Impact of misclassification on measures of cardiovascular disease mortality in the Islamic Republic of Iran: a cross-sectional study
Open accessAbstract
OBJECTIVE: To assess the extent and pattern of misclassification of death from non-specific diagnoses emanating from the Iranian death registration system, and to correct the data for health policy and planning. METHODS: Detailed medical records for 1426 hospital deaths classified to seven ill-defined or vague causes of death were reviewed by trained physicians, who then completed standard death certificates. Underlying causes of death from the review were compared with the cause assigned in registration data. FINDINGS: The probable underlying pattern of causes of death in the Islamic Republic of Iran is substantially different to that suggested by the death registration system. About 88% of 582 cases with non-specific diagnoses at ages 15-69 years were reassigned to various specific causes including ischaemic heart disease (33%), stroke (13%) and injuries (10%). A similar pattern of misclassification is apparent for 738 deaths at older ages (70 years and over), with 46% being reassigned to ischaemic heart disease and stroke. CONCLUSION: A significant proportion of deaths in the Iranian death registration system are being classified to cause groups of little relevance to epidemiological research or health policy. Reassignment of these deaths would increase the proportion of deaths from ischaemic heart disease and cerebrovascular diseases each by 32%, diabetes mellitus by 68% and chronic lower respiratory diseases by 73%. Substantial changes to procedures for diagnosing causes of death are urgently required if registration data are to effectively guide health policies and programmes in the Islamic Republic of Iran.
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Extensive misclassification of deaths in hospitals by physicians, especially in developing countries, has been widely documented.
“Extensive misclassification of deaths in hospitals by physicians, especially in developing countries, has been widely documented [88–90].”
From Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis (2014) · cites this paper as [90]
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Cites
(2005) · Europe PMC (PubMed Central) · Cited by 1,975 · see citing works
Soleman, N. (2006) · Bulletin of the World Health Organization · doi:10.2471/blt.05.027003 · Cited by 313 · see citing works
Unintentional Injuries in Developing Countries: The Epidemiology of a Neglected Problem
Smith, G. S., & Barss, P. G. (1991) · Epidemiologic Reviews · doi:10.1093/oxfordjournals.epirev.a036070 · Cited by 238 · see citing works
Road-traffic-related mortality in Iran: a descriptive study
Montazeri, A. (2003) · Public Health · doi:10.1016/s0033-3506(03)00173-2 · Cited by 222 · see citing works
Epidemiology of violent deaths in the world
Reza, A., Mercy, J. A., & Krug, E. (2001) · Injury Prevention · doi:10.1136/ip.7.2.104 · Cited by 221 · see citing works
Validation of verbal autopsy procedures for adult deaths in China
Yang, G., Rao, C., Ma, J., Wang, L., Wan, X., Dubrovsky, G., & Lopez, A. D. (2006) · International Journal of Epidemiology · doi:10.1093/ije/dyi181 · Cited by 187 · see citing works
Deaths: leading causes for 2003.
Heron, M. P., & Smith, B. L. (2007) · PubMed · Cited by 175 · see citing works
Validity of verbal autopsy procedures for determining cause of death in Tanzania
Setel, P., Whiting, D. R., Hemed, Y., Chandramohan, D., Wolfson, L. J., Alberti, K. G. M. M., & López, A. D. (2006) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2006.01603.x · Cited by 165 · see citing works
The University of North Carolina at Chapel Hill University Libraries (2020) · PubMed · doi:10.17615/8k7j-7g38 · Cited by 155 · see citing works
Sington, J. D., & Cottrell, B. (2002) · Journal of Clinical Pathology · doi:10.1136/jcp.55.7.499 · Cited by 135 · see citing works
Comparing hospital discharge records with death certificates: Can the differences be explained?
Johansson, L. A., & Westerling, R. (2002) · Journal of Epidemiology & Community Health · doi:10.1136/jech.56.4.301 · Cited by 125 · see citing works
Mortality in the Islamic Republic of Iran, 1964-2004
Khosravi, A. (2007) · Bulletin of the World Health Organization · doi:10.2471/blt.06.038802 · Cited by 117 · see citing works
Self-citationSecular trends in cardiovascular mortality in Iran, with special reference to Isfahan.
