| dc.description.abstract | Background: Heart failure is sometimes incorrectly listed as the underlying cause of death (UCD) on death certificates,
thus compromising the accuracy and comparability of mortality statistics. Statistical redistribution of the UCD has been
used to examine the effect of misclassification of the UCD attributed to heart failure, but sex- and race-specific
redistribution of deaths on coronary heart disease (CHD) mortality in the United States has not been examined.
Methods: We used coarsened exact matching to infer the UCD of vital records with heart failure as the UCD from
1999 to 2010 for decedents 55 years old and older from states encompassing regions under surveillance by the
Atherosclerosis Risk in Communities (ARIC) Study (Maryland, Minnesota, Mississippi, and North Carolina). Records with
heart failure as the UCD were matched on decedent characteristics (five-year age groups, sex, race, education, year of
death, and state) to records with heart failure listed among the multiple causes of death. Each heart failure death was
then redistributed to plausible UCDs proportional to the frequency among matched records.
Results: After redistribution the proportion of deaths increased for CHD, chronic obstructive pulmonary disease, diabetes,
hypertensive heart disease, and cardiomyopathy, P < 0.001. The percent increase in CHD mortality after redistribution was
the highest in Mississippi (12%) and lowest in Maryland (1.6%), with variations by year, race, and sex. Redistribution
proportions for CHD were similar to CHD death classification by a panel of expert reviewers in the ARIC study.
Conclusions: Redistribution of ill-defined UCD would improve the accuracy and comparability of mortality statistics used
to allocate public health resources and monitor mortality trends.
Keywords: Cause of death, Coronary heart disease, Death certificates, Heart failure, Mortality, Vital statistics, Ill-defined
causes of death | |
