State differences in the reporting of 'unspecified stroke' on death certificates

Implications for improvement

Tain Junn Cheng, Chia Yu Chang, Ching Yih Lin, Der Shin Ke, Tsung-Hsueh Lu, Ichiro Kawachi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background and Purpose: Little is known about the comparability of stroke subtype mortality across states. We conducted a cross-sectional descriptive study to examine state differences in the reporting of "unspecified stroke" on death certificates in the United States. Methods: The number of deaths from different subtypes of stroke in each state for the years 2007 to 2009 were obtained from the CDC WONDER online databases. We calculated the percentage of stroke deaths classified as unspecified stroke (International Classification of Diseases, 10th Revision [ICD-10] code I64) among all stroke deaths (ICD-10 codes I60-I69) for each state. Results: Of 398 942 people who died from stoke in the United States between 2007 and 2009, in 209 933 (53%) cases, the medical certifier did not specify whether the stroke was hemorrhage or infarction on the death certificate. There were 44 states in which the percentage of unspecified stroke among all strokes was ≥50% and 20 states in which the percentage was ≥55%. The percentage was lowest in the District of Columbia (46%) and highest in Oklahoma (64%). The state variation in the proportion of unspecified stroke decreased with age of the deceased. The state percentage of unspecified stroke correlated most with the state percentage of cerebral infarction and other and sequelae of cerebrovascular disease. Conclusions: Owing to the high percentage and state variation in the reporting of unspecified stroke on death certificates, the comparability of stroke subtype mortality is threatened. Querying of medical certifiers for more specific information for better coding is needed.

Original languageEnglish
Pages (from-to)3336-3342
Number of pages7
JournalStroke
Volume43
Issue number12
DOIs
Publication statusPublished - 2012 Dec 1

Fingerprint

Death Certificates
Stroke
International Classification of Diseases
Cerebrovascular Disorders
Mortality
Cerebral Infarction
Centers for Disease Control and Prevention (U.S.)
Infarction

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialised Nursing

Cite this

Cheng, Tain Junn ; Chang, Chia Yu ; Lin, Ching Yih ; Ke, Der Shin ; Lu, Tsung-Hsueh ; Kawachi, Ichiro. / State differences in the reporting of 'unspecified stroke' on death certificates : Implications for improvement. In: Stroke. 2012 ; Vol. 43, No. 12. pp. 3336-3342.
@article{faa10b1ce26e4ccca20b955a3065842e,
title = "State differences in the reporting of 'unspecified stroke' on death certificates: Implications for improvement",
abstract = "Background and Purpose: Little is known about the comparability of stroke subtype mortality across states. We conducted a cross-sectional descriptive study to examine state differences in the reporting of {"}unspecified stroke{"} on death certificates in the United States. Methods: The number of deaths from different subtypes of stroke in each state for the years 2007 to 2009 were obtained from the CDC WONDER online databases. We calculated the percentage of stroke deaths classified as unspecified stroke (International Classification of Diseases, 10th Revision [ICD-10] code I64) among all stroke deaths (ICD-10 codes I60-I69) for each state. Results: Of 398 942 people who died from stoke in the United States between 2007 and 2009, in 209 933 (53{\%}) cases, the medical certifier did not specify whether the stroke was hemorrhage or infarction on the death certificate. There were 44 states in which the percentage of unspecified stroke among all strokes was ≥50{\%} and 20 states in which the percentage was ≥55{\%}. The percentage was lowest in the District of Columbia (46{\%}) and highest in Oklahoma (64{\%}). The state variation in the proportion of unspecified stroke decreased with age of the deceased. The state percentage of unspecified stroke correlated most with the state percentage of cerebral infarction and other and sequelae of cerebrovascular disease. Conclusions: Owing to the high percentage and state variation in the reporting of unspecified stroke on death certificates, the comparability of stroke subtype mortality is threatened. Querying of medical certifiers for more specific information for better coding is needed.",
author = "Cheng, {Tain Junn} and Chang, {Chia Yu} and Lin, {Ching Yih} and Ke, {Der Shin} and Tsung-Hsueh Lu and Ichiro Kawachi",
year = "2012",
month = "12",
day = "1",
doi = "10.1161/STROKEAHA.112.670877",
language = "English",
volume = "43",
pages = "3336--3342",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

State differences in the reporting of 'unspecified stroke' on death certificates : Implications for improvement. / Cheng, Tain Junn; Chang, Chia Yu; Lin, Ching Yih; Ke, Der Shin; Lu, Tsung-Hsueh; Kawachi, Ichiro.

