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Castro AF, Li W, Bernard-Davila B, Huynh M, Van Wye G. Recent Advances in the Use of the Mortality Syndromic Surveillance System-New York City, 2015-2020. Public Health Rep 2024; 139:317-324. [PMID: 37610119 PMCID: PMC11037230 DOI: 10.1177/00333549231190115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
OBJECTIVE New York City's automated mortality syndromic surveillance system monitors temporal and spatial patterns in mortality. To describe the use of the syndromic surveillance system, we used the system to find mortality patterns for the 15 leading causes of death and for deaths from rare and reportable diseases in New York City from February 2015 through June 2020. We used results to find aberrations that indicate threats to public health. METHODS We used unobserved components models to analyze time series of mortality counts for leading causes of death, historical limits methods for rare and reportable diseases, and SaTScan for temporal-spatial cluster analysis. We obtained data on the number of deaths from the electronic death registry system maintained by the city's Bureau of Vital Statistics. RESULTS The mortality syndromic surveillance system detected an increase in the number of deaths from heart disease by April 1, 2020, when 75.0 deaths occurred on March 24, 2020, instead of an expected 45.8 deaths (95% upper prediction limit of 61.0) and an increase in the number of deaths from all causes on March 20, 2020, when 194.0 deaths were observed while 150.1 deaths were expected (95% upper prediction limit of 178.0). The number of deaths from all causes returned to normal the week beginning June 14, 2020, when 990.0 deaths were observed and 998.8 deaths were expected. PRACTICE IMPLICATIONS When compared with efforts from New York City to provide yearly vital statistics, the automated mortality syndromic surveillance system can provide timely mortality data with fewer resources and raise the capacity to detect anomalous increases in mortality.
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Affiliation(s)
- Alejandro F Castro
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Wenhui Li
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Blanca Bernard-Davila
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Mary Huynh
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Gretchen Van Wye
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, NY, USA
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Rebanal J, Adair T, Mikkelsen L. Is training doctors in medical certification effective? Evidence from a prospective study in the Philippines. HEALTH INF MANAG J 2021; 52:101-107. [PMID: 34894798 DOI: 10.1177/18333583211059229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Correct certification of causes of death by physicians according to International Classification of Diseases (ICD) rules is essential to generate mortality statistics of the quality needed to guide public health policy debates and reliably monitor the impact of health interventions. Several efforts to train doctors have been undertaken in the Philippines to improve Medical Certification of Causes of Death (MCCOD). However, there is very little evidence about the long-term effects of training interventions for medical certification. OBJECTIVE To test whether there were measurable long-term impacts of this large-scale training intervention for improving medical certification and reducing different types of certification errors. METHOD We assessed the quality of 2100 MCCOD completed before face-to-face training with those written by the same doctors 6 months after the training. An assessment tool was used to evaluate the quality of MCCOD. RESULTS Less than 1% of the 2100 MCCOD assessed prior to the training were completely error-free, increasing to 19.2% 6 months after the training. On average, the number of errors per certificate fell from 2.2 pre-training to 1.3, six months after training. Importantly, there was a 38% decrease in writing ill-defined causes on the last line, which is particularly important for the policy utility of data. CONCLUSION Training doctors in correct medical certification can have a long-term impact on medical certification practices. IMPLICATIONS Shorter, more focused, trainings that address the most common medical certification errors could have an even greater impact on medical certification practices.
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Affiliation(s)
- Jomilynn Rebanal
- Philippine Department of Health, Knowledge Management and Information Technology Service, Manila, Philippines
| | - Tim Adair
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Spradling PR, Zhong Y, Moorman AC, Rupp LB, Lu M, Teshale EH, Schmidt MA, Daida YG, Boscarino JA, Gordon SC. The Persistence of Underreporting of Hepatitis C as an Underlying or Contributing Cause of Death, 2011-2017. Clin Infect Dis 2021; 73:891-894. [PMID: 33561187 DOI: 10.1093/cid/ciab108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 11/14/2022] Open
Abstract
Using electronic health records, we found that hepatitis C virus (HCV) reporting on death certificates of 2901 HCV-infected decedents from 4 US healthcare organizations during 2011-2017 was documented in only 50% of decedents with hepatocellular carcinoma and less than half with decompensated cirrhosis. National figures likely underestimate the US HCV mortality burden.
