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Accuracy of death certification of dementia in population-based samples of older people: analysis over time

Lookup NU author(s): Professor Carol Brayne, Professor Fiona MatthewsORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background Death certification data are routinely collected in most developed countries. Coded causes of death are a readily accessible source and have the potential advantage of providing complete follow-up, but with limitations. Objective To investigate the reliability of using death certificates for surveillance of dementia, the time trend of recording dementia on death certificates, and predictive factors of recording of dementia. Subjects Individuals aged 65 and over in six areas cross England and Wales were random selected for the Medical Research Council Cognitive Function and Ageing Study (CFAS) and CFAS II with mortality follow-up. Methods Prevalence of dementia recorded on death certificates were calculated by year. Reporting of dementia on death certificates compared with the study diagnosis of dementia, with sensitivity, specificity and Cohen’s κ estimated. Multivariable logistic regression models explored the impact of potential factors on the reporting of dementia on the death certificate. Results: The overall unadjusted prevalence of dementia on death certificates rose from 5.3% to 25.9% over the last 26 years. Dementia reported on death certificates was poor with sensitivity 21.0% in earlier cohort CFAS, but it had increased to 45.2% in CFAS II. Dementia was more likely to be recorded on death certificates in individuals with severe dementia, or those living in an institution, yet less likely reported if individuals died in hospital. Conclusion: Recording dementia on death certificate has improved significantly in England and Wales. However, such information is still an underestimate and should be used alongside epidemiological estimations.

Publication metadata

Author(s): Gao L, Calloway R, Zhao E, Brayne C, Matthews FE, CFAS

Publication type: Article

Publication status: Published

Journal: Age and Ageing

Year: 2018

Volume: 47

Issue: 4

Pages: 589–594

Print publication date: 01/07/2018

Online publication date: 28/04/2018

Acceptance date: 10/04/2018

Date deposited: 17/03/2018

ISSN (print): 0002-0729

ISSN (electronic): 1468-2834

Publisher: Oxford University Press


DOI: 10.1093/ageing/afy068

Notes: DOI correct but not activated by OUP.


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