Errors in Clinical Statements of Causes of Death

Accuracy of admission and pre-autopsy clinical diagnoses in the light of autopsy findings: a study conducted in Budapest

Pre- and post-autopsy diagnoses of underlying cause of death were compared in consecutive autopsies on persons aged 30 to 80 years; 1000 from each of two pathology departments in Budapest. Data on admission diagnoses and on contributory causes of death were also analysed. At autopsy, the percentages of deaths by underlying cause were neoplasms (any site) 34.9%, diseases of the circulatory system 40.2%, digestive system 13.8%, endocrine, nutritional, metabolic or immune systems 2.7%, and respiratory system 2.2%. For these five disease groupings, the percentages of cases diagnosed clinically as the underlying cause of death which were confirmed at autopsy were, respectively, 90.9%, 84.0%, 82.9%, 55.2% and 32.5%. Although, out of 697 cases with an autopsy diagnosis of neoplasia as the underlying cause, there were only 61 (8.8%) where neoplasms were not diagnosed clinically as the underlying cause, this conceals the fact that in 130 (18.7%) the two diagnoses differed as to the site of the primary neoplasm (ICD 3 digit code). The fact that 43% of post-mortem diagnoses (ICD major category) of underlying cause are missed on admission, and that 19% are missed clinically, indicates that improved clinical diagnostic procedures have not diminished the need for high autopsy rates. Morbid anatomy needs to be better resourced.

Trends in female breast cancer in Connecticut and the United States

Trends for female breast cancer were examined by age, period and cohort for the years 1950-1984 in U.S. mortality. Connecticut mortality and Connecticut incidence. Birth cohort patterns were evident for all three sets of data. The results confirm a continuing increase in invasive breast cancer by providing evidence of a strong birth cohort pattern, over a time series of 90 years of birth cohorts. This trend appears to be real for the most part because of the cohort patterns and because there is minimal underdetection in data obtained by autopsy and blind biopsy. Secondly, when cohort modeling is applied to breast cancer mortality, there is an indication of a modest decline in recent breast cancer mortality (in the face of an apparent long-term increase), which suggests that control of breast cancer mortality may have developed in recent decades, perhaps through earlier detection and improved treatment. Finally, in contrast with a prior report, there is little evidence for a clinically important difference in time trend between pre- and postmenopausal breast cancer.

Health of the Chinese elderly in America

This article examines the mortality and morbidity patterns of Chinese elderly in America by using two established data sources: (1) the most recent vital statistics maintained by the National Center for Health Statistics, and (2) the cancer registry program called SEER (Surveillance, Epidemiology, and End Results) maintained by the National Cancer Institute at the National Institute of Health. The results suggest that Chinese Americans are relatively healthier than white Americans, the average age-adjusted death rate being lower for Chinese than for white Americans. Likewise, the age-specific death rates for all causes of death are lower for Chinese than for the majority white population. Details of statistics on rates of suicide, heart disease, neoplasms, and various forms of cancer are presented.

Making sense of mortality

This paper focuses upon the collection and processing of government mortality statistics, and especially upon the organisational and theoretical contexts within which such statistics are assembled. Two items of mortality data in particular are examined with a view to illustrating the broader issues: medical cause of death, and social class of deceased. Using a 10 per cent sample of 1981 Belfast death certificates as a base, the paper attempts to trace the specific stages through which the cause of death and social class data have to pass prior to their incorporation into mortality reports. The paper indicates that there are numerous grounds for believing that both kinds of data are flawed at their points of origin, and that the transformations which the data undergo during coding procedures leads to further distortions of our image of mortality and its social base. It is argued that these flaws and distortions are only partly due to technical and organisational shortcomings, and more likely due to weaknesses in the theoretical frameworks through which the data are sifted. The paper concludes by suggesting that the existing arrangements for registering deaths, dominated as they are by the principles of forensic medicine, are more properly viewed as a system for policing the dead, than as a mechanism for generating worthwhile data about diseases and their social distribution.

Respiratory disease mortality in New Mexico's American Indians and Hispanics

To determine the effect of ethnic group on respiratory disease occurrence, average annual sex, ethnic, and disease specific mortality rates for the period of 1969 to 1977 were calculated for New Mexico's American Indian, Hispanic, and Anglo populations. Incidence data were available for respiratory tract cancer. This study corroborates previous findings of reduced mortality from lung cancer in American Indians of both sexes and in Hispanic males. American Indian mortality from tuberculosis and from influenza and pneumonia was high. Hispanic males and American Indians of both sexes showed low mortality rates for chronic obstructive pulmonary disease (COPD). Differing cigarette usage is the most obvious explanation for the variations in COPD and lung cancer occurrence with ethnic group.

Relation between clinical and autopsy diagnoses, especially as regards cancer

The clinical diagnoses of 377 patients were compared with those derived from autopsy; the incidence, confirmation rate and detection rate were correlated to age, sex and duration of stay in the hospital. The diagnoses were in complete agreement in 75% of the cases; as regards location they differed in 20% and malignancy being unsuspected in 5% of the cases, where vascular diseases were the most frequent clinical findings. Lymphomas and leukemias were overrepresented in the study and had a high confirmation and detection rate, 97% resp. 94%. Tumours of the liver, gallbladder and pancreas were underrepresented and had a low detection rate, 37%, and confirmation rate, 59%. For other tumours the confirmation rate was higher, 84-97%, and detection rate lower, 72-80%. Similar antemortem and postmortem diagnoses were seen most commonly in young patients, regardless of sex and who stayed in the hospital for an extended period of time.

Autopsy in California

From information complied from death certificates registered in 1952 and 1962 an examination was made of California's autopsy performance and the characteristics of deaths in which autopsy was done. The data indicated that California had an overall autopsy rate of 37 per cent of total deaths in 1962, probably higher than any other state. In the decade reviewed, there was a 62 per cent absolute increase in autopsies and a 7 per cent increase relative to total deaths. Substantial increases in the proportion of deaths in which autopsy was done were found for physician-certified deaths in both metropolitan and nonmetropolitan counties and for coroner-certified deaths in nonmetropolitan counties. For all but two of forty-five selected natural causes of death there were increases in the proportion of deaths in which autopsy was done. Seventy per cent of deaths occurred in some type of facility. About one-half of all deaths occurred in general hospitals, and autopsy was done in 42 per cent of such cases. The dual factors of a high autopsy rate and overrepresentation of deaths brought to autopsy in white males, ages 35-64, support the validity of a reported decline in California's death rate for arteriosclerotic heart disease.