Validity of the European short list of respiratory diseases: a 40-year autopsy study

Abstract

The predictors of autopsy and the accuracy of European short list (E) codes of respiratory diseases lack recent knowledge.A 10% random sample (n=6811) of inhabitants of Bergen, Norway, aged 20–70 years, was invited to participate in a survey in 1965–1971 (participation rate 83%).By December 31, 2005, 4387 (64%) participants had died and 1163 (27% of the deceased) had been given an autopsy. Causes of death were tuberculosis (E02, 0.2%), lung malignancy (E15, 3.5%), influenza (E38, 0.2%), pneumonia (E39, 6.5%) and chronic lower respiratory diseases (E40, 3.2%). Male sex, early deaths in the surveillance period and E15 were positive predictors of an autopsy examination, whereas old age and E39 were strong negative predictors. Among those referred for apost mortemexamination, the cause of death was verified as tuberculosis in 0.3%, lung cancer in 8.1%, acute pneumonia in 2.0% and chronic obstructive lung diseases in 4.9%. Cohen’s kappa coefficients (E codesversusautopsy) were 0.91 (95% CI 0.86–0.96) for E15, 0.37 (95% CI 0.20–0.54) for E39 and 0.65 (95% CI 0.54–0.76) for E40.These findings matter when deaths from respiratory diseases are used as end-points in epidemiological association studies and clinical trials.