International Journal of Epidemiology 2000;29:495-502
© International Epidemiological Association 2000
Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics
a Statistics Sweden.
b Department of Public Health and Caring Sciences, Unit of Social Medicine, Uppsala University, Sweden.
Reprint requests to: Lars Age Johansson, BV/HS, Statistics Sweden, Box 24 300, SE-104 51 Stockholm, Sweden.
Background 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.
Methods 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.
Results 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.
Conclusions 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.
Keywords Cause of death, death certificates, main diagnosis, hospital records, quality control, medical record linkage
Accepted 27 October 1999
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