- 期刊
Querying the ILL-Defined Stroke Diagnoses on Death Certificates and Their Effects on Type-Specific Mortality in Taiwan
複查台灣腦中風診斷欠明死亡證明書及其對類型別死亡率之影響
摘要
台灣腦中風死亡個案有高比例原死因被分類為診斷欠明，這會影響次分類死亡率分析之準確性。本研究目的想瞭解複查開具醫師後，台灣腦中風次分類死亡數分布與死亡率的改變程度。一九九八年一月至六月台灣共有2632份死亡證明書原死因分類為診斷欠明腦血管疾病(國際疾病分類第九版譯碼為436與437.9)，衛生署統計室工作人員影印其中2305份醫院開具的死亡證明書再郵寄回具醫師，要求提供更明確腦中風次分類訊息。複查2035份死亡證明書中有1505份(74%)回覆，其中四分之三(1191/1505)可更改為較明確的診斷，大多改變到腦出血(譯碼431,239/1505)與腦梗塞(譯碼433-4,819/1505)。經過複查後，腦出血年齡調整死亡率(每十萬人口)改變率，男性為+16%，女性為+20%；腦梗塞改變率男性為+16%，女性為+20%；腦梗塞改變率男性為+100%，女性為+130%。隨著死者年齡增加，改變率也增加。腦出血與腦梗塞死亡率比，複查前後之改變以低年齡組較顯著(小於65歲者)。經過複查後有高比例腦中風診斷欠明個案可以更改為較明確診斷，因此複查是改善死因統計品質的有用做法。由於腦中風次分類分布與死亡率經過複查後有相當大改變，所以不適合以未經複查的死因統計資料進行腦中風次分類分析。
關鍵字
無資料並列摘要
In Taiwan, the high proportion of stroke deaths of which the underlying causes of death (UCD) has been classified to ill-defined categories, has impeded valid type-specific mortality studies. The aim of this study was to assess the extent of changes in the distributions of stroke subtypes and mortality after querying the certifying physicians. There were 2632 death certificates issued from January through June 1998 in Taiwan of which the UCD was classified to illdefined cerebrovascular disease categories (international Classification of. Diseases, 9th Revision ICD-9 code 436 or 437.9). Staff of the Office of Statistics, Department of Health copied 2035 death certificates issued by hospitals and mailed them back to the certifying physicians to request more specific information on the stroke subtype. Responses were obtained for 1505 (74%) of the 2035 queries sent. Four fifths of these (1191/1S0S) resulted in a change to a more specific code. In most cases, the ICD-9 code was changed to 431 (cerebral hemorrhage, CH, 239/1505) or 433-4 (cerebral infarction, CI, 819/1505). After the querying, the percentage changes in the age-adjusted death rate (per 100 000 population) for CH were +16% for men and +20% for women; and for CI the percent changed were +100% for men and +130% for women. The changes increased as the age of the deceased increased. The changes in the CH/CI death ratios resulting from querying were greater in younger (less than 65 years old) age groups than in older age groups. Given the large gains of more specific information on stroke subtypes, querying is a useful method to improve the quality of cause of death statistics. However, the large changes in distributions and death rates of different stoke subtypes as a result of querying, show the non-querying mortality data are not suitable for type-specific analysis.