The Validity of the Routine Mortality Statistics on Coronary Heart Disease in Finland:

Abstract 

We compared the diagnoses obtained from the routine mortality statistics with the standardized World Health Organization (WHO) MONICA (multinational MONItoring of trends and determinants in CArdiovascular disease) classification in suspect coronary heart disease (CHD) deaths registered in the FINMONICA myocardial infarction (MI) register during 1983–1992. All CHD deaths from routine mortality statistics (International Classification of Diseases codes 410–414) were registered in the MI register. Of the CHD deaths in routine mortality statistics 1.7% in men and 4.8% in women did not fulfill the MONICA criteria for CHD death (P < 0.001 for the difference between the sexes). In men 4.7% and in women 7.3% (P = 0.004) of the deaths registered in the MI Register and classified as CHD deaths by MONICA criteria had another underlying cause of death than CHD in routine mortality statistics; this proportion increased over time in both sexes (P = 0.002 in men and P = 0.77 in women). The CHD mortality trends obtained separately from the routine mortality statistics and from the FINMONICA MI Register were very similar. In conclusion, the high CHD mortality in Finland reported by the routine mortality statistics is real. It is possible that some CHD deaths have escaped registration, but the decline seen in the CHD mortality is also real.

Keywords:  Vital statistics, coronary heart disease, mortality, validity, diagnostic accuracy, epidemiology