Out-of-hospital coronary death in an urban population-validation of death certificate diagnosis: The minnesota heart survey

To assess the validity of death certificate diagnoses of out-of-hospital coronary heart disease deaths, the authors studied a one-third random sample of out-of-hospital deaths occurring in 1979 in Minneapolis-St Paul, Minnesota, residents. Death certificates with diagnoses possibly containing coronary heart disease deaths were enumerated, and cause of death was recorded from the certificate in two ways: 1) as the first listed ("immediate") cause and 2) as the "underlying cause" assigned by a trained nosologist. Validation was performed by standardized physician review of information obtained about the death, which included one or more of the following: An interview with a relative or friend, physician report, autopsy report, medical record, and/or nursing home record. Missing information was frequent, but cases with at least an informant interview and/or autopsy report (82%) were representative and could be used for validation. The sensitivity and specificity of the underlying cause of coronary heart disease (International Classification of Diseases, Ninth Revision, codes 410-414, 427) on the death certificate were 90.3% and 82.7%, respectively, compared with the physician-assigned diagnosis. For the immediate cause, sensitivity and specificity were 90.3% and 67.9%, respectively. These findings suggest that the validity of death certificates for out-of-hospital coronary heart disease death is high, as assessed by this method of retrospective physician review.