Influence of age at death on accuracy of death certificate disease diagnosis: findings in 475 consecutive deaths of mesothelioma among asbestos insulation workers and asbestos factory workers

Our plain-English summary of Influence of age at death on accuracy of death certificate disease diagnosis: findings in 475 consecutive deaths of mesothelioma among asbestos insulation workers and asbestos factory workers, by I.J. Selikoff (American Journal of Industrial Medicine, 1992).

The study

• Author: I.J. Selikoff
• Journal: American Journal of Industrial Medicine
• Published: 1992;22(4):505-10
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Age at death had no appreciable influence on accuracy of death certificate diagnoses of 475 consecutive deaths of mesothelioma among asbestos insulation and asbestos factory workers, until age 75 or older.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This study asked whether death certificates become less accurate at identifying mesothelioma as age at death rises. The author compared the cause on each death certificate with a 'best evidence' diagnosis made after review of all available material, including Mount Sinai histopathological review. This was done for 458 consecutive mesothelioma deaths among asbestos insulation workers in the United States and Canada (1967-1986) and 17 among asbestos factory workers (1941-1990). Among the insulation workers, the certificate disagreed with the verified diagnosis in 176 of 458 cases (38.4%). Until age 75 there was no drop-off in accuracy, with certificates correct in about two-thirds of cases. At 75 and older, disagreement rose to 29 of 50 cases (58%). Separately, 25 certificates named mesothelioma where review found another diagnosis. Results for the factory workers looked similar, but 17 cases were too few for confident evaluation. Among 137 lung cancer deaths in factory workers, 23 (16.7%) were discordant. The author concluded that accuracy did not vary appreciably with age at death, at least until 75 or older.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Comparison of death certificate diagnoses with verified ('best evidence') diagnoses, analyzed by age at death, within ongoing mortality studies of asbestos worker cohorts
• Who was studied: 458 consecutive mesothelioma deaths among asbestos insulation workers in the United States and Canada, 1967-1986, and 17 consecutive mesothelioma deaths among asbestos factory workers, 1941-1990, all verified by Mount Sinai histopathological review; also 137 consecutive lung cancer deaths among the asbestos factory workers
• Exposure: Asbestos insulation work and asbestos factory work (the article text does not specify fiber types for this analysis)
• Main results:
  • Among insulation workers, there was no drop in death certificate accuracy for mesothelioma until age 75. Certificates were accurate in about two-thirds of cases up to that age.
  • Among insulation workers aged 75 and older at death, discordance increased to 29 of 50 cases (58%). The table gives 18 of 29 (62.1%) at ages 75-79 and 11 of 20 (55.0%) at ages 80-84.
  • Overall, death certificates were discordant in 176 of 458 insulation worker mesothelioma deaths (38.4%). Among those dying under 65, 98 of 279 (35.1%) were discordant.
  • Among insulation workers, discordance was 82 of 231 (35.5%) when autopsy was available and 92 of 227 (40.5%) when histopathology was based on surgical material.
  • In a further 25 insulation worker cases, the death certificate said mesothelioma but histopathological review showed other diagnoses.
  • Among asbestos factory workers, 6 of 17 mesothelioma deaths (35.3%) were discordant. The author described the results as very much the same as for insulation workers.
  • Among asbestos factory workers, 23 of 137 lung cancer deaths (16.7%) were discordant. The author reported no great difference by age until 80, when accuracy diminished (9 deaths, 3 discordant).
• The authors' conclusion: The author concluded that the accuracy of death certificate diagnoses of mesothelioma and lung cancer in asbestos insulation and factory workers did not vary appreciably with age at death, at least until age 75 or older.
• Limitations the authors state:
  • Only 17 mesothelioma deaths among factory workers, too few for confident evaluation
  • The finding of reduced lung cancer accuracy at age 80 and over among factory workers is insecure because there were few deaths in that age group

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer, Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Death Certificate, Mesothelioma, Insulator.

Related studies

• Use of death certificates in epidemiological studies, including occupational hazards: variations in discordance of different asbestos-associated diseases on best evidence ascertainment — I.J. Selikoff, H. Seidman (1992)
• Death certificates in epidemiological studies, including occupational hazards: inaccuracies in occupational categories — I.J. Selikoff (1992)
• Estimation of the incidence of pleural mesothelioma according to death certificates in France — Y. Iwatsubo, M. Matrat, et al. (2002)
• Recovering missing mesothelioma deaths in death certificates using hospital records — V.S. Santana, E. Algranti, et al. (2018)
• Validation of death certificates in asbestos workers — M.L. Newhouse, J.C. Wagner (1969)
• Decline in death rates among asbestos insulation workers 1967-1986 associated with diminution of work exposure to asbestos — H. Seidman, I.J. Selikoff (1990)

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