title: Impact of a hospital-level intervention to reduce heart disease overreporting on leading causes of death.
abstract: BACKGROUND
  The quality of cause-of-death reporting on death certificates affects the usefulness of vital statistics for public health action. Heart disease deaths are overreported in the United States. We evaluated the impact of an intervention to reduce heart disease overreporting on other leading causes of death.
  
  
  METHODS
  A multicomponent intervention comprising training and communication with hospital staff was implemented during July through December 2009 at 8 New York City hospitals reporting excessive heart disease deaths. We compared crude, age-adjusted, and race/ethnicity-adjusted proportions of leading, underlying causes of death reported during death certification by intervention and nonintervention hospitals during preintervention (January-June 2009) and postintervention (January-June 2010) periods. We also examined trends in leading causes of death for 2000 through 2010.
  
  
  RESULTS
  At intervention hospitals, heart disease deaths declined by 54% postintervention; other leading causes of death (ie, malignant neoplasms, influenza and pneumonia, cerebrovascular disease, and chronic lower respiratory diseases) increased by 48% to 232%. Leading causes of death at nonintervention hospitals changed by 6% or less. In the preintervention period, differences in leading causes of death between intervention and nonintervention hospitals persisted after controlling for race/ethnicity and age; in the postintervention period, age accounted for most differences observed between intervention and nonintervention hospitals. Postintervention, malignant neoplasms became the leading cause of premature death (ie, deaths among patients aged 35-74 y) at intervention hospitals.
  
  
  CONCLUSIONS
  A hospital-level intervention to reduce heart disease overreporting led to substantial changes to other leading causes of death, changing the leading cause of premature death. Heart disease overreporting is likely obscuring the true levels of cause-specific mortality.
authors.affiliation: Santa Clara County Department of Public Health, San Jose, CA 95126, USA. teeb.al-samarrai@phd.sccgov.org
authors.forename: Teeb
authors.initials: T
authors.lastname: Al-Samarrai
authors.forename: Ann
authors.initials: A
authors.lastname: Madsen
authors.forename: Regina
authors.initials: R
authors.lastname: Zimmerman
authors.forename: Gil
authors.initials: G
authors.lastname: Maduro
authors.forename: Wenhui
authors.initials: W
authors.lastname: Li
authors.forename: Carolyn
authors.initials: C
authors.lastname: Greene
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Begier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D003644:Death Certificates; D005260:Female; D006331:Heart Diseases / Q000145:classification / Q000208:ethnology / Q000401:mortality* / Q000517:prevention & control*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education* / Q000523:psychology; D008875:Middle Aged; D015233:Models, Statistical; D009519:New York City; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000592:standards*; D015397:Program Evaluation