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Affiliation(s)
- Philip R Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Yuna Zhong
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Anne C Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | - Mei Lu
- Henry Ford Health System, Detroit, Michigan, USA
| | - Eyasu H Teshale
- Division of Viral Hepatitis, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Mark A Schmidt
- The Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA
| | - Yihe G Daida
- The Center for Integrated Health Research, Kaiser Permanente Hawaii, Honolulu, Hawaii, USA
| | - Joseph A Boscarino
- Department of Population Health Sciences, Geisinger Clinic, Danville, Pennsylvania, USA
| | - Stuart C Gordon
- Henry Ford Health System, Detroit, Michigan, USA.,Wayne State University School of Medicine, Detroit, Michigan, USA
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Ning P, Schwebel DC, Chu H, Zhu M, Hu G. Changes in reporting for unintentional injury deaths, United States of America. Bull World Health Organ 2019; 97:190-199. [PMID: 30992632 PMCID: PMC6453323 DOI: 10.2471/blt.18.215327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To quantify how changes in reporting of specific causes of death and of selecting underlying cause from among multiple causes of death contribute to trends in mortality from unintentional injury in Americans aged 65 years or older. Methods We extracted age-standardized unintentional injury mortality data in the United States Centers for Disease Control and Prevention online databases from 1999 to 2016. We used an attribution method to calculate two indicators: the proportion of mortality with specific codes out of all mortality; and the proportion of mortality with underlying cause of death selected from multiple causes of death. We conducted a linear regression to examine the changes over time in these proportions and in reported and age-adjusted mortality. Findings From 1999 through 2016, the proportion of cause-specific unintentional injury mortality in this age group increased from 74% in 1999 (136.9 out of 185.0 per 100 000 population) to 85% in 2016 (143.0 out of 169.1 per 100 000 population) based on multiple causes of death codes. The proportions of mortality with underlying cause of death selected out of multiple causes of death rose in all specific causes of unintentional injury except motor vehicle crash. Age-standardized mortality attributed to reporting changes increased steadily between 1999 and 2016. The increases for overall unintentional injury, fall, motor vehicle crash, suffocation, poisoning and fire or hot object were 24.2, 13.5, 2.1, 2.3, 1.6 and 0.4 deaths per 100 000 persons, respectively. Conclusion Changes in data reporting affect trends in overall and specific unintentional injury mortality over time for older Americans.
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Affiliation(s)
- Peishan Ning
- Xiangya School of Public Health, Central South University, Changsha, China
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, United States of America (USA)
| | - Haitao Chu
- School of Public Health, University of Minnesota, Minneapolis, USA
| | - Motao Zhu
- The Research Institute at Nationwide Children's Hospital; Ohio State University, Columbus, USA
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, Hunan, China
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Falci L, Lee Argov EJ, Van Wye G, Plitt M, Soto A, Huynh M. Examination of Cause-of-Death Data Quality Among New York City Deaths Due to Cancer, Pneumonia, or Diabetes From 2010 to 2014. Am J Epidemiol 2018; 187:144-152. [PMID: 28595293 DOI: 10.1093/aje/kwx207] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/15/2017] [Indexed: 11/12/2022] Open
Abstract
The cause-of-death (COD) statement on the standard US death certificate is a valuable tool for public health practice, but its utility is impaired by reporting inaccuracies. To assess the quality of CODs reported in New York City, we developed and applied a quality measure to 3 leading CODs: cancer, pneumonia, and diabetes. The COD quality measure characterized 5 common issues with COD completion: nonspecific conditions as the underlying COD (UCOD); UCOD discrepancies; the presence of only 1 informative cause on the entire certificate; competing causes listed together on 1 line; and clinically improbable sequences. COD statements with more than 1 quality issue were defined as statements of "limited" quality. Of 82,116 deaths with cancer, diabetes, or pneumonia assigned as the UCOD in New York City from 2010 to 2014, 66.8% of pneumonia certificates were classified as "limited" quality as compared with 45.6% of cancer certificates and 32.3% of diabetes certificates. Forty percent of cancer certificates listed only 1 informative condition on the death certificate. Almost half of pneumonia certificates (45.9%) contained only enough information to assign International Classification of Diseases, Tenth Revision, code J18.9 ("unspecified pneumonia") as the UCOD, whereas most diabetes certificates contained UCOD discrepancies (25.2%). These limitations affect the quality of mortality data but may be reduced through quality improvement efforts.
