The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #63942

Amanda J Durante, MSc, PhD¹, Andre Sofair, MD, MPH¹, Stacey Schuft, MPH¹, Ahang Zafari, MD¹, Thomas St. Louis, MSPH¹, and Beth P Bell, MD, MPH². (1) Connecticut Emerging Infections Program, Yale University, One Church Street, 7th Floor, New Haven, CT 06510, 203 764 9921, amanda.durante@yale.edu, (2) Division of Viral Hepatitis, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, N.E., MS G-37, Atlanta, GA 30333

Background: Chronic liver disease (CLD) mortality burden is defined by the Division of Vital Statistics (DVS) as death certificates with ICD10 codes K70, K73-K74 listed as the primary cause of death. We examine the accuracy of CLD ascertainment using this definition and the use of ICD10-coded data to establish CLD etiology. Method: We created a comprehensive list of ICD10 codes that could be CLD-related. We identified death certificates of New Haven County adults who died from 10/99-09/00 that had one of these codes listed on any line. We collected data on these deaths from at least one of three sources: chart review, certifier questionnaire and medical examiner report. If we established that death was due to a variceal bleed, spontaneous bacterial peritonitis, hepatic encephalopathy or hepatocellular carcinoma we classified it as caused by CLD. Results: Of 7595 death certificates, 466 included a possible CLD-related code. Of 304 (65%) deaths assessed to date, 159 (52%) had evidence of CLD. Of these, 89 (56%) deaths were caused by CLD. Using our results as the gold standard, the sensitivity of the DVS CLD death detection method was 38% (34/89) and the specificity was 88% (46/52). Only 1 of 23 hepatitis C (HCV) CLD death certificates included the chronic HCV ICD10 code. Conclusions: The DVS method accurately identified some CLD deaths, but missed many others. Mortality rate and leading cause of death calculations based on this method could underestimate CLD burden. The contribution of HCV to CLD mortality may be under-represented on death certificates.

Learning Objectives:

• Explain the likely effects of using the Division of Vital Statistics method for estimating the mortality burden of chronic liver disease.
• Articulate the reasons the Division of Vital Statistics method could understate the chronic liver disease mortality burden.
• Describe the limitations of using ICD10 coded death certificate data for assessing the contribution of chronic hepatitis C infection to chronic liver disease.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.