Overreporting of deaths from coronary heart disease in New York City hospitals, 2003

Abstract

Introduction: New York City has one of the highest reported death rates from coronary heart disease in the United States. We sought to measure the accuracy of this rate by examining death certificates.

Methods: We conducted a cross-sectional validation study by using a random sample of death certificates that recorded in-hospital deaths in New York City from January through June 2003, stratified by neighborhoods with low, medium, and high coronary heart disease death rates. We abstracted data from hospital records, and an independent, blinded medical team reviewed these data to validate cause of death. We computed a comparability ratio (coronary heart disease deaths recorded on death certificates divided by validated coronary heart disease deaths) to quantify agreement between death certificate determination and clinical judgment.

Results: Of 491 sampled death certificates for in-hospital deaths, medical charts were abstracted and reviewed by the expert panel for 444 (90%). The comparability ratio for coronary heart disease deaths among decedents aged 35 to 74 years was 1.51, indicating that death certificates overestimated coronary heart disease deaths in this age group by 51%. The comparability ratio increased with age to 1.94 for decedents aged 75 to 84 years and to 2.37 for decedents aged 85 years or older.

Conclusion: Coronary heart disease appears to be substantially overreported as a cause of death in New York City among in-hospital deaths.

Figure 1.

Age-adjusted deaths from coronary heart disease in New York City (NYC) versus the United States overall. "ICD" indicates the revisions of the International Classification of Diseases that were used to categorize cause of death. US data for 1950 through 2002 from National Heart, Lung, and Blood Institute, 2002. US data for 2003 through 2006 from Centers for Disease Control and Prevention. NYC data from NYC Department of Health and Mental Hygiene, Bureau of Vital Statistics. NYC population data from 1971 through 2003 census estimates. NYC population data from 1961 through 1969 from linear interpolation.