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Affiliation(s)
- Laura Falci
- Bureau of Vital Statistics, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York
| | - Erica J Lee Argov
- Bureau of Vital Statistics, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York
| | - Gretchen Van Wye
- Bureau of Vital Statistics, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York
| | - Madia Plitt
- Bureau of Vital Statistics, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York
| | - Antonio Soto
- Bureau of Vital Statistics, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York
| | - Mary Huynh
- Bureau of Vital Statistics, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, New York
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Ong P, Lovasi GS, Madsen A, Van Wye G, Demmer RT. Evaluating the Effectiveness of New York City Health Policy Initiatives in Reducing Cardiovascular Disease Mortality, 1990-2011. Am J Epidemiol 2017; 186:555-563. [PMID: 28911010 DOI: 10.1093/aje/kwx134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 10/24/2016] [Indexed: 12/23/2022] Open
Abstract
Beginning in 2002, New York City (NYC) implemented numerous policies and programs targeting cardiovascular disease (CVD) risk factors. Using death certificates, we analyzed trends in NYC-specific and US mortality rates from 1990 to 2011 for all causes, any CVD, atherosclerotic CVD (ACVD), coronary artery disease (CAD), and stroke. Joinpoint analyses quantified annual percent change (APC) and evaluated whether decreases in CVD mortality accelerated after 2002 in either NYC or the total US population. Our analyses included 1,149,217 NYC decedents. The rates of decline in mortality from all causes, any CVD, and stroke in NYC did not change after 2002. Among men, the decline in ACVD mortality accelerated during 2002-2011 (APC = -4.8%, 95% confidence interval (CI): -6.1, -3.4) relative to 1990-2001 (APC = -2.3%, 95% CI: -3.1, -1.5). Among women, ACVD rates began declining more rapidly in 1993 (APC = -3.2%, 95% CI: -3.8, -2.7) and again in 2006 (APC = -6.6%, 95% CI: -8.9, -4.3) as compared with 1990-1992 (APC = 1.6%, 95% CI: -2.7, 6.0). In the US population, no acceleration of mortality decline was observed in either ACVD or CAD mortality rates after 2002. Relative to 1990-2001, atherosclerotic CVD and CAD rates began to decline more rapidly during the 2002-2011 period in both men and women-a pattern not observed in the total US population, suggesting that NYC initiatives might have had a measurable influence on delaying or reducing ACVD mortality.
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Increased Life Expectancy in New York City, 2001-2010: An Exploration by Cause of Death and Demographic Characteristics. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 22:255-64. [PMID: 25887941 DOI: 10.1097/phh.0000000000000265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE New York City's (NYC's) life expectancy gains have been greater than those seen nationally. We examined life-expectancy changes over the past decade in selected NYC subpopulations and explored which age groups and causes of death contributed most to the increases. METHODS We calculated life expectancy with 95% confidence intervals (CIs) for 2001-2010 by sex and race/ethnicity. Life expectancy was decomposed by age group and cause of death. Logistic regressions were conducted to reinforce the results from decomposition by controlling confounders. RESULTS Overall, NYC residents' life expectancy at birth increased from 77.9 years (95% CI, 77.8-78.0) in 2001 to 80.9 years (95% CI, 80.8-81.0) in 2010. Decreases in deaths from heart disease, cancer, and HIV disease accounted for 50%, 16%, and 11%, respectively, of the gains. Decreased mortality in older age groups (≥65 years) accounted for 45.6% of the overall change. CONCLUSIONS Life expectancy increased for both sexes, across all racial/ethnic groups, and for both the US-born and the foreign-born. Disparities in life expectancy decreased as overall life expectancy increased. Decreased mortality among older adults and from heart disease, cancer, and HIV infection accounted for most of the increases.
