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Hermann Brenner - One of the best experts on this subject based on the ideXlab platform.
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Death Certificate only proportions should be age adjusted in studies comparing cancer survival across populations and over time
European Journal of Cancer, 2016Co-Authors: Hermann Brenner, Bernd Holleczek, Lina Jansen, Felipe A Castro, Andrea Eberle, Katharina Emrich, Alexander Katalinic, Gekid Cancer Survival WorkgroupAbstract:Abstract Background The proportion of cases notified by Death Certificate only (DCO) is a commonly used data quality indicator in studies comparing cancer survival across regions and over time. We aimed to assess dependence of DCO proportions on the age structure of cancer patients. Methods Using data from a national cancer survival study in Germany, we determined age specific and overall (crude) DCO proportions for 24 common forms of cancer. We then derived overall (crude) DCO proportions expected in case of shifts of the age distribution of the cancer populations by 5 and 10 years, respectively, assuming age specific DCO proportions to remain constant. Results Median DCO proportions across the 24 cancers were 2.4, 3.7, 5.5, 8.5 and 23.9% in age groups 15–44, 45–54, 55–64, 65–74, and 75+, respectively. A decrease of ages by 5 and 10 years resulted in decreases of cancer specific crude DCO proportions ranging from 0.4 to 4.8 and from 0.7 to 8.6 percent units, respectively. Conversely, an increase of ages by 5 and 10 years led to increases of cancer specific crude DCO proportions ranging from 0.8 to 4.8 and from 1.8 to 9.6 percent units, respectively. These changes were of similar magnitude (but in opposite direction) as changes in crude 5-year relative survival resulting from the same shifts in age distribution. Conclusions The age structure of cancer patient populations has a substantial impact on DCO proportions. DCO proportions should therefore be age adjusted in comparative studies on cancer survival across regions and over time.
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implications from under reporting at lifetime Death Certificate notifications and trace back on the recorded incidence of a newly established population based cancer registry
Methods of Information in Medicine, 2015Co-Authors: Bernd Holleczek, Hermann BrennerAbstract:Objectives: Population-based cancer registries (CRs) are powerful tools for measuring cancer burden and progress against cancer. The study’s objective was to investigate the effects of under-reporting at lifetime, Death Certificate notifications, and trace-back on the incidence a newly established population-based CR may record during its initial 15 years of operation. Methods: Using cancer data of nine CRs of the SEER programme we performed model calculations to investigate temporal trends of the recorded incidence that might be expected if registration started in 1995 with gradually increasing proportions of cancers reported to the CR. It was assumed that the CR obtains all Death Certificates providing cancer as the underlying cause of Death. Different scenarios with regard to the development of the proportions of cancers reported to the CR and the use of trace-back were evaluated. Results: Our model calculations demonstrated that the inclusion of cancers notified from Death Certificates which were diagnosed prior to the start of registration and which attribute to the incidence estimates of the year of Death (‘prevalent’ cases) may compensate under-reporting typically observed right after the start of a CR. The recorded incidence may even be overestimated during the first years of registration, if large amounts of prevalent cancers are notified from Death Certificates (e.g. overestimation of lung cancer incidence by 8% and 21% in the first year of registration, if the proportions of cases reported were 50% and 70% in that year, overestimation of myeloma incidence still exceeding 5% after eight years of registration, if the proportion of cases reported to the CR had reached 97.5% after six years). Trace-back may effectively reduce the recorded surplus cancer cases. Conclusions: During the initial years of registration, the inclusion of prevalent cancers from Death Certificates may compensate the higher amount of underreporting right after the start of a CR. Accurate incidence estimates may nevertheless be observed for highly fatal cancers if substantial proportions of cancer cases are missed at lifetime, however apparent incidence trends observed in the initial years of registration need to be interpreted with caution.
