Effects of inappropriate cause-of-death certification on mortality from cardiovascular disease and diabetes mellitus in Tonga.
Adult mortality
Cardiovascular disease
Cause of death
Death certification
Diabetes
ICD coding
Tonga
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
01 Dec 2023
01 Dec 2023
Historique:
received:
07
09
2023
accepted:
22
11
2023
medline:
4
12
2023
pubmed:
2
12
2023
entrez:
1
12
2023
Statut:
epublish
Résumé
Cardiovascular disease (CVD) and diabetes mellitus are major health issues in Tonga and other Pacific countries, although mortality levels and trends are unclear. We assess the impacts of cause-of-death certification on coding of CVD and diabetes as underlying causes of death (UCoD). Tongan records containing cause-of-death data (2001-2018), including medical certificates of cause-of-death (MCCD), had UCoD assigned according to International Classification of Diseases 10th revision (ICD-10) coding rules. Deaths without recorded cause were included to ascertain total mortality. Diabetes and hypertension causes were reallocated from Part 1 of the MCCD (direct cause) to Part 2 (contributory cause) if potentially fatal complications were not recorded, and an alternative UCoD was assigned. Proportional mortality by cause based on the alternative UCoD were applied to total deaths then mortality rates calculated by age and sex using census/intercensal population estimates. CVD and diabetes mortality rates for unaltered and alternative UCoD were compared using Poisson regression. Over 2001-18, in ages 35-59 years, alternative CVD mortality was higher than unaltered CVD mortality in men (p = 0.043) and women (p = 0.15); for 2010-18, alternative versus unaltered measures in men were 3.3/10 Diabetes reporting in Part 1 of the MCCD, without potentially fatal diabetes complications, has led to over-estimation of diabetes, and under-estimation of CVD, as UCoD in Tonga. This indicates the importance of controlling various modifiable risks for atherosclerotic CVD (including stroke) including hypertension, tobacco use, and saturated fat intake, besides obesity and diabetes. Accurate certification of diabetes as a direct cause of death (Part 1) or contributory factor (Part 2) is needed to ensure that valid UCoD are assigned. Examination of multiple cause-of-death data can improve understanding of the underlying causes of premature mortality to better inform health planning.
Sections du résumé
BACKGROUND
BACKGROUND
Cardiovascular disease (CVD) and diabetes mellitus are major health issues in Tonga and other Pacific countries, although mortality levels and trends are unclear. We assess the impacts of cause-of-death certification on coding of CVD and diabetes as underlying causes of death (UCoD).
METHODS
METHODS
Tongan records containing cause-of-death data (2001-2018), including medical certificates of cause-of-death (MCCD), had UCoD assigned according to International Classification of Diseases 10th revision (ICD-10) coding rules. Deaths without recorded cause were included to ascertain total mortality. Diabetes and hypertension causes were reallocated from Part 1 of the MCCD (direct cause) to Part 2 (contributory cause) if potentially fatal complications were not recorded, and an alternative UCoD was assigned. Proportional mortality by cause based on the alternative UCoD were applied to total deaths then mortality rates calculated by age and sex using census/intercensal population estimates. CVD and diabetes mortality rates for unaltered and alternative UCoD were compared using Poisson regression.
RESULTS
RESULTS
Over 2001-18, in ages 35-59 years, alternative CVD mortality was higher than unaltered CVD mortality in men (p = 0.043) and women (p = 0.15); for 2010-18, alternative versus unaltered measures in men were 3.3/10
CONCLUSIONS
CONCLUSIONS
Diabetes reporting in Part 1 of the MCCD, without potentially fatal diabetes complications, has led to over-estimation of diabetes, and under-estimation of CVD, as UCoD in Tonga. This indicates the importance of controlling various modifiable risks for atherosclerotic CVD (including stroke) including hypertension, tobacco use, and saturated fat intake, besides obesity and diabetes. Accurate certification of diabetes as a direct cause of death (Part 1) or contributory factor (Part 2) is needed to ensure that valid UCoD are assigned. Examination of multiple cause-of-death data can improve understanding of the underlying causes of premature mortality to better inform health planning.
Identifiants
pubmed: 38041110
doi: 10.1186/s12889-023-17294-z
pii: 10.1186/s12889-023-17294-z
pmc: PMC10691179
doi:
Substances chimiques
methylcyanocarbamate dimer
100753-38-6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2381Informations de copyright
© 2023. The Author(s).
Références
BMC Med Inform Decis Mak. 2021 Jun 2;21(1):175
pubmed: 34078366
Eur J Cardiovasc Prev Rehabil. 2006 Oct;13(5):760-8
pubmed: 17001216
BMC Public Health. 2019 May 2;19(1):481
pubmed: 31046741
Popul Health Metr. 2015 Aug 25;13:21
pubmed: 26309427
BMC Public Health. 2021 Jan 6;21(1):36
pubmed: 33407295
World J Diabetes. 2015 Oct 10;6(13):1246-58
pubmed: 26468341
Popul Health Metr. 2010 May 10;8:9
pubmed: 20459720
J Diabetes. 2016 Nov;8(6):766-769
pubmed: 27400903
J Am Coll Cardiol. 2017 Aug 15;70(7):883-893
pubmed: 28797359
Cancer Causes Control. 2011 Jul;22(7):1047-53
pubmed: 21617924
Diabet Med. 2017 May;34(5):654-661
pubmed: 27505623
J Clin Epidemiol. 2005 Nov;58(11):1150-7
pubmed: 16223658
Asia Pac J Public Health. 2016 Sep;28(6):475-85
pubmed: 27122623
J Clin Epidemiol. 2013 Feb;66(2):236-7
pubmed: 23159105
Popul Health Metr. 2012 Aug 14;10(1):14
pubmed: 22891707
Ann Intern Med. 2019 Aug 6;171(3):190-198
pubmed: 31284304
J Clin Epidemiol. 2013 Feb;66(2):237-8
pubmed: 23186993
JAMA. 2016 Sep 27;316(12):1289-97
pubmed: 27673306
Diabetes Care. 1990 Nov;13(11):1169-79
pubmed: 2261838
BMC Public Health. 2018 Sep 15;18(1):1122
pubmed: 30219049
Popul Health Metr. 2012 Mar 05;10(1):4
pubmed: 22390221
Diabetes Care. 2011 Jul;34(7):1529-33
pubmed: 21709292
Am J Epidemiol. 1990 Feb;131(2):373-5
pubmed: 2296988
Popul Health Metr. 2011 Mar 15;9:8
pubmed: 21406100
Public Health Action. 2014 Jun 21;4(Suppl 1):S44-9
pubmed: 26477287
J Clin Epidemiol. 2010 Feb;63(2):199-204
pubmed: 19664902
Br J Gen Pract. 2001 Apr;51(465):291-4
pubmed: 11458482
Lancet. 1992 May 23;339(8804):1268-78
pubmed: 1349675
Aust N Z J Public Health. 2008 Apr;32(2):117-25
pubmed: 18412680
Prev Med. 2018 Apr;109:82-97
pubmed: 29291422
Stat Med. 1991 Mar;10(3):457-62
pubmed: 2028128
Cochrane Database Syst Rev. 2011 Jan 19;(1):CD001561
pubmed: 21249647
Lancet Glob Health. 2019 Oct;7(10):e1332-e1345
pubmed: 31488387