摘要：Objectives. Heart disease death overreporting is problematic in New York City (NYC) and other US jurisdictions. We examined whether overreporting affects the premature (< 65 years) heart disease death rate disparity between non-Hispanic Blacks and non-Hispanic Whites in NYC. Methods. We identified overreporting hospitals and used counts of premature heart disease deaths at reference hospitals to estimate corrected counts. We then corrected citywide, age-adjusted premature heart disease death rates among Blacks and Whites and a White–Black premature heart disease death disparity. Results. At overreporting hospitals, 51% of the decedents were White compared with 25% at reference hospitals. Correcting the heart disease death counts at overreporting hospitals decreased the age-adjusted premature heart disease death rate 10.1% (from 41.5 to 37.3 per 100 000) among Whites compared with 4.2% (from 66.2 to 63.4 per 100 000) among Blacks. Correction increased the White–Black disparity 6.1% (from 24.6 to 26.1 per 100 000). Conclusions. In 2008, NYC’s White–Black premature heart disease death disparity was underestimated because of overreporting by hospitals serving larger proportions of Whites. Efforts to reduce overreporting may increase the observed disparity, potentially obscuring any programmatic or policy-driven advances. Heart disease remains the number one killer of men and women in New York City (NYC) and the United States. 1,2 In 2003, the age-adjusted coronary heart disease death rate was 1.7 times higher in NYC than nationally; yet, on average, NYC’s heart disease risk profile was better than that of the United States. 3,4 The NYC Department of Health and Mental Hygiene (DOHMH) and the Centers for Disease Control and Prevention (CDC) conducted a cross-sectional validation study to investigate this paradox, comparing the cause of death on the death certificate with a validated cause of death determined by a blinded medical team. In a sample of 444 reviewed cases, coronary heart disease deaths were overreported by 91% overall and increased with decedent’s age: 51% among decedents aged between 35 and 74 years, 94% among decedents aged between 75 and 84 years, and 137% for decedents aged 85 years or older. 4 Overreporting of coronary heart disease has also been found in other US jurisdictions. 5 More generally, overreporting of heart disease, comprising rheumatic, hypertensive, and chronic ischemic heart diseases; acute myocardial infarction; cardiomyopathy; and heart failure, varies substantially by hospital in NYC. 6 This is potentially problematic because patient demographics differ among NYC hospitals because of residential segregation, insurance status, and health services provided. 7,8 As a consequence, the prevalence of heart disease overreporting likely differs by decedents’ demographic characteristics including ethnicity. If this is the case, overreporting of heart disease deaths may distort observed racial/ethnic disparities in heart disease death rates. Premature death (i.e., at ages < 65 years) rates are of particular interest because they contribute disproportionately to the years of life lost from heart disease. Such disparity measures are used extensively by the New York City DOHMH to guide health policy, design public health programs, and measure the impact of local and national public health interventions. In addition, they are a part of the Healthy People 2020 national health objectives and DOHMH’s Take Care New York comprehensive health policy goals. 9,10 The goal of this study was to better understand the impact of heart disease overreporting, which occurs at all ages and among all races, on the measurement of the premature heart disease death disparity between Blacks and Whites in NYC. We assessed the impact of vital data quality issues on health disparity tracking. Our methods will be useful to other jurisdictions faced with similar overreporting issues or other cause-of-death data quality issues in any disease category, and our results may suggest outcomes in other urban settings.
