Coultas D B, Hughes M P
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque 87131, USA.
Thorax. 1996 Jul;51(7):717-20. doi: 10.1136/thx.51.7.717.
The sensitivity and accuracy of death certificates and mortality data as sources of population based data on the occurrence of interstitial lung diseases has received limited attention. To determine the usefulness of these data sources, death certificates and mortality data from patients in New Mexico were examined.
Patients with an interstitial lung disease were identified from a population based registry. For subjects who had died, diagnostic information from their death certificates and from mortality data was compared with the clinical diagnoses made before death.
Of 385 patients with a clinical diagnosis of an interstitial lung disease, 134 died between October 1988 and August 1994. Death certificates were obtained for 96% of these patients. An interstitial lung disease was listed somewhere on the death certificate for only 46% of the patients, and as an immediate cause of death for only 15%. For the patients with an interstitial lung disease listed somewhere on the death certificate the overall concordance between the diagnoses before death and those on the death certificate was 76%. Mortality data for the State of New Mexico showed a diagnosis of interstitial lung disease to be the assigned cause of death for only 22% of the patients. The overall agreement between the diagnoses made before death and those of the state mortality data was only 21%.
These results suggest that death certificates and state mortality data are neither sensitive nor accurate for describing the occurrence of interstitial lung diseases. This finding may partly explain the apparently low mortality rates from idiopathic pulmonary fibrosis in the USA compared with other countries.
作为基于人群的间质性肺疾病发病数据来源,死亡证明和死亡率数据的敏感性和准确性受到的关注有限。为了确定这些数据来源的实用性,对新墨西哥州患者的死亡证明和死亡率数据进行了研究。
从基于人群的登记处识别出患有间质性肺疾病的患者。对于已死亡的受试者,将其死亡证明和死亡率数据中的诊断信息与死亡前做出的临床诊断进行比较。
在385例临床诊断为间质性肺疾病的患者中,134例于1988年10月至1994年8月期间死亡。这些患者中有96%获得了死亡证明。只有46%的患者在死亡证明的某处列出了间质性肺疾病,而作为直接死因列出的仅占15%。对于在死亡证明某处列出间质性肺疾病的患者,死亡前诊断与死亡证明上诊断的总体一致性为76%。新墨西哥州的死亡率数据显示,只有22%的患者被指定的死亡原因是间质性肺疾病诊断。死亡前诊断与该州死亡率数据诊断之间的总体一致性仅为21%。
这些结果表明,死亡证明和州死亡率数据在描述间质性肺疾病的发生方面既不敏感也不准确。这一发现可能部分解释了与其他国家相比,美国特发性肺纤维化的死亡率明显较低的原因。