Redistribution of heart failure as the cause of death: the Atherosclerosis Risk in Communities Study.
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.
Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, 137 E, Franklin St,, Suite 306, Chapel Hill, NC 27514, USA. mlmeyer@unc.edu.
Michelle L
ML
Snyder
Shelly-Ann
SA
Love
Paul D
PD
Sorlie
Wayne D
WD
Rosamond
Carmen
C
Antini
Patricia A
PA
Metcalf
Shakia
S
Hardy
Chirayath M
CM
Suchindran
Eyal
E
Shahar
Gerardo
G
Heiss