[Review of mortality from hypertensive disease and diabetes mellitus after the error because of new death certificate: region of Murcia, Spain, 2009]. / Revisión de la mortalidad por diabetes mellitus y enfermedad hipertensiva tras el error detectado en el nuevo certificado de defunción: Región de Murcia en 2009.

BACKGROUND: The Medical Death Certificate and the Death Statistics Bulletin were unified and implemented in the year 2009 in Spain. National statistics detected an unusual increase for diabetes mellitus (DM) and hypertensive disease (HT) deaths in 2009, in relation to previous years trend.The objective is to study the documental causes of the increase, and describe the procedures and consequences in rates, after the revision and recodification of DM and HT. METHODS: All death certificates in 2009 for diabetes and hypertension in the Region of Murcia (cases=670) were revised, according to previous guidelines for direct recoding after consultation to the certifying physician. A telephone survey to certifying physician was designed to determine the accuracy of the pattern of recoding. Kappa index and 95% confidence intervals (95%CI) were performed between initial and recoded causes. Confirmation rate and 95%CI was estimated after phone inquiry to the certifying physician, and the annual age-adjusted and age-specific rates from 1999 to 2009 (uncorrected and corrected) for DM and HT were calculated. RESULTS: Simple agreement was 37% for DM and 30% for HT. The Kappa index between the initial and final causes was 49% (95%CI, 45 to 54%). Confirmation rates were 47% (95%CI, 43 to 52%) for DM and 38% (95%CI, 34 to 43%) for HT. The initial annual rates of 2009 for DM were corrected from 21.4 per 100,000 inhabitants to 17.1, and from 19.0 to 14.0 for hypertension. The respective specific age rates of 70 to 84 and older experienced similar reductions. CONCLUSIONS: The revision restored temporal trends in mortality of DM and HT in 2009, and identified no variations from previous years. It was detected that the erroneous fulfillment of DM AND HT came from the new death certificate.

Revisión de la mortalidad por diabetes mellitus y enfermedad hipertensiva tras el error detectado en el nuevo certificado de defunción. Región de Murcia en 2009 / Review of mortality from hypertensive disease and diabetes mellitus after the error because of new death certificate. Region of Murcia, Spain, 2009

Fundamentos: En el año 2009 se unificó el Certificado Médico de Defunción con el Boletín Estadístico de Defunción (CMD/BED). En la estadística nacional del año 2009 se detectó un aumento inusual en las defunciones por diabetes mellitus (DM) y enfermedad hipertensiva (HTA) en relación a la tendencia en años anteriores. El objetivo del trabajo es estudiar las causas documentales del aumento y describir los procedimientos y consecuencias en las tasas tras la revisión y recodificación de ambas causas. Métodos: Se revisaron todas las certificaciones de defunciones de 2009 por DM e HTA en la Región de Murcia (casos=670) según pautas previas de recodificación directa o tras consulta al médico certificador. Se diseñó una encuesta telefónica al médico certificador para determinar la exactitud de la pauta de recodificación. Se calculó el índice Kappa e intervalo de confianza (IC95%) entre las causas iniciales y recodificadas. Se estimó la tasa de confirmación e IC95% tras consulta telefónica; y las tasas totales y específicas por edad del año 1999 a 2009 con y sin corrección para DM e HTA. Resultados: Los casos concordantes fueron el 37% en DM y 29% HTA. El índice Kappa entre causas iniciales y finales fue del 49% (IC95%, 45-54%). Las tasas de confirmación fueron del 47% (IC95%, 43 a 52%) para DM y del 38% (IC95%, 34 a 43%) para HTA. Las tasas iniciales anuales del año 2009 para DM se corrigieron de 21,4 por cien mil habitantes a 17,1, y de 19,0 a 14,0 para HTA. Las respectivas tasas específicas por edad de 70 a 84 y más años presentaron reducciones similares. Conclusiones: La revisión restableció la tendencia temporal de la mortalidad por DM e HTAen 2009, e identificó que no tuvo variaciones respecto a años anteriores. Se detectó que la cumplimentación errónea de DM e HTA provenía del CMD/BED(AU)

Background: The Medical Death Certificate and the Death Statistics Bulletin were unified and implemented in the year 2009 in Spain. National statistics detected an unusual increase for diabetes mellitus (DM) and hypertensive disease (HT) deaths in 2009, in relation to previous years trend.The objective is to study the documental causes of the increase, and describe the procedures and consequences in rates, after the revision and recodification of DM and HT. Methods: All death certificates in 2009 for diabetes and hypertension in the Region of Murcia (cases=670) were revised, according toprevious guidelines for direct recoding after consultation to the certifying physician. A telephone survey to certifying physician was designed to determine the accuracy of the pattern of recoding. Kappa index and 95% confidence intervals (95%CI) were performed between initial and recoded causes. Confirmation rate and 95%CI was estimated after phone inquiry to the certifying physician, and the annual age-adjusted and agespecific rates from 1999 to 2009 (uncorrected and corrected) forDMand HT were calculated. Results: Simple agreement was 37% for DM and 30% for HT. The Kappa index between the initial and final causes was 49% (95%CI, 45 to 54%). Confirmation rates were 47% (95%CI, 43 to 52%) for DM and 38% (95%CI, 34 to 43%) for HT. The initial annual rates of 2009 forDM were corrected from 21.4 per 100,000 inhabitants to 17.1, and from 19.0 to 14.0 for hypertension. The respective specific age rates of 70 to 84 and older experienced similar reductions. Conclusions: The revision restored temporal trends in mortality of DM and HT in 2009, and identified no variations from previous years. It was detected that the erroneous fulfillment of DMAND HT came from the new death certificate(AU)