Contemporary accuracy of death certificates for coding prostate cancer as a cause of death: Is reliance on death certification good enough? A comparison with blinded review by an independent cause of death evaluation committee.
Turner EL., Metcalfe C., Donovan JL., Noble S., Sterne JAC., Lane JA., I Walsh E., Hill EM., Down L., Ben-Shlomo Y., Oliver SE., Evans S., Brindle P., Williams NJ., Hughes LJ., Davies CF., Ng SY., Neal DE., Hamdy FC., Albertsen P., Reid CM., Oxley J., McFarlane J., Robinson MC., Adolfsson J., Zietman A., Baum M., Koupparis A., Martin RM.
BACKGROUND: Accurate cause of death assignment is crucial for prostate cancer epidemiology and trials reporting prostate cancer-specific mortality outcomes. METHODS: We compared death certificate information with independent cause of death evaluation by an expert committee within a prostate cancer trial (2002-2015). RESULTS: Of 1236 deaths assessed, expert committee evaluation attributed 523 (42%) to prostate cancer, agreeing with death certificate cause of death in 1134 cases (92%, 95% CI: 90%, 93%). The sensitivity of death certificates in identifying prostate cancer deaths as classified by the committee was 91% (95% CI: 89%, 94%); specificity was 92% (95% CI: 90%, 94%). Sensitivity and specificity were lower where death occurred within 1 year of diagnosis, and where there was another primary cancer diagnosis. CONCLUSIONS: UK death certificates accurately identify cause of death in men with prostate cancer, supporting their use in routine statistics. Possible differential misattribution by trial arm supports independent evaluation in randomised trials.