Mackenbach J P, Snels I A, Friden-Kill L M
Erasmus Universiteit, Instituut Maatschappelijke Gezondheidszorg, Rotterdam.
Ned Tijdschr Geneeskd. 1991 Aug 17;135(33):1492-6.
Certification and coding of diabetes mellitus as a cause of death were investigated by sending a random sample of 300 physicians a set of 6 case histories. Of these, 228 (76%) participated in the study by completing a death certificate for each of these cases. The certificates were subsequently coded by the Central Bureau of Statistics. The main finding was that doctors varied enormously in the way in which diabetes mellitus was mentioned on the death certificate: not at all, as a contributory cause of death, or as an underlying cause of death. Coding removes some of the inconsistencies, but induces additional variation: a higher age of the deceased is associated with a lower probability of having diabetes mellitus coded as the underlying cause of death, and a higher probability of not receiving a code of diabetes mellitus at all. It is concluded that the cause-of-death registration does not provide an accurate picture of the contribution of diabetes mellitus to the cause-of-death pattern of the Netherlands. This is due, amongst other things, to the conceptualization of causes of death on which the registration is based. On the other hand, changes in certification and coding practice within the current system may already lead to some improvement.
通过向300名医生随机抽取一组6个病例史，对糖尿病作为死因的认证和编码进行了调查。其中，228名（76%）医生通过为每个病例填写死亡证明参与了研究。这些证明随后由中央统计局进行编码。主要发现是，医生在死亡证明上提及糖尿病的方式差异极大：根本未提及、作为死亡的促成原因或作为根本死因。编码消除了一些不一致性，但也引发了额外的差异：死者年龄越大，糖尿病被编码为根本死因的可能性越低，完全不被编码为糖尿病的可能性越高。得出的结论是，死因登记并未准确反映糖尿病对荷兰死因模式的影响。这在一定程度上归因于登记所依据的死因概念。另一方面，现行系统内认证和编码做法的改变可能已经带来了一些改善。
