Kharrazi Rebekah J, Nash Denis, Mielenz Thelma J
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
School of Public Health, City University of New York, New York, New York.
J Am Geriatr Soc. 2015 Sep;63(9):1913-7. doi: 10.1111/jgs.13591. Epub 2015 Jul 22.
To investigate whether changes in death certificate coding and reporting practices explain part or all of the recent increase in the rate of fatal falls in adults aged 65 and older in the United States.
Trends in coding and reporting practices of fatal falls were evaluated under mortality coding schemes for International Classification of Diseases (ICD), Ninth Revision (1992-1998) and Tenth Revision (1999-2005).
United States, 1992 to 2005.
Individuals aged 65 and older with falls listed as the underlying cause of death (UCD) on their death certificates.
The primary outcome was annual fatal falls rates per 100,000 U.S. residents aged 65 and older. Coding practice was assessed through analysis of trends in rates of specific UCD fall ICD e-codes over time. Reporting quality was assessed by examining changes in the location on the death certificate where fall e-codes were reported, in particular, the percentage of fall e-codes recorded in the proper location on the death certificate.
Fatal falls rates increased over both time periods: 1992 to 1998 and 1999 to 2005. A single falls e-code was responsible for the increasing trend of fatal falls overall from 1992 to 1998 (E888, other and unspecified fall) and from 1999 to 2005 (W18, other falls on the same level), whereas trends for other falls e-codes remained stable. Reporting quality improved steadily throughout the study period.
Better reporting quality, not coding practices, contributed to the increasing rate of fatal falls in older adults in the United States from 1992 to 2005.
调查死亡证明编码和报告方式的变化是否能解释美国65岁及以上成年人近期致命跌倒率上升的部分或全部原因。
根据国际疾病分类（ICD）第九版（1992 - 1998年）和第十版（1999 - 2005年）的死亡率编码方案，评估致命跌倒编码和报告方式的趋势。
美国，1992年至2005年。
65岁及以上且死亡证明上列出跌倒为根本死因（UCD）的个体。
主要结果是每10万美国65岁及以上居民的年度致命跌倒率。通过分析特定UCD跌倒ICD电子编码率随时间的趋势来评估编码方式。通过检查死亡证明上报告跌倒电子编码的位置变化来评估报告质量，特别是在死亡证明正确位置记录的跌倒电子编码百分比。
在1992年至1998年以及1999年至2005年这两个时间段内，致命跌倒率均有所上升。单一跌倒电子编码导致了1992年至1998年（E888，其他及未指明的跌倒）和1999年至2005年（W18，同一水平的其他跌倒）总体致命跌倒率的上升趋势，而其他跌倒电子编码的趋势保持稳定。在整个研究期间，报告质量稳步提高。
1992年至2005年美国老年人致命跌倒率上升的原因是报告质量的提高，而非编码方式。
