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Unveiling the Burden of Miscoding and Misclassification in Stroke Mortality: Analysis of Multiple Cause-of-Death Data in Mexico.

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dc.contributor.author Cahuana Hurtado, Lucero
dc.contributor.author Gómez-Dantés, Héctor
dc.contributor.author De la Cruz-Góngora, Vanessa
dc.contributor.author Chiquete, Erwin
dc.contributor.author Cantú-Brito, Carlos
dc.coverage.spatial México
dc.date.accessioned 2023-12-05T17:48:05Z
dc.date.available 2023-12-05T17:48:05Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14681
dc.description.abstract BACKGROUND: The prevalence of risk factors for cerebrovascular diseases in Mexico is increasing although stroke mortality declined from 1990 to 2010, without meaningful changes afterward. While improving access to adequate prevention and care could explain this trend, miscoding and misclassification in death certificates need to be assessed to unveil the true burden of stroke in Mexico. Practices in death certification along with the presence of multi-morbidity could contribute to this distortion. Analyses of multiple causes of death could reveal ill-defined stroke deaths, providing a glimpse of this bias. METHODS: Cause-of-death information from 4,262,666 death certificates in Mexico from 2009 to 2015, was examined to determine the extent of miscoding and misclassification on the true burden of stroke. Age-standardized mortality rates per 100,000 inhabitants (ASMR) were calculated for stroke as underlying and multiple causes of death, by sex and state. Deaths were classified following international standards as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and unspecified, which were kept as an independent category to measure miscoding. To approximate misclassification, we compared ASMR under three misclassification scenarios: (1) current (the status quo); (2) moderate, which includes deaths from selected causes mentioning stroke; and (3) high which includes all deaths mentioning stroke. National and subnational data were analyzed to search for geographical patterns. RESULTS: The burden of stroke in Mexico is underreported due to miscoding and misclassification. Miscoding is an important issue since almost 60% of all stroke deaths are registered as unspecified. Multiple cause analysis indicates that stroke ASMR could increase 39.9%-52.9% of the current ASMR under moderate and high misclassification scenarios, respectively. Both problems indicate the need to improve death codification procedures and cause-of-death classification. CONCLUSIONS: Miscoding and misclassification lead to underestimation of the burden of stroke in Mexico. Stroke deaths are underreported when other important causes coexist, being diabetes the most frequent. en_US
dc.language.iso eng
dc.publisher Karger
dc.relation.ispartofseries Neuroepidemiology
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Cerebrovascular disease en_US
dc.subject Coding en_US
dc.subject Death certificate en_US
dc.subject Hemorrhagic stroke en_US
dc.subject Ischemic stroke en_US
dc.subject Mexico en_US
dc.subject.mesh Trastornos Cerebrovasculares
dc.subject.mesh Codificación Clínica
dc.subject.mesh Certificado de Defunción
dc.subject.mesh Accidente Cerebrovascular Hemorrágico
dc.subject.mesh Accidente Cerebrovascular Isquémico
dc.subject.mesh México
dc.title Unveiling the Burden of Miscoding and Misclassification in Stroke Mortality: Analysis of Multiple Cause-of-Death Data in Mexico. en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1159/000531537
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.09
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.25
dc.relation.issn 1423-0208


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