Department of Sociology and Aging Studies Institute, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, New York, USA
Department of Physical Medicine and Rehabilitation, SUNY Upstate Medical University, Syracuse, New York, USA.
BMJ Open. 2021 Jan 31;11(1):e045360. doi: 10.1136/bmjopen-2020-045360.
To investigate whether uncertainty surrounding the death is associated with the inaccurate reporting of intellectual disability as the underlying cause of death.
National Vital Statistics System 2005-2017 US Multiple Cause-of-Death Mortality files.
USA.
Adults with an intellectual disability reported on their death certificate, aged 18 and over at the time of death. The study population included 26 555 adults who died in their state of residence between 1 January 2005 and 31 December 2017.
Decedents with intellectual disability reported on their death certificate were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for intellectual disability (F70-79). Bivariate analysis and multilevel logistic regression models were used to investigate whether individual-level and state-level characteristics indicative of increased uncertainty at the time of death were associated with the inaccurate reporting of intellectual disability as the underlying cause of death.
Inaccurate reporting of intellectual disability as the underlying cause of death was associated with sociodemographic characteristics, death context characteristics and comorbidities indicative of an increased amount of uncertainty surrounding the death. Most striking were increased odds of having intellectual disability reported as the underlying cause of death for decedents who had a choking event (OR=14.7; 95% CI 12.9 to 16.6, p<0.001), an external cause of death associated with a high degree of uncertainty, reported on their death certificate.
It is imperative that medical personnel not let increased uncertainty lead to the inaccurate reporting of intellectual disability as the underlying cause of death as this practice obscures cause of death trends for this population. Instead, even in instances when increased uncertainty surrounds the death, certifiers should strive to accurately identify the disease or injury causing death, and report the disability in Part II of the death certificate.
调查围绕死亡的不确定性是否与不准确报告智力障碍作为根本死因有关。
2005-2017 年美国国家生命统计系统多原因死亡率文件。
美国。
在死亡证明上报告有智力障碍的成年人，死亡时年龄在 18 岁及以上。研究人群包括 2005 年 1 月 1 日至 2017 年 12 月 31 日期间在其居住州死亡的 26555 名成年人。
使用智力障碍的国际疾病分类第十版（F70-79）代码，在死亡证明上报告有智力障碍的死者被确定为智力障碍。使用双变量分析和多层次逻辑回归模型，调查表明死亡时不确定性增加的个体和州级特征是否与不准确报告智力障碍作为根本死因有关。
不准确地报告智力障碍作为根本死因与社会人口统计学特征、死亡背景特征和表明死亡周围不确定性增加的合并症有关。最引人注目的是，在死亡证明上报告与高度不确定性相关的窒息事件（OR=14.7；95%CI 12.9 至 16.6，p<0.001）的死者，将智力障碍报告为根本死因的可能性增加。
医务人员绝不能让增加的不确定性导致不准确地报告智力障碍作为根本死因，因为这种做法掩盖了该人群的死亡趋势。相反，即使在死亡周围存在增加的不确定性的情况下，认证人员也应努力准确识别导致死亡的疾病或伤害，并在死亡证明的第二部分报告残疾。