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determinants and interpretation of Death Certificate only proportions in the initial years of newly established cancer registries
European Journal of Cancer, 2013Co-Authors: Hermann Brenner, Lina JansenAbstract:Abstract Background The proportion of cases notified by Death Certificate only (DCO) is a commonly used criterion to judge completeness of cancer registration even though it is affected by additional factors, particularly during initial years of newly established registries. Methods Based on cancer registry data from the United States, we provide model calculations to demonstrate the magnitude and time course of the impact of the following mechanisms on DCO proportions of “young” registries: registration of cancer Deaths from patients diagnosed prior to the registration period and delayed registration by Death Certificate of patients diagnosed but not reported after initiation of registration. Results DCO proportions of up to ⩾30% can be expected from Deaths of previously diagnosed patients during the first year of registration. Although this proportion is expected to gradually diminish over subsequent years, DCO proportions may be dominated for several years by this source, which may still be relevant after 10 or more years of cancer registration for cancers with relatively large proportions of late Deaths. Otherwise, however, underreporting during patients’ lifetime is expected to become the predominant source of DCO proportions in the long run. Conclusions Our results may guide interpretation of DCO proportions of relatively “young” cancer registries.
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Reduction of population-based cancer survival estimates by trace back of Death Certificate notifications: an empirical illustration.
European journal of cancer (Oxford England : 1990), 2011Co-Authors: Bernd Holleczek, Hermann BrennerAbstract:Abstract Background Survival studies using data from population-based cancer registries allow assessing effectiveness of cancer care on a population level. However, population-based cancer registries differ in the proportion of cases first notified by Death Certificate, as well as in the efforts to trace back such Death Certificate notifications (DCN). We aimed to assess the impact of such trace back on population-based cancer survival estimates. Materials and methods In this study from the population-based Saarland Cancer Registry (Germany) we investigated the survival experience of successfully traced back DCN cases from 1994 to 2003. Five-year relative survival of patients with DCN cancers and the effect of trace back on population-based 5-year relative survival estimates were analysed by age and tumour site. Results Twelve percent of all cancers were DCN and such cases occurred most often amongst sites with poor prognosis and amongst elderly patients. Approximately half of DCN cases could be successfully traced back. Five-year relative survival of patients with DCN cancers with trace back was 2%. The inclusion of DCN cancers with additional registrations reduced the 5-year relative survival estimate for all cancers combined by 4% points. Reductions were stronger for older patients and highly fatal cancers. Conclusions Trace back results in increased inclusion of patients with very poor prognosis. Varying extent of trace back across registries may compromise comparability of cancer survival estimates and should be taken into account in comparative cancer survival studies.
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limitations of the Death Certificate only index as a measure of incompleteness of cancer registration
British Journal of Cancer, 1995Co-Authors: Hermann BrennerAbstract:The Death Certificate only (DCO) index, which quantifies the proportion of patients for whom the Death Certificate provides the only notification to the registry, is a widely used measure of incompleteness of population-based cancer registration. This paper provides an algebraic assessment and a quantitative illustration of the relationship between the DCO index and incompleteness of cancer registration. It is shown that the relationship between the DCO index and incompleteness of registration is strongly dependent on the case fatality rate and the misclassification rates of cancer Deaths among unregistered patients. Therefore, the DCO index is a very poor indicator of incompleteness. Similar limitations apply to the DCN index (proportion of cases first notified by Death Certificate), which has been proposed as an alternative measure of incompleteness.
Luc Deliens - One of the best experts on this subject based on the ideXlab platform.
