McComish Stacey L, Liu Xirui, Martinez Florencio T, Zhou Joey Y, Tolmachev Sergey Y
United States Transuranium and Uranium Registries, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Richland, Washington, United States of America.
Office of Domestic and International Health Studies, United States Department of Energy, Washington, District of Columbia, United States of America.
PLoS One. 2024 May 3;19(5):e0302069. doi: 10.1371/journal.pone.0302069. eCollection 2024.
The U.S. Transuranium and Uranium Registries performs autopsies on each of its deceased Registrants as a part of its mission to follow up occupationally-exposed individuals. This provides a unique opportunity to explore death certificate misclassification errors, and the factors that influence them, among this small population of former nuclear workers. Underlying causes of death from death certificates and autopsy reports were coded using the 10th revision of the International Classification of Diseases (ICD-10). These codes were then used to quantify misclassification rates among 268 individuals for whom both full autopsy reports and death certificates with legible underlying causes of death were available. When underlying causes of death were compared between death certificates and autopsy reports, death certificates correctly identified the underlying cause of death's ICD-10 disease chapter in 74.6% of cases. The remaining 25.4% of misclassified cases resulted in over-classification rates that ranged from 1.2% for external causes of mortality to 12.2% for circulatory disease, and under-classification rates that ranged from 7.7% for external causes of mortality to 47.4% for respiratory disease. Neoplasms had generally lower misclassification rates with 4.3% over-classification and 13.3% under-classification. A logistic regression revealed that the odds of a match were 2.8 times higher when clinical history was mentioned on the autopsy report than when it was not. Similarly, the odds of a match were 3.4 times higher when death certificates were completed using autopsy findings than when autopsy findings were not used. This analysis excluded cases where it could not be determined if autopsy findings were used to complete death certificates. The findings of this study are useful to investigate the impact of death certificate misclassification errors on radiation risk estimates and, therefore, improve the reliability of epidemiological studies.
美国超铀和铀登记处会对每一位去世的登记人进行尸检，这是其对职业暴露个体进行随访使命的一部分。这为探究这一小群前核工业工人的死亡证明错误分类情况及其影响因素提供了独特契机。使用《国际疾病分类》第10版（ICD - 10）对死亡证明和尸检报告中的根本死因进行编码。然后利用这些编码对268名个体的错误分类率进行量化，这些个体既有完整的尸检报告，又有死因清晰的死亡证明。当比较死亡证明和尸检报告中的根本死因时，死亡证明在74.6%的病例中正确识别了根本死因的ICD - 10疾病章节。其余25.4%的错误分类病例导致了过度分类率，范围从外部死因死亡率的1.2%到循环系统疾病的12.2%，以及漏分类率，范围从外部死因死亡率的7.7%到呼吸系统疾病的47.4%。肿瘤的错误分类率总体较低，过度分类率为4.3%，漏分类率为13.3%。逻辑回归显示，尸检报告中提及临床病史时匹配的几率比未提及临床病史时高2.8倍。同样，使用尸检结果填写死亡证明时匹配的几率比未使用尸检结果时高3.4倍。该分析排除了无法确定是否使用尸检结果填写死亡证明的病例。本研究结果有助于调查死亡证明错误分类对辐射风险估计的影响，从而提高流行病学研究的可靠性。
