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全科医生是否准确记录死亡日期?一项英国观察性分析。

Do GPs accurately record date of death? A UK observational analysis.

作者信息

Harshfield Amelia, Abel Gary A, Barclay Stephen, Payne Rupert A

机构信息

Primary Care Unit, University of Cambridge, Cambridge, UK.

RAND Europe, Cambridge, UK.

出版信息

BMJ Support Palliat Care. 2020 Sep;10(3):e24. doi: 10.1136/bmjspcare-2018-001514. Epub 2018 Jun 27.

Abstract

OBJECTIVE

To examine the concordance between dates of death recorded in UK primary care and national mortality records.

METHODS

UK primary care data from the Clinical Practice Research Datalink were linked to Office for National Statistics (ONS) data, for 118 571 patients who died between September 2010 and September 2015. Logistic regression was used to examine factors associated with discrepancy in death dates between data sets.

RESULTS

Death dates matched in 76.8% of cases with primary care dates preceding ONS date in 2.9%, and following in 20.3% of cases; 92.2% of cases differed by <2 weeks. Primary care date was >4 weeks later than ONS in 1.5% of cases and occurred more frequently with deaths categorised as 'external' (15.8% vs 0.8% for cancer), and in younger patients (15.9% vs 1% for 18-29 and 80-89 years, respectively). General practices with the greatest discrepancies (97.5th percentile) had around 200 times higher odds of recording substantially discordant dates than practices with the lowest discrepancies (2.5th percentile).

CONCLUSION

Dates of death in primary care records often disagree with national records and should be treated with caution. There is marked variation between practices, and studies involving young patients, unexplained deaths and where precise date of death is important are particularly vulnerable to these issues.

摘要

目的

研究英国初级医疗记录中的死亡日期与国家死亡率记录之间的一致性。

方法

将临床实践研究数据链中的英国初级医疗数据与国家统计局(ONS)的数据相链接,涉及2010年9月至2015年9月期间死亡的118571名患者。采用逻辑回归分析来研究与数据集之间死亡日期差异相关的因素。

结果

76.8%的病例死亡日期匹配,其中初级医疗记录日期早于ONS记录日期的占2.9%,晚于ONS记录日期的占20.3%;92.2%的病例差异小于2周。1.5%的病例中初级医疗记录日期比ONS记录日期晚4周以上,这种情况在归类为“外部原因”的死亡中更常见(15.8%对比癌症患者中的0.8%),在年轻患者中也更频繁(18 - 29岁患者中为15.9%对比80 - 89岁患者中的1%)。差异最大(第97.5百分位数)的全科医疗记录与死亡日期严重不一致的几率比差异最小(第2.5百分位数)的全科医疗记录高出约200倍。

结论

初级医疗记录中的死亡日期常常与国家记录不一致,应谨慎对待。不同医疗机构之间存在显著差异,涉及年轻患者、不明原因死亡以及死亡精确日期很重要的研究尤其容易受到这些问题的影响。

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