The existence of standard-biased mortality ratios due to death certificate misclassification - a simulation study based on a true story

BMC Medical Research Methodology
Andreas Deckert

Abstract

Mortality statistics are used to compare health status of populations; optimally, they base on individual death certificates. However, determining cause of death is error-prone. E.g. cardiovascular disease (CVD) death determination is characterized by sensitivity (SE) and specificity (SP) lower than 85%. Furthermore, differential misclassification may be present in case of homogenous target populations. We investigate the bias of standardized mortality ratios (SMR), based on real-world data. CVD mortality of 6378 ethnic German repatriates was assessed and the SMR calculated. Non-differential age-dependent misclassification was introduced into data by scenarios of equal SE and SP in a range of 0.7 to 0.85. The bias between originally reported and actual SMR was calculated for each pair of values. Additionally, four differential misclassification scenarios were simulated, reflecting two extreme scenarios of both quality criteria varied in the cohort but fixed to either higher or lower in the reference, and two scenarios of crossed criteria values. In case of non-differential misclassification the bias is always towards the null-hypothesis. The lowest bias was 13.5% (SE, SP = 0.85 constantly), the maximum bias was 40% (SP = 0.7). ...Continue Reading

References

Dec 29, 1998·Annals of Internal Medicine·D M Lloyd-JonesD Levy
Apr 29, 1999·International Journal of Medical Informatics·G Surján
Jun 22, 2007·Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz·T Schelhase, S Weber
Jul 29, 2009·International Journal of Public Health·Volker WinklerHeiko Becher
May 15, 2015·Lancet·Kenji Shibuya, Stuart Gilmour

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Citations

Dec 12, 2018·Clinical & Translational Oncology : Official Publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico·A Roca-BarcelóR Marcos-Gragera

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