Abstract
Causes of death of 625 subjects who died during the 4-year follow-up of a large population-based elderly cohort (Three-City study) were independently classified by the study adjudication committee and the national mortality register. The former used all available data about the cause of death (hospital records, medical data obtained from family physicians or specialists, and proxy interviews) and the latter used internationally standardized recommendations for processing death certificate data. Comparison showed a moderate overall agreement for underlying cause of death between the study adjudication committee and the national register (kappa = 0.51). Differences were found especially for cardiovascular diseases (20.6% of deaths from the study committee vs. 32.5% from the national register) and ill-defined causes of death (22.7 vs. 4%). The proportion of disagreement increased in participants dying at age >85 compared to those dying at age ≤70 (adjusted odds ratio = 2.46, 95% confidence interval = 1.10–5.49). It was also higher when the study committee used hospital record data for defining cause of death, compared to adjudication based on data obtained from proxy (adjusted odds ratio = 1.85, 95% CI = 1.09–3.14). These findings raise questions about the validity of national mortality registers in very old persons. Disease-specific causes of death, especially vascular diseases, could be overestimated in this age group.
Similar content being viewed by others
References
Alperovitch A. Vascular factors and risk of dementia: design of the Three-City study and baseline characteristics of the study population. Neuroepidemiology. 2003;22(6):316–25.
International classification of diseases 10th revision. World Health Organization: Geneva; 1993.
CepiDc-Inserm. Centre d’épidémiologie sur les causes médicales de décès (CépiDc-Inserm). http://www.cepidc.vesinet.inserm.fr (2008).
Ives DG, Samuel P, Psaty BM, Kuller LH. Agreement between nosologist and cardiovascular health study review of deaths: implications of coding differences. J Am Geriatr Soc. 2009;57:133–9.
Rao C, Yang G, Hu J, Ma J, Xia W, Lopez AD. Validation of cause-of-death statistics in urban China. Int J Epidemiol. 2007;36:642–51.
Makinen T, Karhunen P, Aro J, Lahtela J, Maattanen L, Auvinen A. Assessment of causes of death in a prostate cancer screening trial. Int J Cancer. 2008;122:413–7.
Ducimetiere P, Jougla E, Haas B, Montaye M, Ruidavets JB, Amouyel P, et al. [Coronary mortality in France according to data sources] Mortalite coronaire en France selon les sources d’information. Rev Epidemiol Sante Publique. 2006;54:453–61.
Pajunen P, Koukkunen H, Ketonen M, Jerkkola T, Immonen-Raiha P, Karja-Koskenkari P, et al. The validity of the Finnish Hospital Discharge Register and causes of death register data on coronary heart disease. Eur J Cardiovasc. 2005;12:132–7.
Chugh SS, Jui J, Gunson K, Stecker EC, John BT, Thompson B, et al. Current burden of sudden cardiac death: multiple source surveillance versus retrospective death certificate-based review in a large U.S. community. J Am Coll Cardiol. 2004;44:1268–75.
Saydah SH, Geiss LS, Tierney E, Benjamin SM, Engelgau M, Brancati F. Review of the performance of methods to identify diabetes cases among vital statistics, administrative, and survey data. Ann Epidemiol. 2004;14:507–16.
Coady SA, Sorlie PD, Cooper LS, Folsom AR, Rosamond WD, Conwill DE. Validation of death certificate diagnosis for coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study. J Clin Epidemiol. 2001;54:40–50.
Goraya TY, Jacobsen SJ, Belau PG, Weston SA, Kottke TE, Roger VL. Validation of death certificate diagnosis of out-of-hospital coronary heart disease deaths in Olmsted County, Minnesota. Mayo Clin Proc. 2000;75:681–7.
Sidenius KE, Munch EP, Madsen F, Lange P, Viskum K, Soes-Petersen U. Accuracy of recorded asthma deaths in Denmark in a 12-months period in 1994/95. Respir Med. 2000;94:373–7.
Ederer F, Geisser MS, Mongin SJ, Church TR, Mandel JS. Colorectal cancer deaths as determined by expert committee and from death certificate: a comparison. The Minnesota Study. J Clin Epidemiol. 1999;52:447–52.
Iribarren C, Crow RS, Hannan PJ, Jacobs DR Jr, Luepker RV. Validation of death certificate diagnosis of out-of-hospital sudden cardiac death. Am J Cardiol. 1998;82:50–3.
Johansson LA, Westerling R, Rosenberg HM. Methodology of studies evaluating death certificate accuracy were flawed. J Clin Epidemiol. 2006;59:125–31.
World Health Organization DoMaHI. Mortality indicators by 67 causes of death, age and sex (HFA-MDB). WHO 2009 Available from: http://data.euro.who.int/hfamdb/ (2009).
Avila-Funes JA, Amieva H, Barberger-Gateau P, Le Goff M, Raoux N, Ritchie K, et al. Cognitive impairment improves the predictive validity of the phenotype of frailty for adverse health outcomes: the three-city study. J Am Geriatr Soc. 2009;57:453–61.
Schultz-Larsen K, Rahmanfard N, Kreiner S, Avlund K, Holst C. Cognitive impairment as assessed by a short form of MMSE was predictive of mortality. J Clin Epidemiol. 2008;61:1227–33.
Freedberg DE, Dave J, Kurth T, Gaziano JM, Bludau JH. Cognitive impairment over the age of 85: hospitalization and mortality. Arch Gerontol Geriatr. 2008;46:137–45.
Kohn RR. Cause of death in very old people. JAMA. 1982;247:2793–7.
Acknowledgments
The Three-City (3C) Study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Medicale (INSERM), the Victor Segalen–Bordeaux II University, and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The 3C Study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, Mutuelle Générale de l’Education Nationale, Institut de la Longévité, Conseils Régionaux of Aquitaine and Bourgogne, Fondation de France, and Ministry of Research–INSERM Programme “Cohortes et collections de données biologiques.” Sponsors are involved neither in the design of the study nor in the data analyses or manuscript elaboration.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alpérovitch, A., Bertrand, M., Jougla, E. et al. Do we really know the cause of death of the very old? Comparison between official mortality statistics and cohort study classification. Eur J Epidemiol 24, 669–675 (2009). https://doi.org/10.1007/s10654-009-9383-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10654-009-9383-2