Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
Eur J Public Health. 2010 Dec;20(6):671-5. doi: 10.1093/eurpub/ckp230. Epub 2010 Feb 2.
There is increasing recognition of the importance of obesity as a cause of death but it is uncommon for obesity to be certified on death certificates. We considered it useful to study what doctors actually do in respect of certification of obesity and to study trends, if any, in certification practice.
Analysis of two datasets that include all certified causes of death ('mentions'), not just the underlying cause-the Oxford record linkage study 1979-2006 and English national mortality data 1995-2006.
Underlying-cause mortality identified only a quarter (26% in Oxford, 25% in England) of all deaths with obesity as a certified cause. The longstanding Oxford dataset showed that there were significant changes over time in the percentage of certificates, with mention of obesity, that were coded with obesity as the underlying cause. Changes coincided with times of national change in selection and coding rules for underlying cause mortality. In the recent English dataset from 1995-2006, mention-based death rates rose by an average annual rate of 7.5% [95% confidence intervals (CI) 6.1-8.8] for men and by 4.0% (2.3-5.7) for women. Analysis of mortality based on underlying cause alone would have missed this rise. We report on diseases commonly certified alongside obesity on death certificates in England.
There is an emerging trend of increased certification of obesity as a cause of death in England. The use of underlying-cause mortality statistics alone fails to capture the majority of obesity deaths.
人们越来越认识到肥胖是导致死亡的一个重要原因，但肥胖症在死亡证明上被认证的情况并不常见。我们认为，研究医生在认证肥胖症方面的实际做法以及认证实践是否存在任何趋势是有用的。
分析包括所有认证死因（“提及”）的两个数据集，而不仅仅是根本死因——牛津记录链接研究 1979-2006 年和 1995-2006 年英国国家死亡率数据。
根本死因死亡率仅确定了肥胖作为认证死因的所有死亡人数的四分之一（牛津的 26%，英格兰的 25%）。长期以来的牛津数据集显示，随着时间的推移，以肥胖为根本死因的认证证书的比例发生了重大变化。这些变化与国家根本死因死亡率选择和编码规则变化的时间相吻合。在最近的 1995-2006 年英国数据集，基于提及的死亡率男性平均每年增长 7.5%（95%置信区间为 6.1-8.8），女性增长 4.0%（2.3-5.7）。仅基于根本死因的死亡率分析会错过这种增长。我们报告了在英国死亡证明上与肥胖症一起认证的常见疾病。
在英国，将肥胖症作为死因进行认证的趋势正在出现。仅使用根本死因死亡率统计数据无法捕捉到大多数肥胖症死亡人数。