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Lloyd J, Jahanpour E, Angell B, Ward C, Hunter A, Baysinger C, Turabelidze G. Using National Inpatient Death Rates as a Benchmark to Identify Hospitals with Inaccurate Cause of Death Reporting - Missouri, 2009-2012. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2017; 66:19-22. [PMID: 28081064 PMCID: PMC5687260 DOI: 10.15585/mmwr.mm6601a5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Reporting causes of death accurately is essential to public health and hospital-based programs; however, some U.S. studies have identified substantial inaccuracies in cause of death reporting. Using CDC's national inpatient hospital death rates as a benchmark, the Missouri Department of Health and Senior Services (DHSS) analyzed inpatient death rates reported by hospitals with high inpatient death rates in St. Louis and Kansas City metro areas. Among the selected hospitals with high inpatient death rates, 45.8% of death certificates indicated an underlying cause of death that was inconsistent with CDC's Guidelines for Death Certificate completion. Selected hospitals with high inpatient death rates were more likely to overreport heart disease and renal disease, and underreport cancer as an underlying cause of death. Based on these findings, the Missouri DHSS initiated a new web-based training module for death certificate completion based on the CDC guidelines in an effort to improve accuracy in cause of death reporting.
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Affiliation(s)
| | | | - Brian Angell
- Missouri Department of Health and Senior Services
| | - Craig Ward
- Missouri Department of Health and Senior Services
| | - Andy Hunter
- Missouri Department of Health and Senior Services
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Hanna DB, Ramaswamy C, Kaplan RC, Kizer JR, Anastos K, Daskalakis D, Zimmerman R, Braunstein SL. Trends in Cardiovascular Disease Mortality Among Persons With HIV in New York City, 2001-2012. Clin Infect Dis 2016; 63:1122-1129. [PMID: 27444412 PMCID: PMC5873364 DOI: 10.1093/cid/ciw470] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/03/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) has become more prominent among human immunodeficiency virus (HIV)-infected individuals. The extent to which CVD mortality rates are changing is unclear. METHODS We analyzed surveillance data for all persons aged ≥13 years with HIV infection between 2001 and 2012 reported to the New York City HIV Surveillance Registry. We examined age-specific and age-standardized mortality rates due to major CVDs. We compared mortality time trends among persons with HIV with the general population, and examined differences among HIV-infected persons by RNA level. RESULTS There were 29 588 deaths reported among 145 845 HIV-infected persons. Ten percent of deaths were attributed to CVD as the underlying cause, including chronic ischemic heart disease (42% of CVD deaths), hypertensive diseases (27%), and cerebrovascular diseases (10%). While proportionate mortality due to CVD among persons with HIV increased (6% in 2001 to 15% in 2012, P < .001), the CVD mortality rate decreased from 5.1 to 2.7 per 1000 person-years. After controlling for sex, race/ethnicity, borough of residence, and year, those with HIV had significantly higher CVD mortality than the general population in all age groups through age 65. The CVD mortality rate was highest among viremic persons (adjusted rate ratio [RR], 3.53 [95% confidence interval {CI}, 3.21-3.87]) but still elevated among virally suppressed (<400 copies/mL) persons (adjusted RR, 1.53 [95% CI, 1.41-1.66]) compared with the general population. CONCLUSIONS Our findings support continued emphasis by HIV care providers on both viremic control and preventive measures including smoking cessation, blood pressure control, and lipid management.
