Lloyd-Jones D M, Martin D O, Larson M G, Levy D
National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
Ann Intern Med. 1998 Dec 15;129(12):1020-6. doi: 10.7326/0003-4819-129-12-199812150-00005.
Death certificates are widely used in epidemiologic and clinical investigations and for national statistics.
To examine the accuracy of death certificates for coding coronary heart disease as the underlying cause of death.
Community-based inception cohort followed since 1948.
Framingham, Massachusetts.
2683 deceased Framingham Heart Study participants.
Sensitivity, specificity, and predictive values of the death certificate. The reference standard was cause of death adjudicated by a panel of three physicians.
Among 2683 decedents, the death certificate coded coronary heart disease as the underlying cause of death for 942; the physician panel assigned coronary heart disease for 758. The death certificate had a sensitivity of 83.8% (95% CI, 81.1 % to 86.4%), positive predictive value of 67.4% (CI, 64.4% to 70.4%), specificity of 84.1% (CI, 82.4% to 85.7%), and negative predictive value of 92.9% (CI, 91.7% to 94.1%) for coronary heart disease. The death certificate assigned coronary heart disease in 51.2% of 242 deaths (9.0% of total deaths) for which the physician panel could not determine a cause. Compared with the physician panel, the death certificate attributed 24.3% more deaths to coronary heart disease overall and more than twice as many deaths to coronary heart disease in decedents who were at least 85 years of age. When deaths that were assigned unknown cause by the physician panel were excluded, the death certificate still assigned more deaths to coronary heart disease (7.9% overall and 43.1% in the oldest age group).
Coronary heart disease may be overrepresented as a cause of death on death certificates. National mortality statistics, which are based on death certificate data, may overestimate the frequency of coronary heart disease by 7.9% to 24.3% overall and by as much as two-fold in older persons.
死亡证明广泛应用于流行病学和临床研究以及国家统计。
检验将冠心病作为根本死因进行编码的死亡证明的准确性。
自1948年起对基于社区的初始队列进行随访。
马萨诸塞州弗雷明汉。
2683名弗雷明汉心脏研究的已故参与者。
死亡证明的敏感性、特异性和预测值。参考标准是由三名医生组成的小组判定的死因。
在2683名死者中，死亡证明将冠心病列为根本死因的有942例；医生小组判定为冠心病的有758例。死亡证明对冠心病的敏感性为83.8%（95%可信区间，81.1%至86.4%），阳性预测值为67.4%（可信区间，64.4%至70.4%），特异性为84.1%（可信区间，82.4%至85.7%），阴性预测值为92.9%（可信区间，91.7%至94.1%）。在医生小组无法确定死因的242例死亡（占总死亡人数的9.0%）中，死亡证明将冠心病列为死因的占51.2%。与医生小组相比，死亡证明总体上将归因于冠心病的死亡人数多24.3%，在至少85岁的死者中，归因于冠心病的死亡人数是医生小组判定的两倍多。当排除医生小组判定为死因不明的死亡后，死亡证明仍将更多死亡归因于冠心病（总体上占7.9%，在最年长年龄组中占43.1%）。
在死亡证明上，冠心病作为死因的比例可能被高估。基于死亡证明数据的国家死亡率统计可能会高估冠心病的总体发病频率7.9%至24.3%，在老年人中高估幅度高达两倍。
