Accuracy of Death Certificates in COPD: Analysis from the TORCH Trial

Figures & data

Figure 1. Flow of case selection (TORCH = Towards a Revolution in COPD Health).

Table 1.  Demographic and Clinical Characteristics of 911 Torch Deaths

	Informative Death Certificate	Unobtainable or Non-informative Death Certificate	p-value
N	395	516
Age (years)	68.5 (7)	67.8 (7)	0.21
Male sex, n(%)	310 (79)	424 (82)	0.16
Current smoker, n(%)	155 (39)	229 (44)	0.12
Pack-years, no.	54.1 (32)	52.3 (29)	0.37
No. of exacerbations*
Total	1.47 (1.8)	1.58 (1.8)	0.37
Requiring antibiotics or steroids	1.15 (1.6)	1.14 (1.5)	0.95
Requiring hospitalization	0.32 (0.7)	0.44 (0.8)	0.02
FEV1,% pred	39.4 (13.2)	40.7 (13.3)	0.17
Total SGRQ Score	54.6 (16.7)	53.5 (16.8)	0.38
Geographic Region
Americas	160 (41)	105 (20)
Europe	112 (28)	294 (57)
Western Pacific	86 (22)	87 (17)
Africa	27 (7)	10 (2)
Southeast Asia	10 (3)	20 (4)	<0.01
Cause of death
Pulmonary	168 (43)	155 (30)
Cardiovascular	111 (28)	126 (24)
Cancer	83 (21)	110 (21)
Other	33 (8)	51 (10)
Unknown	0 (0)	74 (14)	<0.01

Values are mean (S.D.) or n(%). FEV1 = Forced expiratory volume in 1 sec; SGRQ = St. George's Respiratory Questionnaire. *number of exacerbations in year prior to randomization.

Table 2.  Demographic and clinical characteristics

	Overall	Pulmonary	Cardiovascular	Cancer	Other
N (%)	395 (100)	168 (43)	111 (28)	83 (21)	33 (8)
Age (years)	68.5 (7)	67.9 (8)	69.1 (6)	68.6 (6)	69.2 (8)
Male sex, n(%)	310 (79)	127 (76)	93 (84)	67 (81)	23 (70)
Current smoker, n(%)	155 (39)	60 (36)	45 (41)	37 (45)	13 (39)
Pack-years, no.	54.1 (32)	54.7 (32)	50.6 (27)	58.3 (36)	52.3 (31)
No. of exacerbations,*
Total	1.47 (1.8)	1.73 (1.9)	1.54 (1.8)	1.09 (1.5)	0.91 (1.7)
Requiring antibiotics	1.15 (1.6)	1.33 (1.7)	1.23 (1.6)	0.88 (1.2)	0.70 (1.3)
or steroids
Requiring	0.32 (0.7)	0.40 (0.6)	0.32(0.7)	0.22 (0.5)	0.21 (0.8)
hospitalization
FEV1, % pred^†	39.4 (13.2)	35.9 (13.3)	43.7 (12.8)	40.8 (12.9)	39.7 (9.98)
Total SGRQ Score^±	54.6 (16.7)	58.6 (15.9)	52.8 (17.3)	50.7 (15.9)	50.6 (17.3)

Values are mean (S.D.) or n(%). *Number of exacerbations reported in last year. ^†p<0.01 pulmonary vs. cardiovascular, p = 0.03 pulmonary vs. cancer. ^±p<0.01 pulmonary vs. cancer. FEV1 = Forced expiratory volume in 1 sec; SGRQ = St. George's Respiratory Questionnaire.

Table 3.  Death certificate concordance with adjudicated category of death, n(%)

Death Certificate
	N	Primary and Secondary COD	Primary COD	Secondary COD	Significant Condition	No Concordance
Overall	395	317 (80)	235 (60)	82 (21)	9 (2)	69 (18)
Pulmonary	168	138 (82)	106 (63)	32 (19)	5 (3)	25 (15)
Cardiovascular	111	85 (77)	66 (60)	19 (17)	0 (0)	26 (23)
Cancer	83	66 (80)	43 (52)	23 (28)	4 (5)	13 (16)
Other	33	28 (85)	20 (61)	8 (24)	0 (0)	5 (15)

COD = Cause of death.

Table 4.  Death certificate concordance with adjudicated category of death by geographic region

	N	Primary and Secondary COD	Primary COD	Secondary COD	Significant Condition	No Concordance
Americas	160	133 (83)	102 (64)	31 (19)	5 (3)	22 (14)
Europe	112	97 (87)	71 (63)	26 (23)	1 (1)	14 (13)
Western Pacific	86	71 (83)	48 (56)	23 (27)	2 (2)	13 (15)
Africa	27	9 (33)	9 (33)	0 (0)	1 (4)	17 (63)
Southeast Asia	10	7 (70)	5 (50)	2 (20)	0 (0)	3 (30)

All values listed are n (%). COD = Cause of death.

Figure 2. Percentage of death certificates (DC) by general pathophysiologic category listing Chronic Obstructive Pulmonary Disease (COPD). (Pulm = Pulmonary, CV = Cardiovascular).

Table 5.  Proportion of Death Certificates Listing COPD Anywhere

	Death Certificates Listing COPD, n (%)
Overall (n = 395)	229 (58)
Pulmonary (n = 168)	130 (77)
COPD (n = 127)	100 (79)
Pneumonia (n = 34)	28 (82)
Pulmonary Embolism (n = 1)	0
Other (n = 6)	2 (33)
Cardiovascular (n = 111)	57 (51)
Sudden Death (n = 70)	37 (53)
Stroke (n = 15)	8 (53)
MI (n = 11)	5 (46)
CHF (n = 9)	5 (56)
Other (n = 6)	2 (33)
Cancer (n = 83)	29 (35)
Lung (n = 55)	17 (31)
Colorectal Cancer (n = 3)	2 (67)
Breast (n = 2)	0
Other (n = 23)	10 (43.5)
Other (n = 33)	13 (39.4)

COPD = Chronic obstructive pulmonary disease; MI = Myocardial infarction; CHF = Congestive heart failure.