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Sensitivity and Specificity of Death Certificates for Diabetes: As Good as it Gets?

¹Joint Doctoral Program, University of California, San Diego, San Diego State University
²University of California, San Diego, Family and Preventive Medicine

dwingard{at}ucsd.edu

ABSTRACT

Objective: Diabetes is the sixth leading cause of death in U.S adults, which may be an underestimate due to under-reporting on the death certificate. This study examines death certificate sensitivity and specificity for diabetes in a community-based sample.

Research Design and Methods: Death certificates were obtained for 3209 decedents from the Rancho Bernardo cohort who were enrolled in 1972-74 and followed through 2003. Diabetes status was reassessed at periodic clinic visits and annual mailed surveys during an average follow-up of 15.2 ±7.6 years. Diabetes reported anywhere on death certificates was abstracted. Sensitivity and specificity calculations among diabetic participants were stratified by age, sex, year, place, and cause of death, and diabetic medication use.

Results: Among 1641 men and 1568 women, 378 decedents had a history of diabetes; 168 of whom had diabetes listed anywhere on their death certificates. The sensitivity and specificity were 34.7% and 98.1%. Diabetes reporting on death certificates did not improve over time, or vary significantly by age or sex, but sensitivity for diabetes reporting was better for recent (1992-2003) cardiovascular disease deaths compared to any other causes of death (48.9% vs. 28.6% respectively, p<0.05).

Conclusions: Although diabetes reporting on death certificates did not improve over time, sensitivity was better for diabetes in context of cardiovascular disease deaths, likely reflecting the increasing recognition that diabetes is a major cardiovascular risk factor.

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