Should Cause of Death From the Death Certificate Be Used to Examine Cancer-Specific Survival? A Study of Patients With Distant Stage Disease

Department of Epidemiology, University of North Carolina, Chapel Hill, 27599-7435, USA.
Cancer Investigation (Impact Factor: 2.22). 08/2010; 28(7):758-64. DOI: 10.3109/07357901003630959
Source: PubMed


Death certificates are used to classify cause of death for studies of cancer survival and mortality. Using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, we evaluated cause of death (site-specific, cancer cause-specific, or other cause of death) for 229,181 patients with distant stage disease during 1994-2003 who died by 2005. Agreement between coded cause of death and initial diagnosis was 85% in patients with only one primary and 64% in patients with more than one primary. Our findings support the usefulness of site and cancer cause-specific causes of death reported on the death certificate for distant stage patients with a single cancer.

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Available from: Jennifer Lund, Oct 05, 2015
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    • "Inaccuracies in cause of death recording through death certificates have been reported ( O ' Sullivan , 2011 ) . With regard to cancer , this mainly concerns site - specific accuracy rather than causes other than cancer being recorded ( Lund et al , 2010 ) . Our use of aggregated cause of death categories ( solid vs haematological cancer ) may have mitigated this problem . "
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    • "We therefore sought to test two hypotheses regarding patients who die as inpatients: (1) at the individual-level, there would be poor agreement between death certificate-derived causes of death and the proximal causes of death as revealed by the primary diagnosis of a terminal hospitalization; and (2) there would be systematic under-representation of infections in death certificate data relative to terminal hospitalization data. Unlike most past studies of the accuracy of death certificates, which often rely on data from only a single/few institutions or examine only one pathology [12]–[19], we examined all inpatient deaths across multiple pathologies in the Health and Retirement Study (HRS)—a nationwide sample of older Americans—who had linked Medicare claims and National Death Index (NDI) data from 1993–2007 (the latest years for which all data is available). "
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    ABSTRACT: Background Death certificates are a primary data source for assessing the population burden of diseases; however, there are concerns regarding their accuracy. Diagnosis-Related Group (DRG) coding of a terminal hospitalization may provide an alternative view. We analyzed the rate and patterns of disagreement between death certificate data and hospital claims for patients who died during an inpatient hospitalization. Methods We studied respondents from the Health and Retirement Study (a nationally representative sample of older Americans who had an inpatient death documented in the linked Medicare claims from 1993–2007). Causes of death abstracted from death certificates were aggregated to the standard National Center for Health Statistics List of 50 Rankable Causes of Death. Centers for Medicare and Medicaid Services (CMS)-DRGs were manually aggregated into a parallel classification. We then compared the two systems via 2×2, focusing on concordance. Our primary analysis was agreement between the two data sources, assessed with percentages and Cohen's kappa statistic. Results 2074 inpatient deaths were included in our analysis. 36.6% of death certificate cause-of-death codes agreed with the reason for the terminal hospitalization in the Medicare claims at the broad category level; when re-classifying DRGs without clear alignment as agreements, the concordance only increased to 61%. Overall Kappa was 0.21, or “fair.” Death certificates in this cohort redemonstrated the conventional top 3 causes of death as diseases of the heart, malignancy, and cerebrovascular disease. However, hospitalization claims data showed infections, diseases of the heart, and cerebrovascular disease as the most common diagnoses for the same terminal hospitalizations. Conclusion There are significant differences between Medicare claims and death certificate data in assigning cause of death for inpatients. The importance of infections as proximal causes of death is underestimated by current death certificate-based strategies.
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