In: Stroke, Vol. 43, No. 12, 01.12.2012, p. 3336-3342.

Research output: Contribution to journalArticle

TY - JOUR

T1 - State differences in the reporting of 'unspecified stroke' on death certificates

T2 - Implications for improvement

AU - Cheng, Tain Junn

AU - Chang, Chia Yu

AU - Lin, Ching Yih

AU - Ke, Der Shin

AU - Lu, Tsung-Hsueh

AU - Kawachi, Ichiro

PY - 2012/12/1

Y1 - 2012/12/1

N2 - Background and Purpose: Little is known about the comparability of stroke subtype mortality across states. We conducted a cross-sectional descriptive study to examine state differences in the reporting of "unspecified stroke" on death certificates in the United States. Methods: The number of deaths from different subtypes of stroke in each state for the years 2007 to 2009 were obtained from the CDC WONDER online databases. We calculated the percentage of stroke deaths classified as unspecified stroke (International Classification of Diseases, 10th Revision [ICD-10] code I64) among all stroke deaths (ICD-10 codes I60-I69) for each state. Results: Of 398 942 people who died from stoke in the United States between 2007 and 2009, in 209 933 (53%) cases, the medical certifier did not specify whether the stroke was hemorrhage or infarction on the death certificate. There were 44 states in which the percentage of unspecified stroke among all strokes was ≥50% and 20 states in which the percentage was ≥55%. The percentage was lowest in the District of Columbia (46%) and highest in Oklahoma (64%). The state variation in the proportion of unspecified stroke decreased with age of the deceased. The state percentage of unspecified stroke correlated most with the state percentage of cerebral infarction and other and sequelae of cerebrovascular disease. Conclusions: Owing to the high percentage and state variation in the reporting of unspecified stroke on death certificates, the comparability of stroke subtype mortality is threatened. Querying of medical certifiers for more specific information for better coding is needed.

AB - Background and Purpose: Little is known about the comparability of stroke subtype mortality across states. We conducted a cross-sectional descriptive study to examine state differences in the reporting of "unspecified stroke" on death certificates in the United States. Methods: The number of deaths from different subtypes of stroke in each state for the years 2007 to 2009 were obtained from the CDC WONDER online databases. We calculated the percentage of stroke deaths classified as unspecified stroke (International Classification of Diseases, 10th Revision [ICD-10] code I64) among all stroke deaths (ICD-10 codes I60-I69) for each state. Results: Of 398 942 people who died from stoke in the United States between 2007 and 2009, in 209 933 (53%) cases, the medical certifier did not specify whether the stroke was hemorrhage or infarction on the death certificate. There were 44 states in which the percentage of unspecified stroke among all strokes was ≥50% and 20 states in which the percentage was ≥55%. The percentage was lowest in the District of Columbia (46%) and highest in Oklahoma (64%). The state variation in the proportion of unspecified stroke decreased with age of the deceased. The state percentage of unspecified stroke correlated most with the state percentage of cerebral infarction and other and sequelae of cerebrovascular disease. Conclusions: Owing to the high percentage and state variation in the reporting of unspecified stroke on death certificates, the comparability of stroke subtype mortality is threatened. Querying of medical certifiers for more specific information for better coding is needed.

UR - http://www.scopus.com/inward/record.url?scp=84870954794&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84870954794&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.112.670877

DO - 10.1161/STROKEAHA.112.670877

M3 - Article

VL - 43

SP - 3336

EP - 3342

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 12

ER -