National mortality statistics report that UK Indian Asians are at approxiamately 2 fold higher risk of cardiovascular disease mortality compared with people of European ancestry. However, previous studies in North American and European populations suggest that up to 40% of death certificates are incorrect, leading to an overestimation of cardiovascular disease mortality. The validity of routine death certification amongst Indian Asians is unknown.Aims and methods
We investigated the accuracy of routine death certification amongst UK Indian Asians, to determine whether incorrect certification contributes to the reported higher cardiovascular disease amongst Indian Asians. We reviewed all available medical records (hospital, primary care and coroner) for a representative sample of 315 Indian Asians and Europeans who died in London, UK between 2002 and 2011. Deaths were independently coded as cardiovascular or non-cardiovascular according to published international diagnostic criteria by 2 cardiologists; where there was disagreement a third adjudicated.Results
Age of death was lower amongst Indian Asians than Europeans (66.6 ± 10.1 vs. 69.7 ± 8.2, P = 0.003). Compared to review of records, routine death certification overestimated cardiovascular disease as underlying cause of death amongst Indian Asians (33.6 vs. 29.6%, p < 0.001) and Europeans (32.5 vs. 27.0%, p < 0.001). However, routine death certification showed similar accuracy for the diagnosis of cardiovascular disease amongst both Indian Asians and Europeans (sensitivity: 88.9 vs. 93.2%, p = 0.714; specificity: 88.9 vs. 89.9%, p = 0.961; positive predictive value: 78.4 vs. 77.4%, p = 0.895, respectively).Conclusion
Routine death certification overestimates cardiovascular deaths by ~20% amongst UK Indian Asians and Europeans, but the accuracy of death certification is similar in the two populations. Inaccurate death certification does not contribute to higher reported cardiovascular disease mortality amongst Indian Asians compared to Europeans.