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trends in place of Death in a small developing country a population level study using Death Certificate data
Journal of Epidemiology and Community Health, 2020Co-Authors: Nicholas Paul Jennings, Luc Deliens, Kenneth Chambaere, Joachim CohenAbstract:Background Valuable information for planning future end-of-life care (EOLC) services and care facilities can be gained by studying trends in place of Death (POD). Scarce data exist on the POD in small developing countries. This study aims to examine shifts in the POD of all persons dying between 1999 and 2010 in Trinidad and Tobago, to draw conclusions about changes in the distribution of POD over time and the possible implications for EOLC practice and policy. Methods A population-level analysis of routinely collected Death Certificate data of the most recent available fully coded years at the time of the study—1999 to 2010. Observed proportions for the POD of all Deaths were standardised according to the age, sex and cause of Death distribution in 1999. Trends for a subgroup of persons who died from causes indicative of a palliative care (PC) need were also examined. Results The proportion of Deaths in government hospitals increased from 48.9% to 55.4% and decreased from 38.7% to 29.7% at private homes. There was little variation between observed and standardised rates. The decrease in home Deaths was stronger when the PC subcategory was considered, most notably from cancer. Conclusion Internationally, the proportion of Deaths at institutions is increasing. A national strategy on palliative and EOLC is needed to facilitate the increasing number of people who seek EOLC at government hospitals in Trinidad and Tobago, including an investigation into the reasons for the trend. Alternatives to accommodate out-of-hospital Deaths can be considered.
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dying in hospital a study of incidence and factors related to hospital Death using Death Certificate data
European Journal of Public Health, 2014Co-Authors: Dirk Houttekier, Joachim Cohen, Luc Deliens, Thierry PepersackAbstract:Background: Most people prefer not to die in a hospital, and for those with palliative care needs, doing so may result in inappropriate care and poor outcomes. We examined place of Death and factors associated with hospital Death in a population eligible for palliative care. Methods: We used Death Certificate data to identify Deaths from conditions eligible for palliative care and to examine place of Death and demographic, socioeconomic and environmental characteristics associated with hospital Death in Belgium in 2008. Results: Of all people eligible for palliative care (N = 44 229, i.e. 43.5% of all Deaths), 51% died in hospital, 25% at home and 24% in long-term care settings. Of those officially living at home at the time of Death, hospital Death occurred in >60%; of those living in long-term care settings, this was 16%. Nine percent of those living at home alone at the time of Death died in long-term care settings; of those living with others, this was 5%. In both, those living at home and those living in long-term care settings, hospital Death was more likely in areas with higher availability of hospital beds and less likely in areas with higher availability of skilled nursing beds in long-term care settings. Conclusions: Hospital Death is still common among those eligible for palliative care. The significant proportion of people living at home and dying in long-term care settings indicates the need for additional inpatient beds for terminal care in palliative care institutions.
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which patients with cancer die at home a study of six european countries using Death Certificate data
Journal of Clinical Oncology, 2010Co-Authors: Joachim Cohen, Johan Bilsen, Guido Miccinesi, Julia Addingtonhall, Stein Kaasa, Bregje D Onwuteakaphilipsen, Dirk Houttekier, Luc DeliensAbstract:Purpose This study examines the proportion of cancer Deaths occurring at home in six European countries in relation to illness and to demographic and health care factors. Methods Death Certificate data of all cancer-related Deaths in 2002 in Italy and 2003 in Belgium, the Netherlands, Norway, England, and Wales (N = 238,216) were linked with regional health care and area statistics. Multivariate binomial logistic regressions were performed to examine factors associated with dying at home. Results The percentage of all cancer Deaths occurring at home was 12.8 in Norway, 22.1 in England, 22.7 in Wales, 27.9 in Belgium, 35.8 in Italy, and 45.4 in the Netherlands. Having solid cancers and being married increased the chances of dying at home in all countries. Being older and being a woman decreased the chances of dying at home, except in Italy where the opposite was the case. A higher educational attainment was associated with better chances of dying at home in Belgium, Italy, and Norway (countries where infor...
