9. doi: 10.1111/j.1532-5415.2008.02056.x. Epub 2008 Nov 12.
To compare nosologist coding of underlying cause of death according to the death certificate with adjudicated cause of death for subjects aged 65 and older in the Cardiovascular Health Study (CHS).
Observational.
Four communities: Forsyth County, North Carolina (Wake Forest University); Sacramento County, California (University of California at Davis); Washington County, Maryland (Johns Hopkins University); and Pittsburgh, Pennsylvania (University of Pittsburgh).
Men and women aged 65 and older participating in CHS, a longitudinal study of coronary heart disease and stroke, who died through June 2004.
The CHS centrally adjudicated underlying cause of death for 3,194 fatal events from June 1989 to June 2004 using medical records, death certificates, proxy interviews, and autopsies, and results were compared with underlying cause of death assigned by a trained nosologist based on death certificate only.
Comparison of 3,194 CHS versus nosologist underlying cause of death revealed moderate agreement except for cancer (kappa=0.91, 95% confidence interval (CI)=0.89-0.93). kappas varied according to category (coronary heart disease, kappa=0.61, 95% CI=0.58-0.64; stroke, kappa=0.59, 95% CI=0.54-0.64; chronic obstructive pulmonary disease, kappa=0.58, 95% CI=0.51-0.65; dementia, kappa=0.40, 95% CI=0.34-0.45; and pneumonia, kappa=0.35, 95% CI=0.29-0.42). Differences between CHS and nosologist coding of dementia were found especially in older ages in the sex and race categories. CHS attributed 340 (10.6%) deaths due to dementia, whereas nosologist coding attributed only 113 (3.5%) to dementia as the underlying cause.
Studies that use only death certificates to determine cause of death may result in misclassification and potential bias. Changing trends in cause-specific mortality in older individuals may be a function of classification process rather than incidence and case fatality.
在心血管健康研究（CHS）中，比较根据死亡证明确定的65岁及以上受试者潜在死因的疾病分类编码与裁定的死因。
观察性研究。
四个社区：北卡罗来纳州福赛思县（维克森林大学）；加利福尼亚州萨克拉门托县（加利福尼亚大学戴维斯分校）；马里兰州华盛顿县（约翰霍普金斯大学）；宾夕法尼亚州匹兹堡（匹兹堡大学）。
参加CHS的65岁及以上的男性和女性，CHS是一项关于冠心病和中风的纵向研究，研究对象截至2004年6月死亡。
CHS利用病历、死亡证明、代理人访谈和尸检对1989年6月至2004年6月期间的3194例死亡事件的潜在死因进行了集中裁定，并将结果与仅根据死亡证明由训练有素的疾病分类学家确定的潜在死因进行比较。
对3194例CHS裁定的潜在死因与疾病分类学家裁定的潜在死因进行比较，发现除癌症外（kappa=0.91，95%置信区间（CI）=0.89-0.93），一致性中等。kappa值因类别而异（冠心病，kappa=0.61，95%CI=0.58-0.64；中风，kappa=0.59，95%CI=0.54-0.64；慢性阻塞性肺疾病，kappa=0.58，95%CI=0.51-0.65；痴呆，kappa=0.40，95%CI=0.34-0.45；肺炎，kappa=0.35，95%CI=0.29-0.42）。CHS与疾病分类学家对痴呆的编码差异尤其在年龄较大的性别和种族类别中发现。CHS将340例（10.6%）死亡归因于痴呆，而疾病分类学家编码仅将113例（3.5%）归因于痴呆作为潜在死因。
仅使用死亡证明来确定死因的研究可能会导致错误分类和潜在偏差。老年个体特定病因死亡率的变化趋势可能是分类过程的作用，而非发病率和病死率的作用。