Sarrafzadegan, N., Boshtam, M., Malekafzali, H., Bashardoost, N., Sayed‐Tabatabaei, F. A., Rafiei, M., Khalili, A., Mostafavi, S., Khami, M. R., & Hassanvand, R. (1999) · PubMed · Cited by 96 · see citing works
(1990) · PubMed · Cited by 92 · see citing works
Validation of cause-of-death statistics in urban China
Rao, C., Yang, G., Hu, J., Ma, J., Xia, W., & Lopez, A. D. (2007) · International Journal of Epidemiology · doi:10.1093/ije/dym003 · Cited by 88 · see citing works
Survey Methods in Community Medicine: Epidemiological Studies, Programme Evaluation, Clinical Trials
Abramson, J. H. (1991) · Medical Entomology and Zoology · Cited by 79 · see citing works
Mortality certification and cause-of-death reporting in developing countries.
Sibai, A. M. (2004) · PubMed · doi:10.1590/s0042-96862004000200002 · Cited by 62 · see citing works
Lu, T. (2003) · Journal of Epidemiology & Community Health · doi:10.1136/jech.57.6.470 · Cited by 62 · see citing works
The quality of cause-of-death statistics.
Sirken, M. G., Rosenberg, H. M., Chevarley, F. M., et al. (1987) · American Journal of Public Health · doi:10.2105/ajph.77.2.137 · Cited by 50 · see citing works
Estimating mortality and causes of death in Turkey: methods, results and policy implications
Akgün, S., Rao, C., Yardım, N., et al. (2007) · European Journal of Public Health · doi:10.1093/eurpub/ckm022 · Cited by 46 · see citing works
Methodology of studies evaluating death certificate accuracy were flawed
Johansson, L. A., Westerling, R., & Rosenberg, H. M. (2005) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2005.05.006 · Cited by 41 · see citing works
MORTALITY AND CHANGING EPIDEMIOLOGICAL TRENDS IN IRAN DURING 1979-2001
Yavari, P., Abadi, A., & Elah, M. Y. (2003) · Cited by 26 · see citing works
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Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015
Roth, G. A., Johnson, C., Abajobir, A., Abd-Allah, F., Abera, S. F., Abyu, G., Ahmed, M., Aksut, B., Alam, T., Alam, K., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.04.052 · Cited by 3,791 · see citing works
Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis
Mokdad, A. A., Lopez, A. D., Shahraz, S., Lozano, R., Mokdad, A. H., Stanaway, J., Murray, C. J., & Naghavi, M. (2014) · BMC Medicine · doi:10.1186/s12916-014-0145-y · Cited by 1,129 · see citing works
Farzadfar, F., Danaei, G., Namdaritabar, H., Rajaratnam, J. K., Marcus, J. R., Khosravi, A., Alikhani, S., Murray, C. J., & Ezzati, M. (2011) · Population Health Metrics · doi:10.1186/1478-7954-9-55 · Cited by 12 · see citing works
Self-citationNaghavi, M., Richards, N., Chowdhury, H., Eynstone-Hinkins, J., Franca, E., Hegnauer, M., Khosravi, A., Moran, L., Mikkelsen, L., & Lopez, A. D. (2020) · BMC Medicine · doi:10.1186/s12916-020-01525-w · Cited by 74 · see citing works
Self-citationJoshi, R., Chow, C. K., Raju, P. K., Raju, R., Reddy, K. S., MacMahon, S., Lopez, A. D., & Neal, B. (2009) · Circulation · doi:10.1161/circulationaha.108.819201 · Cited by 67 · see citing works
Pattaraarchachai, J., Rao, C., Polprasert, W., Porapakkham, Y., Pao-in, W., Singwerathum, N., & Lopez, A. D. (2010) · Population Health Metrics · doi:10.1186/1478-7954-8-12 · Cited by 64 · see citing works
- Authors
- Khosravi, A.
- Affiliations
- Ministry of Health and Medical Education (IR)
- Corresponding author
- Khosravi, Ardeshir
- ORCID
- Khosravi, Ardeshir
- Venue
- Bulletin of the World Health Organization
- Publisher
- WHO Press
- Published
- 2008-09-01
- Volume
- 86
- Issue
- 9
- Pages
- 688-696
- ISSN
- 0042-9686 (ISSN-L)
- PMC
- PMC2649498
- OpenAlex
- W2107404370
- Cited by
- 69
- References
- 22
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 4 · 2022: 4 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 9 · 2014: 12 · 2013: 4 · 2012: 2
- FWCI
- 10.28
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Bulletin of the World Health Organization (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
- Keywords
- death registration, underlying cause of death, ischemic heart disease, stroke, cerebrovascular disease, diabetes mellitus, chronic lower respiratory diseases, cardiovascular mortality
- MeSH terms
- Adolescent, Adult, Aged, Cardiovascular Diseases, Cause of Death, Death Certificates, Forms and Records Control, Humans, Iran, Medical Records, Middle Aged, Reproducibility of Results, Bias, Young Adult
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