Understanding the Coronary Heart Disease Versus Total Cardiovascular Mortality Paradox
Key result
Adjusting for individual and community-level predictors of cause-of-death assignment increased national CHD death rates by 10% for males and 15% for females, improving comparability across states.
Why the study?
Does adjustment for individual and community-level predictors improve the comparability of coronary heart disease mortality estimates across states?
Study Design
Type
Observational
Multicenter
Yes
Structured PICO
Does adjustment for individual and community-level predictors improve the comparability of coronary heart disease mortality estimates across states?
P
Population
Decedents over 30 years of age in the United States in 2001 with cardiovascular causes of death
I
Intervention
Statistical adjustment for individual-level (race, sex, age, education, place of death) and community-level (cardiologists per capita) predictors of cause-of-death assignment
C
Comparator
Unadjusted cause-of-death assignment
O
Outcome
Likelihood of a death being certified as 1 of 3 ill-defined clusters (general atherosclerosis and unspecified heart disease, heart failure, and cardiac arrest) relative to being certified as coronary heart disease (CHD)
Adjusting for demographic and healthcare access variables significantly alters reported coronary heart disease mortality rates, highlighting disparities in cause-of-death assignment.
Limitations
- The role of the exogenous predictors in validity and comparability of cause-of-death statistics should be confirmed in carefully designed validation autopsy studies.
- The role of exogenous predictors in validity and comparability of cause-of-death statistics should be confirmed in carefully designed validation autopsy studies
Authors
Discussion
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Implication
Unadjusted state CHD mortality rates may misrepresent burden; supports routine adjustment in surveillance research.
Cite This Study
Murray et al. (2006) conducted an observational in Coronary heart disease mortality. Adjustment for individual- and community-level predictors of cause-of-death assignment vs. Unadjusted mortality estimates was evaluated on State-level CHD death rates. Adjusting for individual and community-level predictors of cause-of-death assignment increased national CHD death rates by 10% for males and 15% for females, improving comparability across states.