Validation of death certificate diagnosis for coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) Study

The validity of the death certificate in identifying coronary heart disease deaths was evaluated using data from the community surveillance component of the Atherosclerosis Risk in Communities Study (ARIC). Deaths in the four ARIC communities of Forsyth Co., NC; Jackson, MS; Minneapolis, MN; and Was hington Co., MD were selected based on underlying cause of death codes as d etermined by the rules of the ninth revision of the International Classific ation of Diseases (ICD-9). Information about the deaths was gathered throug h informant interviews, physician or coroner questionnaires, and medical re cord abstraction, and was used to validate the cause of death. Sensitivity, specificity, and positive predictive value of the death certificate classi fication of CHD death (ICD-9 codes 410-414 and 429.2) were estimated by com parison with the validated cause of death based on physician review of all available information. Results from 9 years of surveillance included a posi tive predictive value 0.67 (95% CI 0.66-0.68), sensitivity of 0.81 (95% CI 0.79-0.83), and a false-positive rate ii-specificity) of 0.28 (95% CI 0.26- 0.30). Comparing CHD deaths as defined by the death certificate with valida ted CHD deaths indicated that the death certificate overestimated CHD morta lity by approximately 20% in the ARIC communities. Within subgroups, death certificate overestimation was reduced with advancing age (up to age 74), w as consistent over time, was not dependent on gender, and exhibited conside rable variation among communities. (C) 2001 Elsevier Science Inc. All right s reserved.