TY - JOUR
T1 - Changes in certification of diabetes with cardiovascular diseases increased reported diabetes mortality in Australia and the United States
AU - Adair, Timothy
AU - Rao, Chalapati
PY - 2010/2
Y1 - 2010/2
N2 - Objective: This paper seeks to better understand diabetes-related mortality in Australia and the United States through analysis of the impact of certification practices of diabetes as a multiple cause of death, specifically with cardiovascular diseases (CVDs). Study Design and Setting: Vital registration multiple cause of death data in Australia and the United States since 1999 are used to examine trends in the ratio of diabetes reported in Part I (underlying cause) and Part II (associated cause) of the death certificate, when CVDs are also reported. Results: Underlying cause of death (UCOD) statistics mask the magnitude of diabetes-related mortality. In both countries, since 1999 there has been an increase in the ratio of diabetes deaths in Part I vs. Part II where CVD deaths, including ischemic heart disease and cerebrovascular diseases, are also reported. In Australia, diabetes reported as an UCOD would be 12% lower in 2006 if the ratio from 1999 was applied. Conclusion: The increasing likelihood of physicians to report diabetes in Part I reflects the subjectivity of diabetes death certification. There is a need for specific guidelines on death certification of diabetes with cardiovascular conditions, relating to its reporting as an underlying or associated cause.
AB - Objective: This paper seeks to better understand diabetes-related mortality in Australia and the United States through analysis of the impact of certification practices of diabetes as a multiple cause of death, specifically with cardiovascular diseases (CVDs). Study Design and Setting: Vital registration multiple cause of death data in Australia and the United States since 1999 are used to examine trends in the ratio of diabetes reported in Part I (underlying cause) and Part II (associated cause) of the death certificate, when CVDs are also reported. Results: Underlying cause of death (UCOD) statistics mask the magnitude of diabetes-related mortality. In both countries, since 1999 there has been an increase in the ratio of diabetes deaths in Part I vs. Part II where CVD deaths, including ischemic heart disease and cerebrovascular diseases, are also reported. In Australia, diabetes reported as an UCOD would be 12% lower in 2006 if the ratio from 1999 was applied. Conclusion: The increasing likelihood of physicians to report diabetes in Part I reflects the subjectivity of diabetes death certification. There is a need for specific guidelines on death certification of diabetes with cardiovascular conditions, relating to its reporting as an underlying or associated cause.
KW - Cardiovascular diseases
KW - Cerebrovascular diseases
KW - Death certification
KW - Diabetes
KW - Ischemic heart disease
KW - Multiple causes of death
UR - http://www.scopus.com/inward/record.url?scp=72749116675&partnerID=8YFLogxK
U2 - 10.1016/j.jclinepi.2009.04.002
DO - 10.1016/j.jclinepi.2009.04.002
M3 - Article
SN - 0895-4356
VL - 63
SP - 199
EP - 204
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 2
ER -