ASTHMA MORTALITY AND DEATH CERTIFICATION IN NORTHERN-IRELAND

Background - Asthma mortality has been rising in many western countrie s for largely unknown reasons. One cause could be change in certificat ion practice. This study was designed to investigate the accuracy of d eath certification in Northern Ireland for the years 1981-4 and, in ad dition, to assess the reliability of trends observed in asthma death r egistration from 1957 to 1985. Methods - The following death certifica tes were obtained for the years 1981-4: those mentioning asthma (all a ge groups), chronic obstructive airway disease, emphysema, or chronic bronchitis, but only where the deceased was 55 years or less. Informat ion was collected from medical records, questionnaires to the general practitioner, and interviews with a close relative of the deceased. De ath as a result of asthma was confirmed or otherwise by a panel and th e confirmed deaths were compared with those registered. The numbers as thma for the years 1957-85 were obtained from the offices of the North ern Ireland Registrar General. Results - A total of 174 deaths from as thma was identified; 123 (70.7%) had been registered, while the remain der had been coded under another diagnosis. The annual number of confi rmed deaths differed little from the figures of the Registrar General, A sharp increase in the annual number of deaths from asthma was obser ved, beginning in 1977, following a decline in the mid 1970s. Conclusi ons - During the years 1981-4 death certification for asthma was found to be inaccurate. The number of false positive registrations was bala nced by the number of false negatives, suggesting that the registered totals reflect actual asthma mortality.