International Mortality Statistics by Michael Rowland Alderson

By Michael Rowland Alderson

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They used their data to argue for a rather different system of handling mortality statistics, with the emphasis on multiple cause. 6). There was considerable variation in the mortality rates in the different countries and he concluded that these could not be explained by variation in practice of the official coders. Stocks examined the probability of variation in completeness of recognition of coronary involvement or the mention in the medical records of specific symptoms and signs of these diseases.

In the UK and US chronic valvular disease of unknown aetiology was rarely certified, but it was a relatively frequent term in Italy and Japan. He concluded that there was abundant evidence (but did not quote this) that change in diagnostic semantics is one of the factors in the increased prevalence of ischaemic heart disease. He also identified differences in the trends in mortality within sex and age groups (this makes one think that some general factor such as this could not account for these trends).

Florey et al. (1969) compared clinical records and autopsy material with diagnoses for a large sample of deaths from cerebrovascular disease in the US. For 607 cases who definitely had some form of cerebrovascular disease 74 per cent of the certificates agreed with the diagnosis obtained from the total clinical material. It was suggested that cerebral haemorrhage was over-diagnosed at the expense of thrombo-embolism on the death certificates. Kruger et al. (1967) drew attention to the successive revisions of the lCD, which had changed the definitions of both haemorrhagic and occlusive cerebrovascular disease and had failed to distinguish non-specific cerebrovascular disease.

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