Article

Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics.

Statistics Sweden. Department of Public Health and Caring Sciences, Unit of Social Medicine, Uppsala University, Sweden.
International Journal of Epidemiology (Impact Factor: 9.2). 07/2000; 29(3):495-502. DOI: 10.1093/ije/29.3.495
Source: PubMed

ABSTRACT The quality of mortality statistics is of crucial importance to epidemiological research. Traditional editing techniques used by statistical offices capture only obvious errors in death certification. In this study we match Swedish hospital discharge data to death certificates and discuss the implications for mortality statistics.
Swedish death certificates for 1995 were linked to the national hospital discharge register. The resulting database comprised 69 818 individuals (75% of all deaths), 39 872 (43%) of whom died in hospital. The diagnostic statements were compared at Basic Tabulation List level.
The last main diagnosis and the underlying cause of death agreed in 46% of cases. Agreement decreased rapidly after discharge. For hospital deaths, the main diagnosis was reported on 83% of the certificates, but only on 46% of certificates for non-hospital deaths. Malignant neoplasms and other dramatic conditions showed the best agreement and were often reported as underlying causes. Conditions that might follow from some other disease were often reported as contributory causes, while symptomatic and some chronic conditions were often omitted. In 13% of cases, an ill-defined main condition was replaced by a more specific cause of death.
There is no apparent reason to question the death certificate if the main diagnosis and underlying cause agree, or if the main diagnosis is a probable complication of the stated underlying cause. However, cases in which the main diagnosis cannot be considered a complication of the reported underlying cause should be investigated, and assessments made of the feasibility and cost-effectiveness of routinely linking hospital records to death certificates.

2 Followers
 · 
124 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine associations between varenicline and the incidence of a range of adverse outcomes. Population based cohort study using within person analyses to control for confounding by indication. Whole population of Sweden. 7 917 436 people aged 15 and over, of whom 69 757 were treated with varenicline between 2006 and 2009. Incidence of new psychiatric conditions, suicidal behaviour, suspected and convicted criminal offending, transport accidents, and suspected and convicted traffic offences. In the whole population, 337 393 new psychiatric conditions were diagnosed during follow-up. In addition, 507 823 suspected and 338 608 convicted crimes, 40 595 suicidal events, 124 445 transport accidents, and 99 895 suspected and 57 068 convicted traffic crimes were recorded. Within person analyses showed that varenicline was not associated with significant hazards of suicidal behaviour, criminal offending, transport accidents, traffic offences, or psychoses. However, varenicline was associated with a small increase in the risk of anxiety conditions (hazard ratio 1.23, 95% confidence interval 1.01 to 1.51) and mood conditions (1.31, 1.06 to 1.63), which was only seen in people with pre-existing psychiatric disorders. Concerns that varenicline is associated with an increased risk of many adverse outcomes, including suicidality and accidents, are not supported in this observational study. The small increase in risk of two psychiatric conditions in people with pre-existing psychiatric disorders needs to be confirmed using other research designs. © Molero et al 2015.
    BMJ (online) 01/2015; 350:h2388. · 16.38 Impact Factor
  • Source
    Article: Sex matters
    Archives of Internal Medicine 12/2002; 162(21):2490. DOI:10.1001/archinte.162.21.2490 · 13.25 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We previously discovered that high copeptin is associated with incidence of diabetes mellitus (diabetes), abdominal obesity, and albuminuria. Furthermore, copeptin predicts cardiovascular events after myocardial infarction in diabetic patients, but whether it is associated with heart disease and death in individuals without diabetes and prevalent cardiovascular disease is unknown. In this study, we aim to test whether plasma copeptin (copeptin), the C-terminal fragment of arginine vasopressin prohormone, predicts heart disease and death differentially in diabetic and nondiabetic individuals. We related plasma copeptin to a combined end point composed of coronary artery disease (CAD), heart failure (HF), and death in diabetes (n = 895) and nondiabetes (n = 4187) individuals of the Malmö Diet and Cancer Study-Cardiovascular cohort. Copeptin significantly interacted with diabetes regarding the combined end point (P = .006). In diabetic individuals, copeptin predicted the combined end point (hazard ratio [HR] 1.32 per SD, 95% CI 1.10-1.58, P = .003) after adjustment for conventional risk factors, prevalent HF and CAD, and remained significant after additional adjustment for either fasting glucose (P = .02) or hemoglobin A1c (P = .02). Furthermore, in diabetic individuals, copeptin predicted CAD (HR 1.33 per SD, 95% CI 1.04-1.69, P = .02), HF (HR 1.62 per SD, 95% CI 1.09-2.41, P = .02), and death (HR 1.32 per SD, 95% CI 1.04-1.68, P = .02). Interestingly, among nondiabetic individuals, copeptin was not associated with any of the end points. Copeptin predicted heart disease and death, specifically in diabetes patients, suggesting copeptin and the vasopressin system as a prognostic marker and therapeutic target for diabetic heart disease and death. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.
    American Heart Journal 12/2014; 169(4). DOI:10.1016/j.ahj.2014.11.020 · 4.56 Impact Factor

Preview

Download
1 Download