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Affiliation(s)
| | | | | | - Jorge R. Kizer
- Department of Epidemiology and Population Health
- Department of Medicine, Albert Einstein College of Medicine, Bronx
| | - Kathryn Anastos
- Department of Epidemiology and Population Health
- Department of Medicine, Albert Einstein College of Medicine, Bronx
| | | | - Regina Zimmerman
- Department of Office of Vital Statistics, New York City Department of Health and Mental Hygiene, Long Island City, New York
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Pathak EB. Is Heart Disease or Cancer the Leading Cause of Death in United States Women? Womens Health Issues 2016; 26:589-594. [PMID: 27717539 DOI: 10.1016/j.whi.2016.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE This paper compares the mortality burden of heart disease versus cancer among women by age, race, and ethnicity. METHODS U.S. death and population data for the years 2000 through 2013 were used to calculate heart disease and cancer death rates. Detailed analyses focused on age (15-19 years old to ≥100 years old) and race and ethnicity (Whites, Blacks, Hispanics, Asians and Pacific Islanders (A/PIs), and American Indians and Alaska Natives (AI/ANs)). RESULTS Among women aged 15 years and older, there were 289,467 heart disease deaths and 276,716 cancer deaths in 2013. The majority of heart disease deaths (51.6%) occurred among women 85 years or older, compared with 18.9% of female cancer deaths. The age-adjusted death rates (per 100,000 population) were 171 (95% confidence interval [CI], 170-171) for heart disease versus 177 (95% CI, 176-178) for cancer. For all racial and ethnic groups, cancer mortality was significantly higher than heart disease mortality among women younger than 80 years of age. For all ages combined, cancer deaths exceeded heart disease deaths among Hispanics, A/PIs, and AI/ANs. Black non-Hispanic women were the only racial/ethnic group who had a higher age-adjusted death rate for heart disease than for cancer: 224 (95% CI, 222-226) versus 207 (95% CI, 205-209). CONCLUSIONS Heart disease remains the leading cause of death among all women combined in the United States by a narrow margin. However, cancer predominantly kills middle-aged and young women, whereas heart disease predominantly kills the very old. New research on the overreporting of heart disease on death certificates for elderly women is needed. National summary statistics obscure the fact that cancer is already the overall leading cause of death for Hispanic women, Asian and Pacific Islander women, and American Indian and Alaska Native women.
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Affiliation(s)
- Elizabeth B Pathak
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida.
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Restrepo BJ, Rieger M. Trans fat and cardiovascular disease mortality: Evidence from bans in restaurants in New York. JOURNAL OF HEALTH ECONOMICS 2016; 45:176-196. [PMID: 26620830 DOI: 10.1016/j.jhealeco.2015.09.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/27/2015] [Accepted: 09/17/2015] [Indexed: 06/05/2023]
Abstract
This paper analyzes the impact of trans fat bans on cardiovascular disease (CVD) mortality rates. Several New York State jurisdictions have restricted the use of ingredients containing artificial trans fat in food service establishments. The resulting within-county variation over time and the differential timing of the policy's rollout is used in estimation. The results indicate that the policy caused a 4.5% reduction in CVD mortality rates, or 13 fewer CVD deaths per 100,000 persons per year. The averted deaths can be valued at about $3.9 million per 100,000 persons annually.
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Affiliation(s)
- Brandon J Restrepo
- U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5100 Paint Branch Parkway, College Park, MD 20740, United States.
| | - Matthias Rieger
- The International Institute of Social Studies (ISS) of Erasmus University Rotterdam, Kortenaerkade 12, 2518 AX Den Haag, The Netherlands.