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using Death Certificate data to study place of Death in 9 european countries opportunities and weaknesses
BMC Public Health, 2007Co-Authors: Joachim Cohen, Johan Bilsen, Guido Miccinesi, Rurik Lofmark, Julia Addingtonhall, Stein Kaasa, Michael Norup, Gerrit Van Der Wal, Luc DeliensAbstract:Background Systematic and reliable epidemiological information at population level, preferably cross-national, is needed for an adequate planning of (end-of-life) health care policies, e.g. concerning place of Death, but is currently lacking. This study illustrates opportunities and weaknesses of Death Certificate data to provide such information on place of Death and associated factors in nine European countries (seven entire countries and five regions).
Joachim Cohen - One of the best experts on this subject based on the ideXlab platform.
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trends in place of Death in a small developing country a population level study using Death Certificate data
Journal of Epidemiology and Community Health, 2020Co-Authors: Nicholas Paul Jennings, Luc Deliens, Kenneth Chambaere, Joachim CohenAbstract:Background Valuable information for planning future end-of-life care (EOLC) services and care facilities can be gained by studying trends in place of Death (POD). Scarce data exist on the POD in small developing countries. This study aims to examine shifts in the POD of all persons dying between 1999 and 2010 in Trinidad and Tobago, to draw conclusions about changes in the distribution of POD over time and the possible implications for EOLC practice and policy. Methods A population-level analysis of routinely collected Death Certificate data of the most recent available fully coded years at the time of the study—1999 to 2010. Observed proportions for the POD of all Deaths were standardised according to the age, sex and cause of Death distribution in 1999. Trends for a subgroup of persons who died from causes indicative of a palliative care (PC) need were also examined. Results The proportion of Deaths in government hospitals increased from 48.9% to 55.4% and decreased from 38.7% to 29.7% at private homes. There was little variation between observed and standardised rates. The decrease in home Deaths was stronger when the PC subcategory was considered, most notably from cancer. Conclusion Internationally, the proportion of Deaths at institutions is increasing. A national strategy on palliative and EOLC is needed to facilitate the increasing number of people who seek EOLC at government hospitals in Trinidad and Tobago, including an investigation into the reasons for the trend. Alternatives to accommodate out-of-hospital Deaths can be considered.
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differences in place of Death between lung cancer and copd patients a 14 country study using Death Certificate data
npj Primary Care Respiratory Medicine, 2017Co-Authors: Joachim Cohen, Guido Miccinesi, Bregje D Onwuteakaphilipsen, Marylou Cardenasturanzas, Kim Beernaert, Lieve Van Den Block, Lucas Morin, Kate Hunt, Rod Macleod, Miguel RuizramosAbstract:Chronic obstructive pulmonary disease and lung cancer are leading causes of Death with comparable symptoms at the end of life. Cross-national comparisons of place of Death, as an important outcome of terminal care, between people dying from chronic obstructive pulmonary disease and lung cancer have not been studied before. We collected population Death Certificate data from 14 countries (year: 2008), covering place of Death, underlying cause of Death, and demographic information. We included patients dying from lung cancer or chronic obstructive pulmonary disease and used descriptive statistics and multivariable logistic regressions to describe patterns in place of Death. Of 5,568,827 Deaths, 5.8% were from lung cancer and 4.4% from chronic obstructive pulmonary disease. Among lung cancer decedents, home Deaths ranged from 12.5% in South Korea to 57.1% in Mexico, while hospital Deaths ranged from 27.5% in New Zealand to 77.4% in France. In chronic obstructive pulmonary disease patients, the proportion dying at home ranged from 10.4% in Canada to 55.4% in Mexico, while hospital Deaths ranged from 41.8% in Mexico to 78.9% in South Korea. Controlling for age, sex, and marital status, patients with chronic obstructive pulmonary disease were significantly less likely die at home rather than in hospital in nine countries. Our study found in almost all countries that those dying from chronic obstructive pulmonary disease as compared with those from lung cancer are less likely to die at home and at a palliative care institution and more likely to die in a hospital or a nursing home. This might be due to less predictable disease trajectories and prognosis of Death in chronic obstructive pulmonary disease.
