Impact of misclassification on measures of cardiovascular disease mortality in the Islamic Republic of Iran: a cross-sectional study

Khosravi, Ardeshir, Rao, Chalapati, Naghavi, Mohsen, Taylor, Richard, Jafari, Nahid and Lopez, Alan D. (2008) Impact of misclassification on measures of cardiovascular disease mortality in the Islamic Republic of Iran: a cross-sectional study. Bulletin of the World Health Organization, 86 9: 688-696. doi:10.2471/BLT.07.046532


Author Khosravi, Ardeshir
Rao, Chalapati
Naghavi, Mohsen
Taylor, Richard
Jafari, Nahid
Lopez, Alan D.
Title Impact of misclassification on measures of cardiovascular disease mortality in the Islamic Republic of Iran: a cross-sectional study
Journal name Bulletin of the World Health Organization   Check publisher's open access policy
ISSN 0042-9686
1564-0604
Publication date 2008-09-01
Year available 2008
Sub-type Article (original research)
DOI 10.2471/BLT.07.046532
Open Access Status DOI
Volume 86
Issue 9
Start page 688
End page 696
Total pages 9
Place of publication Geneva, Switzerland
Publisher World Health Organisation
Language eng
Subject 920599 Specific Population Health (excl. Indigenous Health) not elsewhere classified
111711 Health Information Systems (incl. Surveillance)
11 Medical and Health Sciences
1117 Public Health and Health Services
Abstract Objective: To assess the extent and pattern of misclassification of death from non-specific diagnoses emanating from the Iranian death registration system, and to correct the data for health policy and planning. Methods: Detailed medical records for 1426 hospital deaths classified to seven ill-defined or vague causes of death were reviewed by trained physicians, who then completed standard death certificates. Underlying causes of death from the review were compared with the cause assigned in registration data. Findings: The probable underlying pattern of causes of death in the Islamic Republic of Iran is substantially different to that suggested by the death registration system. About 88% of 582 cases with non-specific diagnoses at ages 15-69 years were reassigned to various specific causes including ischaemic heart disease (33%), stroke (13%) and injuries (10%). A similar pattern of misclassification is apparent for 738 deaths at older ages (70 years and over), with 46% being reassigned to ischaemic heart disease and stroke. Conclusion: A significant proportion of deaths in the Iranian death registration system are being classified to cause groups of little relevance to epidemiological research or health policy. Reassignment of these deaths would increase the proportion of deaths from ischaemic heart disease and cerebrovascular diseases each by 32%, diabetes mellitus by 68% and chronic lower respiratory diseases by 73%. Substantial changes to procedures for diagnosing causes of death are urgently required if registration data are to effectively guide health policies and programmes in the Islamic Republic of Iran.
Formatted abstract
Objective:
To assess the extent and pattern of misclassification of death from non-specific diagnoses emanating from the Iranian death registration system, and to correct the data for health policy and planning.

Methods:
Detailed medical records for 1426 hospital deaths classified to seven ill-defined or vague causes of death were reviewed by trained physicians, who then completed standard death certificates. Underlying causes of death from the review were compared with the cause assigned in registration data.

Findings:
The probable underlying pattern of causes of death in the Islamic Republic of Iran is substantially different to that suggested by the death registration system. About 88% of 582 cases with non-specific diagnoses at ages 15–69 years were reassigned to various specific causes including ischaemic heart disease (33%), stroke (13%) and injuries (10%). A similar pattern of misclassification is apparent for 738 deaths at older ages (70 years and over), with 46% being reassigned to ischaemic heart disease and stroke.

Conclusion:
A significant proportion of deaths in the Iranian death registration system are being classified to cause groups of little relevance to epidemiological research or health policy. Reassignment of these deaths would increase the proportion of deaths from ischaemic heart disease and cerebrovascular diseases each by 32%, diabetes mellitus by 68% and chronic lower respiratory diseases by 73%. Substantial changes to procedures for diagnosing causes of death are urgently required if registration data are to effectively guide health policies and programmes in the Islamic Republic of Iran.
Keyword Cerebrovascular diseases
Diabetes mellitus
Ischaemic Heart Disease
Epidemiological Research
Health Policy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online: 30 May 2008.

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Public Health Publications
 
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Created: Thu, 26 Mar 2009, 00:20:47 EST by Geraldine Fitzgerald on behalf of Faculty Of Health Sciences