DEATHS FROM ACTIVE TUBERCULOSIS - CAN WE RELY ON NOTIFICATION AND MORTALITY FIGURES

Setting: Notification rates and mortality are the main indicators in t he epidemiology of tuberculosis. While errors in case notification are known to be considerable, the quality of the data on deaths is largel y unknown. Objective: To validate the quality of data on deaths from a ctive tuberculosis.Design: We compared deaths from active tuberculosis in Statistics Norway with the National Tuberculosis Register (NTR) an d cases found by autopsy in two Norwegian counties in 1977-1989. We al so assessed the diagnostic classification and inclusion criteria for t uberculosis. Results: 110 patients were entered into the study, We exc luded 30 of 106 patients in Statistics Norway, primarily because of in active tuberculosis (16) or minimal lesions (7). We found an additiona l 20 patients in the NTR and 14 more from autopsy reports, These missi ng cases were registered in Statistics Norway with a different diagnos is (28), inactive tuberculosis (4) or not found (2), Nineteen of them were diagnosed with tuberculosis by autopsy and five by cultures repor ted after death. We altered the diagnostic classification of underlyin g cause in 14% and found tuberculosis to be the underlying cause in 65 patients. Conclusion: The mortality rate from active tuberculosis in Statistics Norway was fairly correct, but one-third were under-reporte d and one-third over-reported. The mortality rate includes only half o f all the deaths from active tuberculosis, All the cases in which acti ve tuberculosis is mentioned on the death certificate are a clearer in dication of tuberculosis deaths.