Validity of death certificates for coding coronary heart disease as the cause of death in Bahrain.

This study aimed to examine the accuracy of death certificates for coding coronary heart disease (CHD) as the underlying cause of death in Bahrain. Of the 1714 deaths occurring in Bahrain in 1993, 371 were classified as resulting from CHD. In this study the hospital diagnosis of 109 deaths (52 as CHD and 57 as other causes) were reviewed and re-diagnosed using hospital records. The coding of 459 death certificates (151 as CHD and 308 as other causes) by the Directorate of Public Health was similarly reviewed. The sensitivity and specificity of the hospital diagnosis were 76% and 72% respectively and those of the Directorate of Public Health were 85% and 89% respectively. National mortality statistics in Bahrain, which are based on death certificate data, may overestimate the frequency of CHD. Therefore, it is important that measures are taken to improve the accuracy of certification.