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Ong P, Gambatese M, Begier E, Zimmerman R, Soto A, Madsen A. Effect of cause-of-death training on agreement between hospital discharge diagnoses and cause of death reported, inpatient hospital deaths, New York City, 2008-2010. Prev Chronic Dis 2015; 12:E04. [PMID: 25590598 PMCID: PMC4307833 DOI: 10.5888/pcd12.140299] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Accurate cause-of-death reporting is required for mortality data to validly inform public health programming and evaluation. Research demonstrates overreporting of heart disease on New York City death certificates. We describe changes in reported causes of death following a New York City health department training conducted in 2009 to improve accuracy of cause-of-death reporting at 8 hospitals. The objective of our study was to assess the degree to which death certificates citing heart disease as cause of death agreed with hospital discharge data and the degree to which training improved accuracy of reporting. METHODS We analyzed 74,373 death certificates for 2008 through 2010 that were linked with hospital discharge records for New York City inpatient deaths and calculated the proportion of discordant deaths, that is, death certificates reporting an underlying cause of heart disease with no corresponding discharge record diagnosis. We also summarized top principal diagnoses among discordant reports and calculated the proportion of inpatient deaths reporting sepsis, a condition underreported in New York City, to assess whether documentation practices changed in response to clarifications made during the intervention. RESULTS Citywide discordance between death certificates and discharge data decreased from 14.9% in 2008 to 9.6% in 2010 (P < .001), driven by a decrease in discordance at intervention hospitals (20.2% in 2008 to 8.9% in 2010; P < .001). At intervention hospitals, reporting of sepsis increased from 3.7% of inpatient deaths in 2008 to 20.6% in 2010 (P < .001). CONCLUSION Overreporting of heart disease as cause of death declined at intervention hospitals, driving a citywide decline, and sepsis reporting practices changed in accordance with health department training. Researchers should consider the effect of overreporting and data-quality changes when analyzing New York City heart disease mortality trends. Other vital records jurisdictions should employ similar interventions to improve cause-of-death reporting and use linked discharge data to monitor data quality.
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Affiliation(s)
- Paulina Ong
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Melissa Gambatese
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Elizabeth Begier
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Regina Zimmerman
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Antonio Soto
- New York City Department of Health and Mental Hygiene, New York, New York
| | - Ann Madsen
- New York City Department of Health and Mental Hygiene, 125 Worth St, Room 203B, New York, NY 10013. E-mail:
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Korin L, Das T, Madsen A, Soto A, Begier E. Test of an electronic program to query clinicians about nonspecific causes reported for pneumonia deaths, New York City, 2012. Prev Chronic Dis 2014; 11:E210. [PMID: 25427318 PMCID: PMC4247120 DOI: 10.5888/pcd11.140282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We tested an electronic cause-of-death query system at a hospital in New York City to evaluate clinicians’ reporting of cause of death. We used the system to query clinicians about all deaths assigned International Classification of Disease code J189 (pneumonia, unspecified) as the underlying cause of death. Of 29 death certificates that generated queries, 28 were updated with additional information, which led to revisions in the underlying cause of 27 deaths. The electronic system for querying reported cause of death was feasible and enabled quicker than usual responses; however, follow-up with clinicians to ensure timely, accurate, and complete responses was labor-intensive. Educating clinicians and enforcing reporting standards would reduce the time and effort required to ensure accurate and timely cause-of-death reporting.
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Affiliation(s)
- Laura Korin
- Public Health/Preventive Medicine Residency Program, New York City Department of Health and Mental Hygiene, New York, New York
| | - Tara Das
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York
| | - Ann Madsen
- New York City Department of Health and Mental Hygiene, Bureau of Vital Statistics, 125 Worth Street, Room 204 CN-7, New York, NY 10013.
| | - Antonio Soto
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York
| | - Elizabeth Begier
- Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene, New York, New York
