New York City Department of Health and Mental Hygiene, New York, New York, USA.
Prev Chronic Dis. 2010 May;7(3):A47. Epub 2010 Apr 15.
New York City has one of the highest reported death rates from coronary heart disease in the United States. We sought to measure the accuracy of this rate by examining death certificates.
We conducted a cross-sectional validation study by using a random sample of death certificates that recorded in-hospital deaths in New York City from January through June 2003, stratified by neighborhoods with low, medium, and high coronary heart disease death rates. We abstracted data from hospital records, and an independent, blinded medical team reviewed these data to validate cause of death. We computed a comparability ratio (coronary heart disease deaths recorded on death certificates divided by validated coronary heart disease deaths) to quantify agreement between death certificate determination and clinical judgment.
Of 491 sampled death certificates for in-hospital deaths, medical charts were abstracted and reviewed by the expert panel for 444 (90%). The comparability ratio for coronary heart disease deaths among decedents aged 35 to 74 years was 1.51, indicating that death certificates overestimated coronary heart disease deaths in this age group by 51%. The comparability ratio increased with age to 1.94 for decedents aged 75 to 84 years and to 2.37 for decedents aged 85 years or older.
Coronary heart disease appears to be substantially overreported as a cause of death in New York City among in-hospital deaths.
纽约市的冠心病死亡率在美国是最高的之一。我们试图通过检查死亡证明来衡量这个死亡率的准确性。
我们通过使用随机抽样的方法，对 2003 年 1 月至 6 月期间在纽约市住院死亡的死亡证明进行了一项横断面验证研究，这些证明按冠心病死亡率低、中、高的社区进行了分层。我们从医院记录中提取数据，一个独立的、盲目的医疗团队对这些数据进行了审查，以验证死因。我们计算了可比性比率（死亡证明上记录的冠心病死亡人数除以经临床验证的冠心病死亡人数），以量化死亡证明确定与临床判断之间的一致性。
在 491 份抽样的住院死亡死亡证明中，有 444 份（90%）的医疗记录被专家组提取并审查。35 至 74 岁死者的冠心病死亡可比性比率为 1.51，这表明在这个年龄组，死亡证明高估了 51%的冠心病死亡人数。该比率随年龄的增加而增加，在 75 至 84 岁的死者中为 1.94，在 85 岁或以上的死者中为 2.37。
在纽约市，住院死亡中，冠心病似乎被大大高估为死因。
