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Journal Article

Citation

Ball LB, Macdonald SC, Mott JA, Etzel RA. Arch. Environ. Occup. Health 2005; 60(3): 119-127.

Affiliation

Indoor Air Solutions, Tallahassee, FL 32303, USA. LBALLIAQ@mindspring.com

Copyright

(Copyright © 2005, Informa - Taylor and Francis Group)

DOI

unavailable

PMID

17153084

Abstract

Estimates of unintentional deaths from carbon monoxide (CO) poisoning can be obtained from national mortality data. We explored ways of accurately estimating CO-related deaths from International Classification of Diseases, 9th Revision (ICD-9) coded U.S. mortality data. We evaluated and identified CO-related ICD-9 codes and created five classes of codes for case ascertainment that represented a continuum of the degree of certainty that the ICD-coded death was truly CO-related. We conducted single (underlying) cause-of-death and multiple-cause-of-death analysis using 20 years of data (1979-1998), and calculated sensitivity and positive predictive value using different criteria for case ascertainment. Single-cause analysis provided accurate estimates only when we used CO-exclusive E-codes, however this method failed to identify approximately one third of the CO-related deaths over the study period. Single-cause analysis overestimated the number of CO-related deaths when we used E-codes that were not exclusive to CO exposure. Identification of true CO-related deaths required multiple cause-of-death analysis and use of the CO nature-of-injury code, N986, to confirm suspected cases. Sensitivity of N986 was 99.5%, and positive predictive value of the individual E-codes in single cause-of-death analysis ranged from 1.5% to 92%. Estimating CO-related deaths from ICD-coded data requires a thorough understanding of the ICD codes, coding rules, and of the limitations imposed by case selection criteria and single cause-of-death analysis.


Language: en

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