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Kitahara CM, Flint AJ, Berrington de Gonzalez A, Bernstein L, Brotzman M, MacInnis RJ, Moore SC, Robien K, Rosenberg PS, Singh PN, Weiderpass E, Adami HO, Anton-Culver H, Ballard-Barbash R, Buring JE, Freedman DM, Fraser GE, Beane Freeman LE, Gapstur SM, Gaziano JM, Giles GG, Håkansson N, Hoppin JA, Hu FB, Koenig K, Linet MS, Park Y, Patel AV, Purdue MP, Schairer C, Sesso HD, Visvanathan K, White E, Wolk A, Zeleniuch-Jacquotte A, Hartge P. Association between class III obesity (BMI of 40-59 kg/m2) and mortality: a pooled analysis of 20 prospective studies. PLoS Med 2014; 11:e1001673. [PMID: 25003901 PMCID: PMC4087039 DOI: 10.1371/journal.pmed.1001673] [Citation(s) in RCA: 244] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 05/28/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The prevalence of class III obesity (body mass index [BMI]≥40 kg/m2) has increased dramatically in several countries and currently affects 6% of adults in the US, with uncertain impact on the risks of illness and death. Using data from a large pooled study, we evaluated the risk of death, overall and due to a wide range of causes, and years of life expectancy lost associated with class III obesity. METHODS AND FINDINGS In a pooled analysis of 20 prospective studies from the United States, Sweden, and Australia, we estimated sex- and age-adjusted total and cause-specific mortality rates (deaths per 100,000 persons per year) and multivariable-adjusted hazard ratios for adults, aged 19-83 y at baseline, classified as obese class III (BMI 40.0-59.9 kg/m2) compared with those classified as normal weight (BMI 18.5-24.9 kg/m2). Participants reporting ever smoking cigarettes or a history of chronic disease (heart disease, cancer, stroke, or emphysema) on baseline questionnaires were excluded. Among 9,564 class III obesity participants, mortality rates were 856.0 in men and 663.0 in women during the study period (1976-2009). Among 304,011 normal-weight participants, rates were 346.7 and 280.5 in men and women, respectively. Deaths from heart disease contributed largely to the excess rates in the class III obesity group (rate differences = 238.9 and 132.8 in men and women, respectively), followed by deaths from cancer (rate differences = 36.7 and 62.3 in men and women, respectively) and diabetes (rate differences = 51.2 and 29.2 in men and women, respectively). Within the class III obesity range, multivariable-adjusted hazard ratios for total deaths and deaths due to heart disease, cancer, diabetes, nephritis/nephrotic syndrome/nephrosis, chronic lower respiratory disease, and influenza/pneumonia increased with increasing BMI. Compared with normal-weight BMI, a BMI of 40-44.9, 45-49.9, 50-54.9, and 55-59.9 kg/m2 was associated with an estimated 6.5 (95% CI: 5.7-7.3), 8.9 (95% CI: 7.4-10.4), 9.8 (95% CI: 7.4-12.2), and 13.7 (95% CI: 10.5-16.9) y of life lost. A limitation was that BMI was mainly ascertained by self-report. CONCLUSIONS Class III obesity is associated with substantially elevated rates of total mortality, with most of the excess deaths due to heart disease, cancer, and diabetes, and major reductions in life expectancy compared with normal weight. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Cari M. Kitahara
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
- * E-mail:
| | - Alan J. Flint
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Amy Berrington de Gonzalez
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Leslie Bernstein
- Division of Cancer Etiology, Department of Population Sciences, Beckman Research Institute, City of Hope, Duarte, California, United States of America
| | | | - Robert J. MacInnis
- Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, University of Melbourne, Melbourne, Australia
| | - Steven C. Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Kim Robien
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, District of Columbia, United States of America
| | - Philip S. Rosenberg
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Pramil N. Singh
- Center for Health Research, School of Public Health, Loma Linda University, Loma Linda, California, United States of America
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø—The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Samfundet Folkhälsan, Helsinki, Finland
| | - Hans Olov Adami
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Hoda Anton-Culver
- Department of Epidemiology, School of Medicine, University of California, Irvine, California, United States of America
| | - Rachel Ballard-Barbash
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Julie E. Buring
- Divisions of Preventive Medicine and Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - D. Michal Freedman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Gary E. Fraser
- Department of Epidemiology, Biostatistics, and Population Medicine, Loma Linda University School of Public Health, Loma Linda, California, United States of America
| | - Laura E. Beane Freeman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Susan M. Gapstur
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, United States of America
| | - John Michael Gaziano
- Divisions of Preventive Medicine and Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Massachusetts Veteran's Epidemiology, Research and Information Center, Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Graham G. Giles
- Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, Australia
- Centre for Molecular, Environmental, Genetic, and Analytic Epidemiology, University of Melbourne, Melbourne, Australia
| | - Niclas Håkansson
- Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jane A. Hoppin
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, United States of America
| | - Frank B. Hu
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Karen Koenig
- Division of Epidemiology, Department of Population Health and NYU Cancer Institute, NYU School of Medicine, New York, New York, United States of America
| | - Martha S. Linet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Yikyung Park
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Alpa V. Patel
- Epidemiology Research Program, American Cancer Society, Atlanta, Georgia, United States of America
| | - Mark P. Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Catherine Schairer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Howard D. Sesso
