Abstract
STUDY OBJECTIVE: The aim was to compare the value of four sources of data in assessing morbidity in a population: (1) data from a screening programme including follow up records, (2) death certifications by attending physicians, (3) death certifications by doctor-coroners, and (4) necropsy reports. DESIGN: The study was a cohort analysis of health and mortality in a sample of agricultural workers first examined in 1964-66 when they were aged 60 years or older. Follow up examinations enabled morbidity assessment to be made and ICD diagnostic categories to be compared with data available on persons in the cohort who had died. SETTING: Hajdúszoboszló, a small town in eastern Hungary. PARTICIPANTS: 1412 persons (96.1% of those aged greater than or equal to 60 years) were examined in 1964-6. Those still alive and available in 1989 were examined again. Necropsy records were available for 144 persons from the cohort in 1989 and were extensively reviewed in comparison with data available from other sources. MEASUREMENTS AND MAIN RESULTS: Comparison of causes of death established at necropsy showed marked differences from those registered by attending physicians and doctor-coroners, deviations ranging from -91.6% to +74.8%; 19.4% of underlying causes of death occurred exclusively in the necropsy group. Major divergencies in diagnostic classification occurred in the three data sources, particularly for diseases of the circulatory system, where hypertensive renal disease, old myocardial infarction, acute cerebrovascular disease, and venous thrombosis were rarely documented by physicians/coroners. When necropsy data were used the number of diagnostic categories increased strikingly over the other sources of information. Necropsy records revealed quantitatively similar information on morbidity to follow up examination though there were qualitative differences, necropsy being less likely to document diagnoses of endocrine disorders, mental and neurological diseases, digestive disorders, and musculosketal disorders. CONCLUSIONS: Necropsy records contain much valuable material not available from other sources, exceeding by ninefold the amount of information reported at present. A way should be found to make use of this large data pool.