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international study of the place of Death of people with cancer a population level comparison of 14 countries across 4 continents using Death Certificate data
British Journal of Cancer, 2015Co-Authors: Joachim Cohen, Guido Miccinesi, Lara Pivodic, Bregje D Onwuteakaphilipsen, Wayne Naylor, Donna M Wilson, Martin Loucka, Agnes Csikos, Koen Pardon, Lieve Van Den BlockAbstract:International study of the place of Death of people with cancer: a population-level comparison of 14 countries across 4 continents using Death Certificate data
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dying in hospital a study of incidence and factors related to hospital Death using Death Certificate data
European Journal of Public Health, 2014Co-Authors: Dirk Houttekier, Joachim Cohen, Luc Deliens, Thierry PepersackAbstract:Background: Most people prefer not to die in a hospital, and for those with palliative care needs, doing so may result in inappropriate care and poor outcomes. We examined place of Death and factors associated with hospital Death in a population eligible for palliative care. Methods: We used Death Certificate data to identify Deaths from conditions eligible for palliative care and to examine place of Death and demographic, socioeconomic and environmental characteristics associated with hospital Death in Belgium in 2008. Results: Of all people eligible for palliative care (N = 44 229, i.e. 43.5% of all Deaths), 51% died in hospital, 25% at home and 24% in long-term care settings. Of those officially living at home at the time of Death, hospital Death occurred in >60%; of those living in long-term care settings, this was 16%. Nine percent of those living at home alone at the time of Death died in long-term care settings; of those living with others, this was 5%. In both, those living at home and those living in long-term care settings, hospital Death was more likely in areas with higher availability of hospital beds and less likely in areas with higher availability of skilled nursing beds in long-term care settings. Conclusions: Hospital Death is still common among those eligible for palliative care. The significant proportion of people living at home and dying in long-term care settings indicates the need for additional inpatient beds for terminal care in palliative care institutions.
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which patients with cancer die at home a study of six european countries using Death Certificate data
Journal of Clinical Oncology, 2010Co-Authors: Joachim Cohen, Johan Bilsen, Guido Miccinesi, Julia Addingtonhall, Stein Kaasa, Bregje D Onwuteakaphilipsen, Dirk Houttekier, Luc DeliensAbstract:Purpose This study examines the proportion of cancer Deaths occurring at home in six European countries in relation to illness and to demographic and health care factors. Methods Death Certificate data of all cancer-related Deaths in 2002 in Italy and 2003 in Belgium, the Netherlands, Norway, England, and Wales (N = 238,216) were linked with regional health care and area statistics. Multivariate binomial logistic regressions were performed to examine factors associated with dying at home. Results The percentage of all cancer Deaths occurring at home was 12.8 in Norway, 22.1 in England, 22.7 in Wales, 27.9 in Belgium, 35.8 in Italy, and 45.4 in the Netherlands. Having solid cancers and being married increased the chances of dying at home in all countries. Being older and being a woman decreased the chances of dying at home, except in Italy where the opposite was the case. A higher educational attainment was associated with better chances of dying at home in Belgium, Italy, and Norway (countries where infor...
Bernd Holleczek - One of the best experts on this subject based on the ideXlab platform.
