Chaparro-Narváez Pablo, Manrique Sanchez Jessika Alexandra, Berrio-Parra Laura, Urrego Ricaurte Diana Carolina, Torres-Rojas Luis José, Orjuela Cantor Nidia Patricia, Mora Aguirre Claudia Patricia, Quevedo Yesid Rojas, Suárez Clara, Castañeda-Orjuela Carlos
National Health Observatory, National Institute of Health, Bogotá, Colombia.
PLoS One. 2025 May 20;20(5):e0320466. doi: 10.1371/journal.pone.0320466. eCollection 2025.
This study aimed to estimate the accuracy of the underlying Cause of Death (CoD) in the original death certificate, compared with a gold standard certificate based on information from clinical records and relatives, in population deceased in Colombia during 2021.
A sample size of 806 deaths across 92 municipalities in Colombia were estimated from the pool of 326,833 original certificates provided by the National Department of Statistics. A two-stage stratified random sample with replacement was employed for selection. Information from medical records of the deceased and, when necessary, interviews with relatives or witnesses were used to determine CoDs on the gold standard certificate. We analyzed and compared the underlying CoD of the original and standard death certificates to estimate the level of accuracy. Measures of concordance, patterns of false positives and negatives, and a kappa value were utilized as metrics to evaluate the death certificates quality.
Information was obtained from 776, representing 96% of the desired sample. The concordance between original and gold standard certificates, categorized according to the ICD-10 chapters, was found in 74%. Higher levels of agreement were observed for "codes for special COVID-19 situations" (kappa = 0.84) and neoplasms (kappa = 0.84). Higher levels of agreement were observed for "codes for special COVID-19 situations" (kappa = 0.84) and neoplasms (kappa = 0.84). Overestimation was identified for "circulatory system diseases" (Chapter IX); "pregnancy, childbirth and puerperium" (Chapter XV); "signs, symptoms, and poorly defined conditions" (Chapter XVIII) and "diseases of the respiratory system" (Chapter X), while underestimation in "diseases of the genitourinary system" (Chapter XIV) among CoD. The most significant variations in the fraction of mortality due to specific CoDs corresponded to "codes for special situations COVID-19".
The level of concordance between the original and gold standard death certificates was deemed adequate. However, improvements in the death certification process in Colombia are recommended, emphasizing the enhancement of training programs for health professionals.
本研究旨在评估2021年哥伦比亚死亡人口原始死亡证明书中根本死因(CoD)的准确性,并与基于临床记录和亲属信息的金标准证书进行比较。
从国家统计局提供的326,833份原始证书中,估计出哥伦比亚92个市的806例死亡样本量。采用两阶段分层随机放回抽样进行选择。利用死者病历信息,并在必要时与亲属或证人进行访谈,以确定金标准证书上的根本死因。我们分析并比较了原始死亡证明和标准死亡证明的根本死因,以评估准确性水平。一致性度量、假阳性和假阴性模式以及kappa值被用作评估死亡证明质量的指标。
获得了776例的信息,占所需样本的96%。根据ICD - 10章节分类,原始证书与金标准证书之间的一致性为74%。在“特殊COVID - 19情况代码”(kappa = 0.84)和肿瘤(kappa = 0.84)方面观察到较高的一致性水平。在根本死因中,“循环系统疾病”(第九章)、“妊娠、分娩和产褥期”(第十五章)、“体征、症状和定义不明确的病症”(第十八章)以及“呼吸系统疾病”(第十章)存在高估情况,而“泌尿生殖系统疾病”(第十四章)存在低估情况。特定根本死因导致的死亡率比例最显著的差异对应于“特殊COVID - 19情况代码”。
原始死亡证明与金标准死亡证明之间的一致性水平被认为是足够的。然而,建议改进哥伦比亚的死亡证明程序,强调加强对卫生专业人员的培训计划。