Mackenbach J P, Kunst A E, Lautenbach H, Bijlsma F, Oei Y B
Department of Public Health, Erasmus University Rotterdam, The Netherlands.
Am J Epidemiol. 1995 Mar 1;141(5):466-75. doi: 10.1093/oxfordjournals.aje.a117449.
The standard methodology for cause-elimination life tables assumes that the various causes of death are statistically unrelated to one another, so that the mortality risks of those who are saved from an eliminated cause equal the risks of dying from other causes which are observed for the general population. In the analysis reported in this paper, data on multiple causes of death for the year 1990 in the Netherlands were used to investigate whether this is likely to be a valid assumption. For four groups of underlying causes of death (malignant neoplasms, cardiovascular diseases, and external causes), the age-standardized prevalence at death of other conditions was calculated. Two series of calculations were performed: one with all other coded conditions present at death and one with a selection of conditions that were eligible to become the new underlying cause of death after the present underlying cause had been eliminated. The results suggested that there are major differences between underlying causes of death in the prevalence at death of other conditions. According to the second series of calculations, the prevalence at death of other conditions. According to the second series of calculations, the prevalence of possible new underlying causes of death was relatively high among persons who died from cardiovascular diseases; about average for persons who died from respiratory diseases; and relatively low for persons who died from malignant neoplasms and external causes. Although studies validating the multiple-cause-of-death data as they appear in the official statistics are necessary, these results reconfirm that this is a potentially rich source of information and that the assumption made in conventional cause-elimination life tables is unlikely to be valid.
消除病因寿命表的标准方法假定各种死因在统计上相互独立，因此从已消除病因中获救者的死亡风险等同于普通人群中死于其他病因的风险。在本文所报告的分析中，使用了荷兰1990年多种死因的数据来调查这是否可能是一个有效的假设。对于四组潜在死因（恶性肿瘤、心血管疾病和外部病因），计算了其他病症在死亡时的年龄标准化患病率。进行了两组计算：一组是将死亡时所有其他编码病症都考虑在内，另一组是选择在当前潜在病因被消除后有资格成为新的潜在死因的病症。结果表明，不同潜在死因在其他病症死亡患病率方面存在重大差异。根据第二组计算，其他病症的死亡患病率情况如下。根据第二组计算，死于心血管疾病者中可能的新潜在死因患病率相对较高；死于呼吸系统疾病者中约为平均水平；死于恶性肿瘤和外部病因者中则相对较低。虽然有必要对官方统计中出现的多死因数据进行验证研究，但这些结果再次证实这是一个潜在的丰富信息来源，而且传统消除病因寿命表中的假设不太可能成立。
