RACE DIFFERENCES IN ESTIMATES OF SUDDEN CORONARY HEART-DISEASE MORTALITY, 1980-1988 - THE IMPACT OF ILL-DEFINED DEATH

Coronary heart disease (CHD) deaths occurring outside of hospitals or in emergency rooms (OH/ER) have been used to estimate sudden CHD morta lity. This study quantifies the potential impact of natural deaths cod ed to an unspecified cause on race differences in sudden CHD estimates , during 1980-1988. Death certificate data for OH/ER deaths in 40 U.S. states were used to create annual age adjusted rates for sudden CHD a nd sudden CHD rates revised to include deaths with an unspecified caus e (ICD9, 780-799). Revising the mortality rates to include unspecified deaths results in greater racial disparities for estimates of sudden CHD. In 1980, black-white rate differences went from 89 to 128 and 103 to 121 (per 100,000) for men and women, respectively, with revision. Among blacks, revised sudden CHD mortality declined approximately 22%, during 1980-1988, compared to 19% for unrevised sudden CHD; with no o bserved effect of revision on percent declines among whites. Previous studies may have underestimated declines in racial disparities of sudd en CHD, due to improved quality of OH/ER death certification among bla cks. Improved access to routine and emergency medical care, through in creased affordability and greater availability, may be important to ad dress higher OH/ER CHD among blacks.