文章基本信息

标题：Usefulness of Tobacco Check Boxes on Death Certificates: Texas, 1987–1998
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作者：Juan Carlos Zevallos ; Philip Huang ; Monica Smoot 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：9
页码：1610-1613
语种：English
出版社：American Public Health Association
摘要：Objectives. We compared reports of deaths in which tobacco use was a contributing factor (“tobacco-associated deaths”) before and after the addition to death certificates in Texas of a check-box question asking whether tobacco use contributed to an individual’s death. Methods. We examined Texas vital statistics files from 1987 to 1998. We calculated differences in percentages of reported tobacco-associated deaths (and 95% confidence intervals [CIs]) for the periods 1987 to 1992, before the addition of the check-box question, and 1993 to 1998, after the additon of the check-box. Results. Reports of tobacco-associated deaths were significantly less frequent before addition of the check-box question (0.7%; 95% CI = 0.4%, 1.0%) than after addition of the question (13.9%; 95% CI = 13.0%, 14.7%). From 1993 to 1998, percentages of tobacco-associated deaths reported on the check-box question increased steadily. Conclusions. The addition of a tobacco-associated-death check box on Texas death certificates significantly increased reporting of tobacco use contributions to mortality. Tobacco use is the single most preventable cause of death and disease in the United States. 1 More than 440 000 people die prematurely each year from diseases associated with the use of tobacco. 2 The American Cancer Society estimates that cigarette smoking is responsible for 1 of every 5 deaths in the United States and that tobacco use increases the risk of lung and other cancers as well as the risk of cardiovascular and respiratory diseases. 1, 2 In 1993, Texas became the fifth US state (preceded by Colorado, Oregon, Utah, and Washington) to add a question to its death certificate asking whether tobacco use contributed to an individual’s death. The belief in instituting this change was that information obtained from the tobacco check-box section would be more informative, useful, and interpretable to the public, clinicians, and health policymakers than estimates derived from mathematical models. 3 Before implementation of the check-box question on death certificates in Texas, nosologists from the Bureau of Vital Statistics determined whether deaths were related to tobacco use using International Classification of Diseases, Ninth Revision (ICD-9) code 305.1 (nondependent use of drugs: tobacco). Although nicotine has been widely recognized as the addicting substance in tobacco products, the ICD-9 does not classify it as a dependent drug. 4 The members of a panel formed to evaluate the US standard certificate of death recently recommended that the National Center for Health Statistics include as a standard feature a specific question designed to collect information on whether tobacco use contributed to a particular death. 5 The reason is that such a question would allow monitoring and documentation of the continuing impact of tobacco use on mortality and help to eliminate underreporting of such information on death certificates. The wording of the tobacco check-box question recommended by the panel evaluating the US standard certificate of death is identical to that used on the Texas death certificate. 5 Data obtained from death certificates should provide the greatest possible benefit for registrars compiling health statistics, individuals engaged in medicolegal work, clinicians and other health care personnel, and epidemiologists, as well as the family of the deceased. Death certificate data represent the only continuously collected, population-based, disease-related information available in most parts of the world, including the United States. 6 Although registration of deaths is virtually complete in the United States and demographic items are relatively accurate, the reliability of underlying cause of death data is hampered by several factors: lack of medical knowledge on the part of certifiers, incompleteness of information available at the time of death, lack of training on the proper completion of death certificates, and the system of classification of underlying causes. 7 Several studies conducted in the United States and elsewhere have determined that underlying cause of death data often do not concur with data derived from expert panel reviews and autopsy reports. 7– 10 Several other remedies have been advocated to reduce inaccuracy in death certificate information and to improve the quality of underlying cause of death data reported by certifiers. These remedies include instituting continuous educational sessions and training in practical feedback mechanisms, fostering an understanding of the construction of mortality data, providing evidence-based educational interventions for death certifiers, and creating a more “user-friendly” death certificate. 14– 16