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Death Certificate only proportions should be age adjusted in studies comparing cancer survival across populations and over time
European Journal of Cancer, 2016Co-Authors: Hermann Brenner, Bernd Holleczek, Lina Jansen, Felipe A Castro, Andrea Eberle, Katharina Emrich, Alexander Katalinic, Gekid Cancer Survival WorkgroupAbstract:Abstract Background The proportion of cases notified by Death Certificate only (DCO) is a commonly used data quality indicator in studies comparing cancer survival across regions and over time. We aimed to assess dependence of DCO proportions on the age structure of cancer patients. Methods Using data from a national cancer survival study in Germany, we determined age specific and overall (crude) DCO proportions for 24 common forms of cancer. We then derived overall (crude) DCO proportions expected in case of shifts of the age distribution of the cancer populations by 5 and 10 years, respectively, assuming age specific DCO proportions to remain constant. Results Median DCO proportions across the 24 cancers were 2.4, 3.7, 5.5, 8.5 and 23.9% in age groups 15–44, 45–54, 55–64, 65–74, and 75+, respectively. A decrease of ages by 5 and 10 years resulted in decreases of cancer specific crude DCO proportions ranging from 0.4 to 4.8 and from 0.7 to 8.6 percent units, respectively. Conversely, an increase of ages by 5 and 10 years led to increases of cancer specific crude DCO proportions ranging from 0.8 to 4.8 and from 1.8 to 9.6 percent units, respectively. These changes were of similar magnitude (but in opposite direction) as changes in crude 5-year relative survival resulting from the same shifts in age distribution. Conclusions The age structure of cancer patient populations has a substantial impact on DCO proportions. DCO proportions should therefore be age adjusted in comparative studies on cancer survival across regions and over time.
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implications from under reporting at lifetime Death Certificate notifications and trace back on the recorded incidence of a newly established population based cancer registry
Methods of Information in Medicine, 2015Co-Authors: Bernd Holleczek, Hermann BrennerAbstract:Objectives: Population-based cancer registries (CRs) are powerful tools for measuring cancer burden and progress against cancer. The study’s objective was to investigate the effects of under-reporting at lifetime, Death Certificate notifications, and trace-back on the incidence a newly established population-based CR may record during its initial 15 years of operation. Methods: Using cancer data of nine CRs of the SEER programme we performed model calculations to investigate temporal trends of the recorded incidence that might be expected if registration started in 1995 with gradually increasing proportions of cancers reported to the CR. It was assumed that the CR obtains all Death Certificates providing cancer as the underlying cause of Death. Different scenarios with regard to the development of the proportions of cancers reported to the CR and the use of trace-back were evaluated. Results: Our model calculations demonstrated that the inclusion of cancers notified from Death Certificates which were diagnosed prior to the start of registration and which attribute to the incidence estimates of the year of Death (‘prevalent’ cases) may compensate under-reporting typically observed right after the start of a CR. The recorded incidence may even be overestimated during the first years of registration, if large amounts of prevalent cancers are notified from Death Certificates (e.g. overestimation of lung cancer incidence by 8% and 21% in the first year of registration, if the proportions of cases reported were 50% and 70% in that year, overestimation of myeloma incidence still exceeding 5% after eight years of registration, if the proportion of cases reported to the CR had reached 97.5% after six years). Trace-back may effectively reduce the recorded surplus cancer cases. Conclusions: During the initial years of registration, the inclusion of prevalent cancers from Death Certificates may compensate the higher amount of underreporting right after the start of a CR. Accurate incidence estimates may nevertheless be observed for highly fatal cancers if substantial proportions of cancer cases are missed at lifetime, however apparent incidence trends observed in the initial years of registration need to be interpreted with caution.
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Reduction of population-based cancer survival estimates by trace back of Death Certificate notifications: an empirical illustration.
European journal of cancer (Oxford England : 1990), 2011Co-Authors: Bernd Holleczek, Hermann BrennerAbstract:Abstract Background Survival studies using data from population-based cancer registries allow assessing effectiveness of cancer care on a population level. However, population-based cancer registries differ in the proportion of cases first notified by Death Certificate, as well as in the efforts to trace back such Death Certificate notifications (DCN). We aimed to assess the impact of such trace back on population-based cancer survival estimates. Materials and methods In this study from the population-based Saarland Cancer Registry (Germany) we investigated the survival experience of successfully traced back DCN cases from 1994 to 2003. Five-year relative survival of patients with DCN cancers and the effect of trace back on population-based 5-year relative survival estimates were analysed by age and tumour site. Results Twelve percent of all cancers were DCN and such cases occurred most often amongst sites with poor prognosis and amongst elderly patients. Approximately half of DCN cases could be successfully traced back. Five-year relative survival of patients with DCN cancers with trace back was 2%. The inclusion of DCN cancers with additional registrations reduced the 5-year relative survival estimate for all cancers combined by 4% points. Reductions were stronger for older patients and highly fatal cancers. Conclusions Trace back results in increased inclusion of patients with very poor prognosis. Varying extent of trace back across registries may compromise comparability of cancer survival estimates and should be taken into account in comparative cancer survival studies.
