title: Under reporting of dementia deaths on death certificates: a systematic review of population-based cohort studies.
abstract: The purpose of this review is to assess the extent to which dementia is omitted as a cause of death from the death certificates of patients with dementia. A systematic literature search was performed to identify population-based cohort studies in which all participants were examined or screened for symptoms of dementia with a validated instrument followed by confirmation of any suspected cases with a clinical examination (two-phase investigation). Data were extracted in a standardized manner and assessed through the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative. Seven studies met the selection criteria. These were from the Americas (5 articles: 2 from Canada, 2 from the US, and 1 from Brazil) and Europe (2 articles: 1 from the UK and 1 from Spain). Each met at least 83% of the STROBE criteria. The reporting of dementia on death certificates was poor in these 7 studies, ranging from 7.2%-41.8%. Respiratory or circulatory-related problems were the most frequently reported causes of death among people who were demented but who were not reported as demented on death certificates. The use of death certificates for studying dementia grossly underestimates the occurrence of dementia in the population. The poor reporting of dementia on these certificates suggests a lack of awareness of the importance of dementia as a cause of death among medical personnel. There is an urgent need to provide better education on the importance of codification of dementia on death certificates in order to minimize errors in epidemiological studies on dementia.
authors.affiliation: Department of Neurology University Hospital "12 de Octubre", Madrid, Spain.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Romero
authors.affiliation: Department of Neurology University Hospital "12 de Octubre", Madrid, Spain Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain Department of Medicine, Complutense University, Madrid, Spain.
authors.forename: Julián
authors.initials: J
authors.lastname: Benito-León
authors.affiliation: G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Elan D
authors.initials: ED
authors.lastname: Louis
authors.affiliation: Department of Neurology University Hospital "12 de Octubre", Madrid, Spain Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain Department of Medicine, Complutense University, Madrid, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Bermejo-Pareja
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002423:Cause of Death; D003644:Death Certificates; D003704:Dementia / Q000175:diagnosis* / Q000401:mortality*; D006801:Humans; D013030:Spain / Q000453:epidemiology; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
keywords: Death certificates; elderly; epidemiology; population-based study; systematic review