Balkau B, Jougla E, Papoz L
INSERM U21, Villejuif, France.
Int J Epidemiol. 1993 Feb;22(1):116-26. doi: 10.1093/ije/22.1.116.
This study was designed to investigate the large differences in diabetes mortality rates in Europe. In each of the participating countries (France, Germany, The Netherlands, Northern Ireland-UK, Republic of Ireland, Romania, Scotland-UK, Switzerland) a random sample of certifying physicians was asked to certify the causes of death of six case histories which described the deaths of diabetic patients; the responses from an average of 220 physicians per country were analysed. These registered causes were then coded nationally and the underlying cause was compared with that following a central recoding. Overall 28% of the physicians surveyed recorded diabetes on the death certificate as the underlying cause of death--France was 25% below this overall average and Germany 21% above. The national coding of diabetes as the underlying cause of death differed from the central recoding with a comparative undercoding of almost 40% in Romania, 30% in Northern Ireland and 25% in Switzerland; in contrast, there was an overcoding of diabetes by 80% in The Netherlands and 60% in the Republic of Ireland. After adjusting for central recoding, in part an adjustment for certification habits, the national coding from this simulation study was able to explain 35% of the variation in the diabetes mortality rates. With such differences in the coding of diabetes, the currently published mortality rates for diabetes are not directly comparable between European countries; some suggestions are made for the reduction of the intercountry differences in the collection and analysis of mortality data for diabetes.
本研究旨在调查欧洲糖尿病死亡率的巨大差异。在每个参与国（法国、德国、荷兰、英国北爱尔兰、爱尔兰共和国、罗马尼亚、英国苏格兰、瑞士），随机抽取一定数量的认证医生，要求他们对描述糖尿病患者死亡情况的六个病例的死因进行认证；对每个国家平均220名医生的回复进行了分析。然后对这些登记的死因进行全国范围的编码，并将根本死因与中央重新编码后的结果进行比较。总体而言，接受调查的医生中有28%将糖尿病记录为死亡证明上的根本死因——法国比这个总体平均水平低25%，德国比总体平均水平高21%。将糖尿病作为根本死因的国家编码与中央重新编码存在差异，罗马尼亚的相对编码不足近40%，北爱尔兰为30%，瑞士为25%；相比之下，荷兰对糖尿病的编码过度80%，爱尔兰共和国为60%。在对中央重新编码进行调整（部分是对认证习惯的调整）后，这项模拟研究的国家编码能够解释糖尿病死亡率差异的35%。由于糖尿病编码存在这些差异，目前欧洲各国公布的糖尿病死亡率无法直接进行比较；文中针对减少糖尿病死亡率数据收集和分析中的国家间差异提出了一些建议。
