Comparability of Mortality Follow-Up Before and After the National Death Index

Prior to 1979, epidemiologic studies which included mortality follow-up on large cohorts relied on death certificates from last state of residence and expensive follow-up techniques to determine survival. Beginning with 1979, the National Death Index can be used to search death certificate files from all 50 states, the Virgin Islands, and Puerto Rico. This paper addresses the issue of whether mortality follow-up in epidemiologic studies based on a single state death certificate search using only data available in 1970-1975 can be compared with post-1979 mortality follow-up using the National Death Index. This question was addressed by following a cohort of 2,925 coronary heart disease and cerebrovascular disease 1980 hospital discharges from 1980 through 1983 with the use of both the National Death Index and the Minnesota Death Index (MINNDEX). Algorithms for evaluating potential death certificate matches were developed independently for both systems. The systems agreed on the survival status of 98% of the cohort, and both identified 31% as dead. This study supports the comparison of results of National Death Index follow-up to pre-National Death Index studies using algorithms such as the MINNDEX, and provides evidence that trend analyses relying on single state death searches pre-1979 and on the National Death Index from 1979 are valid, particularly in chronically ill persons.