Overreporting of deaths from coronary heart disease in New York City hospitals, 2003.
BACKGROUND
New York City has one of the highest reported death rates from coronary heart disease in the United States. We sought to measure the accuracy of this rate by examining death certificates.


METHODS
We conducted a cross-sectional validation study by using a random sample of death certificates that recorded in-hospital deaths in New York City from January through June 2003, stratified by neighborhoods with low, medium, and high coronary heart disease death rates. We abstracted data from hospital records, and an independent, blinded medical team reviewed these data to validate cause of death. We computed a comparability ratio (coronary heart disease deaths recorded on death certificates divided by validated coronary heart disease deaths) to quantify agreement between death certificate determination and clinical judgment.


RESULTS
Of 491 sampled death certificates for in-hospital deaths, medical charts were abstracted and reviewed by the expert panel for 444 (90%). The comparability ratio for coronary heart disease deaths among decedents aged 35 to 74 years was 1.51, indicating that death certificates overestimated coronary heart disease deaths in this age group by 51%. The comparability ratio increased with age to 1.94 for decedents aged 75 to 84 years and to 2.37 for decedents aged 85 years or older.


CONCLUSIONS
Coronary heart disease appears to be substantially overreported as a cause of death in New York City among in-hospital deaths.
Agarwal
Reena
R
New York City Department of Health and Mental Hygiene, New York, New York, USA. ragarwal@montefiore.org
Norton
Jennifer M
JM
Konty
Kevin
K
Zimmerman
Regina
R
Glover
Maleeka
M
Lekiachvili
Akaki
A
McGruder
Henraya
H
Malarcher
Ann
A
Casper
Michele
M
Mensah
George A
GA
Thorpe
Lorna
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000401:mortality*; D003644:Death Certificates; D005260:Female; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies
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