Elizabeth Arias - One of the best experts on this subject based on the ideXlab platform.
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Education reporting and classification on Death Certificates in the United States.
Vital and health statistics. Series 2 Data evaluation and methods research, 2010Co-Authors: Brian L. Rostron, John L Boies, Elizabeth AriasAbstract:Objectives-This report analyzes education reporting and classification on the Death Certificate and their effect on estimates of mortality and life expectancy by education level in the United States. Methods-The National Longitudinal Mortality Study (NLMS) was used to analyze education information on the Death Certificate for participants in the Current Population Survey (CPS) from 1992 through 1998 who died by the end of 1998. Educational attainment reported on the Death Certificate for these persons was compared to their educational attainment reported in the CPS. NLMS wasalsousedtocalculate classification ratios consisting of the number of Deaths by education level in the CPS compared to the number of Deaths by education level on the Death Certificate. These classification ratios were then used to produce estimates of life expectancy by education level for the United States in 2005, adjusted for probable education misreporting on the Death Certificate. Results-Comparison of educational attainment from the Death Certificate and CPS shows differences due to the different classification systems used in the two sources and probable misreporting on the Death Certificate. The difference is most pronounced regarding graduation from high school. Black and Hispanic persons at the high school graduate level appear to be more likely than other racial or ethnic groups to have their educational attainment underreported on the Death Certificate as less than 4 years of high school completed. Adjusted estimates for the U.S. population show a large disparity in life expectancy by education level, on the order of 10-12 years for females and 11-16 years for males.
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The validity of race and Hispanic origin reporting on Death Certificates in the United States.
Vital and health statistics. Series 2 Data evaluation and methods research, 2008Co-Authors: Elizabeth Arias, Paul D. Sorlie, William S. Schauman, Karl Eschbach, Eric BacklundAbstract:Objectives This report presents the results of an evaluation study of the validity of race and Hispanic origin reporting on Death Certificates in the United States and its impact on race- and Hispanic origin-specific mortality estimates. Methods The National Longitudinal Mortality Study (NLMS) was used to evaluate Death Certificate classification of race and Hispanic origin by comparing Death Certificate with survey race-ethnicity classifications for a sample of decedents identified in NLMS. NLMS consists of a series of annual Current Population Survey files (1973 and 1978-1998) linked to Death Certificates for years 1979-1998. To identify and measure the effect of race-ethnicity misclassification on Death Certificates on mortality estimates, pooled 1999-2001 vital statistics mortality data and population data from the 2000 census were used to estimate and compare observed and corrected (for Death Certificate misclassification) race-ethnicity specific Death rates. Results Race and ethnicity reporting on the Death Certificate continues to be excellent for the white and black populations. It remains poor for the American Indian or Alaska Native (AIAN) population but is reasonably good for the Hispanic and Asian or Pacific Islander (API) populations. Decedent characteristics such as place of residence and nativity have an important effect on the quality of reporting on the Death Certificate. The effects of misclassification on mortality estimates were most pronounced for the AIAN population, where correcting for misclassification reverses a large AIAN over white mortality advantage to a large disadvantage. Among the Hispanic and API populations, adjustment for Death Certificate misclassification did not significantly affect minority-majority mortality differentials.
