Medical College of Wisconsin, Milwaukee, WI 53226, USA.
J Public Health Policy. 2012 May;33(2):202-14. doi: 10.1057/jphp.2012.6. Epub 2012 Feb 23.
Because good information on deaths caused by a fall would be important for prevention policies, we analyzed the influence of coding differences on variability in state-level fall death rates in the elderly. We examined state differences in the number of cause of death codes on death certificates, death certifiers, completeness of E-coding, and indicators of specificity of coding. We found that state-specific fall mortality rates ranged from 13.9 to 140.4 in people aged 65 years and above. States employing a coroner to investigate injury deaths had 14 per cent fewer recorded fall deaths than those where a medical examiner conducted the investigations. Each unit increase in the median number of cause of death codes was associated with a 10 per cent increase in the number of falls. For each 1 per cent increase in the use of unspecified codes for the underlying cause of death, the number of falls dropped by 2 per cent. Current fall mortality data do not appear to identify all instances of falls. Variability in unintentional fall-related death rates among states may be partly explained by death certification coding practices. Standardization of coding and training for documentation of fall events and death certificate reporting could help uncover the actual fall mortality burden in the elderly.
由于有关跌倒导致死亡的信息对于预防政策非常重要，因此我们分析了编码差异对老年人州级跌倒死亡率差异的影响。我们研究了死亡证明上死因编码数量、死亡证明签发人、E 编码完整性以及编码特异性指标方面的州级差异。结果发现，65 岁及以上人群的特定州跌倒死亡率范围为 13.9 至 140.4。由验尸官调查伤害致死的州比由法医进行调查的州记录的跌倒死亡人数少 14%。死因编码中位数每增加一个单位，跌倒的数量就会增加 10%。死因编码中使用未特指编码的比例每增加 1%，跌倒的数量就会减少 2%。目前的跌倒死亡率数据似乎并未识别出所有跌倒事件。各州之间非故意跌倒相关死亡率的差异可能部分归因于死亡证明编码实践。对跌倒事件和死亡证明报告进行编码和记录方面的标准化和培训，可以帮助发现老年人实际的跌倒死亡率负担。
