title: The mortality burden of chronic liver disease may be substantially underestimated in the United States.
abstract: OBJECTIVE
  The United States National Center for Health Statistics (NCHS) uses death certificate data to estimate the burden of serious disease. This study aimed to determine the accuracy of the NCHS method for estimating the burden of chronic liver disease (CLD).
  
  
  METHODS
  The authors identified death certificates of New Haven County residents who died from October 1999-September 2000 that were assigned one of 115 ICD-10 codes that might indicate CLD. They reviewed medical charts, medical examiner records and a certifier questionnaire to determine whether CLD was the cause of death.
  
  
  RESULTS
  Using the authors' determination of CLD status as the gold standard, the specificity of the NCHS classification was high (86%), but the sensitivity was low (36%). The authors found that adding selected ICD-10 codes to those considered by the NCHS to be CLD (certain CLD malignancies and viral hepatitis) could improve sensitivity. Ensuring that deaths attributed by certifiers to "End Stage Liver Disease" were coded as CLD could also improve completeness. These modifications could increase sensitivity substantially with little effect on specificity.
  
  
  CONCLUSIONS
  The NCHS method may understate the CLD burden substantially which could have a detrimental effect on planning for and evaluating prevention and treatment. Modifications could improve completeness.
authors.affiliation: Yale Center for Public Health, New Haven, CT 06510, USA.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Durante
authors.forename: Thomas
authors.initials: T
authors.lastname: St Louis
authors.forename: James I
authors.initials: JI
authors.lastname: Meek
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Navarro
authors.forename: André N
authors.initials: AN
authors.lastname: Sofair