Statistics Netherlands, The Hague, The Netherlands,
Dement Geriatr Cogn Disord. 2020;49(5):511-517. doi: 10.1159/000510678. Epub 2020 Nov 2.
Dementia is a major cause of death in many countries today. The way in which countries code causes of death determines the occurrence of dementia in statistics. The change over from manual to automated coding is accompanied by a 7-19% increase in the occurrence of dementia as the underlying cause of death. Because of this sudden change, researchers, physicians, policy makers, and press question the validity of the outcome of automated coding. Therefore, the role of dementia as a cause of death was investigated.
A questionnaire was sent to a random sample of 700 certifiers who mentioned "dementia" on a death certificate in the second half of 2017. They were asked questions about the role of dementia as a cause of death. For each certificate, the opinion of the certifier was compared with the outcome of automated coding.
A response of 65% (n = 446) was obtained. The automated coding system selected dementia as the underlying cause of death 9.5% points (95% CI: 5.8-14.4%) more often than the certifier would do. This finding in the sample corresponded to an overestimation of dementia in the cause-of-death statistics with 22.7% (95% CI: 18-28%). Main reason for this overestimation was the selection of dementia as the underlying cause of death by the automated coding system, while it was noted as the contributory cause of death on part 2 of the death certificate by the certifier.
For international comparisons of data on dementia as a cause of death, the outcome of automated coding can be used as the system adheres to international (ICD-10) guidelines and reduces coding variations in and between countries. However, for interpreting the local (national) impact of dementia as a cause of death, the opinion of the certifier should be taken into account.
痴呆症是当今许多国家的主要死因。国家死因编码方式决定了痴呆症在统计数据中的发生情况。从手动编码向自动化编码转变的过程中，痴呆症作为根本死因的发生情况增加了 7-19%。由于这种突然的变化，研究人员、医生、政策制定者和媒体对自动化编码结果的有效性提出了质疑。因此，本研究旨在探讨痴呆症作为死因的作用。
向随机抽取的 700 名在 2017 年下半年的死亡证明上提及“痴呆症”的认证人员发送了一份调查问卷，询问他们对痴呆症作为死因的看法。对于每一份死亡证明，将认证人员的意见与自动化编码的结果进行比较。
收到了 65%（n=446）的回复。自动化编码系统选择痴呆症作为根本死因的比例比认证人员高 9.5%（95%CI：5.8-14.4%）。这一发现与死因统计数据中痴呆症的高估相对应，高估幅度为 22.7%（95%CI：18-28%）。造成这种高估的主要原因是自动化编码系统选择痴呆症作为根本死因，而认证人员在死亡证明的第 2 部分将其记为促成死因。
对于国际间痴呆症作为死因的数据比较，可以使用自动化编码的结果，因为它符合国际（ICD-10）指南，并减少了国家间和国内的编码差异。然而，对于解释痴呆症作为死因的本地（国家）影响，应该考虑认证人员的意见。