- Divisions of Preventive Medicine and Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kala Visvanathan
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, United States of America
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Emily White
- Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Alicja Wolk
- Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anne Zeleniuch-Jacquotte
- Division of Epidemiology, Department of Population Health and NYU Cancer Institute, NYU School of Medicine, New York, New York, United States of America
| | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, United States of America
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Phillips DE, Lozano R, Naghavi M, Atkinson C, Gonzalez-Medina D, Mikkelsen L, Murray CJ, Lopez AD. A composite metric for assessing data on mortality and causes of death: the vital statistics performance index. Popul Health Metr 2014; 12:14. [PMID: 24982595 PMCID: PMC4060759 DOI: 10.1186/1478-7954-12-14] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/23/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Timely and reliable data on causes of death are fundamental for informed decision-making in the health sector as well as public health research. An in-depth understanding of the quality of data from vital statistics (VS) is therefore indispensable for health policymakers and researchers. We propose a summary index to objectively measure the performance of VS systems in generating reliable mortality data and apply it to the comprehensive cause of death database assembled for the Global Burden of Disease (GBD) 2013 Study. METHODS We created a Vital Statistics Performance Index, a composite of six dimensions of VS strength, each assessed by a separate empirical indicator. The six dimensions include: quality of cause of death reporting, quality of age and sex reporting, internal consistency, completeness of death reporting, level of cause-specific detail, and data availability/timeliness. A simulation procedure was developed to combine indicators into a single index. This index was computed for all country-years of VS in the GBD 2013 cause of death database, yielding annual estimates of overall VS system performance for 148 countries or territories. RESULTS The six dimensions impacted the accuracy of data to varying extents. VS performance declines more steeply with declining simulated completeness than for any other indicator. The amount of detail in the cause list reported has a concave relationship with overall data accuracy, but is an important driver of observed VS performance. Indicators of cause of death data quality and age/sex reporting have more linear relationships with simulated VS performance, but poor cause of death reporting influences observed VS performance more strongly. VS performance is steadily improving at an average rate of 2.10% per year among the 148 countries that have available data, but only 19.0% of global deaths post-2000 occurred in countries with well-performing VS systems. CONCLUSIONS Objective and comparable information about the performance of VS systems and the utility of the data that they report will help to focus efforts to strengthen VS systems. Countries and the global health community alike need better intelligence about the accuracy of VS that are widely and often uncritically used in population health research and monitoring.
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Affiliation(s)
- David E Phillips
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA ; National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, MOR 62100, México
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Charles Atkinson
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Diego Gonzalez-Medina
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Lene Mikkelsen
- LM Consulting, Independent Consultant, 4/78 Cairns St., Brisbane, QLD 4169, Australia
| | - Christopher Jl Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA
| | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, 207 Bouverie St., Level 5, Melbourne, VIC 3010, Australia
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Preston SH, Elo IT. Anatomy of a Municipal Triumph: New York City's Upsurge in Life Expectancy. POPULATION AND DEVELOPMENT REVIEW 2014; 40:1-29. [PMID: 25843989 PMCID: PMC4383322 DOI: 10.1111/j.1728-4457.2014.00648.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Over the period 1990-2010, the increase in life expectancy for males in New York City was 6.0 years greater than for males in the United States. The female relative gain was 3.9 years. Male relative gains were larger because of extremely rapid reductions in mortality from HIV/AIDS and homicide, declines that reflect effective municipal policies and programs. Declines in drug- and alcohol-related deaths also played a significant role in New York City's advance, but every major cause of death contributed to its relative improvement. By 2010, New York City had a life expectancy that was 1.9 years greater than that of the US. This difference is attributable to the high representation of immigrants in New York's population. Immigrants to New York City, and to the United States, have life expectancies that are among the highest in the world. The fact that 38 percent of New York's population consists of immigrants, compared to only 14 percent in the United States, accounts for New York's exceptional standing in life expectancy in 2010. In fact, US-born New Yorkers have a life expectancy below that of the United States itself.
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Affiliation(s)
| | - Irma T Elo
- Population Studies Center, University of Pennsylvania
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