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Cited by 108Medical Coding and Health InformationReliability and Agreement in MeasurementHealthcare Systems and Public Health

Agreement Between Nosologist and Cardiovascular Health Study Review of Deaths: Implications of Coding Differences

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Ives, Diane G., Samuel, Paulraj, Psaty, Bruce M., Kuller, Lewis H.·2009·Journal of the American Geriatrics Society
DOI 10.1111/j.1532-5415.2008.02056.xPMC PMC2631612
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Abstract

OBJECTIVES: To compare nosologist coding of underlying cause of death according to the death certificate with adjudicated cause of death for subjects aged 65 and older in the Cardiovascular Health Study (CHS). DESIGN: Observational. SETTING: Four communities: Forsyth County, North Carolina (Wake Forest University); Sacramento County, California (University of California at Davis); Washington County, Maryland (Johns Hopkins University); and Pittsburgh, Pennsylvania (University of Pittsburgh). PARTICIPANTS: Men and women aged 65 and older participating in CHS, a longitudinal study of coronary heart disease and stroke, who died through June 2004. MEASUREMENTS: The CHS centrally adjudicated underlying cause of death for 3,194 fatal events from June 1989 to June 2004 using medical records, death certificates, proxy interviews, and autopsies, and results were compared with underlying cause of death assigned by a trained nosologist based on death certificate only. RESULTS: Comparison of 3,194 CHS versus nosologist underlying cause of death revealed moderate agreement except for cancer (kappa=0.91, 95% confidence interval (CI)=0.89–0.93). kappas varied according to category (coronary heart disease, kappa=0.61, 95% CI=0.58–0.64; stroke, kappa=0.59, 95% CI=0.54–0.64; chronic obstructive pulmonary disease, kappa=0.58, 95% CI=0.51–0.65; dementia, kappa=0.40, 95% CI=0.34–0.45; and pneumonia, kappa=0.35, 95% CI=0.29–0.42). Differences between CHS and nosologist coding of dementia were found especially in older ages in the sex and race categories. CHS attributed 340 (10.6%) deaths due to dementia, whereas nosologist coding attributed only 113 (3.5%) to dementia as the underlying cause. CONCLUSION: Studies that use only death certificates to determine cause of death may result in misclassification and potential bias. Changing trends in cause‐specific mortality in older individuals may be a function of classification process rather than incidence and case fatality.

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  • Pneumonia is the most commonly identified immediate cause of death among older adults with Alzheimer's or other dementias.

    “pneumonia (infection of the lungs), which is the most commonly identified immediate cause of death among older adults with Alzheimer's or other dementias.”

    From 2023 Alzheimer's disease facts and figures (2023) · cites this paper as [378]

    The Methods identify pneumonia as an immediate cause of death secondary to dementia. The Discussion reports that, among Cardiovascular Health Study deaths attributed to dementia, nosologists coded 50 as pneumonia, 10 as sepsis, and 46 as cardiovascular. But the paper compares coding of underlying causes in this cohort; it does not establish that pneumonia is the most commonly identified immediate cause of death among older adults with dementia generally. (LLM, conf=0.86)

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  • Death certificates for individuals with Alzheimer's often list acute conditions such as pneumonia as the primary cause of death rather than Alzheimer's.

    “Death certificates for individuals with Alzheimer's often list acute conditions such as pneumonia as the primary cause of death rather than Alzheimer's.”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [408]

    The Discussion reports that death-certificate coding often assigned CHS dementia cases to immediate causes such as pneumonia when underlying dementia was not documented. The Introduction also notes underreporting of Alzheimer’s disease on death certificates, but the paper does not show that the pneumonia cases specifically involved people with Alzheimer’s rather than other forms of dementia. (LLM, conf=0.84)

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  • Severe dementia frequently causes complications such as immobility, swallowing disorders and malnutrition that significantly increase the risk of acute conditions that can cause death.

    “Severe dementia frequently causes complications such as immobility, swallowing disorders and malnutrition that significantly increase the risk of acute conditions that can cause death.”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [408]

    The Methods (page unavailable) say that the Cardiovascular Health Study classified dementia as the underlying cause of death in many older people whose immediate causes of death included pneumonia or septicemia. The paper does not say that severe dementia frequently causes immobility, swallowing disorders, or malnutrition, or that these complications significantly increase the risk of fatal acute conditions. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Pneumonia is the most commonly identified immediate cause of death among older adults with Alzheimer's or other dementias.

    “One such condition is pneumonia (infection of the lungs), which is the most commonly identified immediate cause of death among older adults with Alzheimer's or other dementias.”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [408]

    The Methods (page unavailable) identify pneumonia as an immediate cause of death secondary to dementia. The Discussion (page unavailable) reports that pneumonia was coded in 50 CHS dementia cases, compared with 10 coded as sepsis, but it does not establish that pneumonia is the most commonly identified immediate cause across older adults with Alzheimer’s or other dementias generally. (LLM, conf=0.84)

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Authors
Ives, D. G., Samuel, P., Psaty, B. M., & Kuller, L. H.
Affiliations
Group Health Cooperative (US)
ORCID
Venue
Journal of the American Geriatrics Society
Publisher
Wiley
Published
2008-12-31
Volume
57
Issue
1
Pages
133-139
ISSN
  • 0002-8614 (ISSN-L)
  • 1532-5415
DOI
10.1111/j.1532-5415.2008.02056.x
PMC
PMC2631612
OpenAlex
W2142266325
Cited by
108
References
21
Citations by year
2026: 2 · 2025: 4 · 2024: 9 · 2023: 5 · 2022: 10 · 2021: 6 · 2020: 10 · 2019: 3 · 2018: 7 · 2017: 5 · 2016: 4 · 2015: 4 · 2014: 7 · 2013: 4 · 2012: 12
FWCI
11.75
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of the American Geriatrics Society (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (n01hc085082-026, n01hc085081-021, n01hc085079-024, n01hc015103-009, n01hc085084-005, n01hc085085-011, n01hc085083-027, n01hc085080-026, n01hc085086-022, n01hc55222-0-0-0, n01hc035129-010)
  • National Heart, Lung, and Blood Institute (N01-HC-85081, N01HC85085, N01 HC085086, N01HC-85083, N01 HC085079, N01HC85082, N01 HC85086, N01 HC035129, N01HC85080, N01 HC015103, N01 HC55222, U01HL080295, N01 HC055222, N01-HC85079, ­N01-HC85084)
Topics
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
  • Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
  • Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
Keywords
underlying cause of death, death certificate coding, misclassification bias, dementia mortality, coronary heart disease mortality, stroke mortality, chronic obstructive pulmonary disease, pneumonia mortality, older adults, Cardiovascular Health Study
MeSH terms
Aged, Aged, 80 and over, Cause of Death, Coronary Disease, Death Certificates, Female, Forms and Records Control, Humans, Longitudinal Studies, Male, Stroke

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