Mortality from Alcoholic Cardiomyopathy: Exploring the Gap between Estimated and Civil Registry Data
Abstract
:1. Introduction
2. Experimental Section
2.1. Description of Data Sources and Disease Definitions
2.2. Descriptive Analyses
2.3. Sensitivity Analyses
3. Results
3.1. Epidemiology of Registered and Estimated ACM Mortality
3.2. Sensitivity Analyses
4. Discussion
4.1. Summary of the Findings
4.2. Improving ACM Mortality Estimates
4.3. The Impact of Garbage Code Redistribution for ACM Mortality Estimates
4.4. Clinical Relevance
4.5. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Conflicts of Interest
Appendix A
Appendix A.1. Methods
Appendix A.1.1. Definition of Cause of Death Categories
GBD Cause of Death Definition | ICD-10 Cause of Death Codes | Short Term Used in Manuscript |
---|---|---|
All cardiovascular diseases (sum of garbage and non-garbage codes) | Non-garbage: B33.2, G45-G46.8, I01-I01.9, I02.0, I05-I09.9, I11-I11.9, I20-I25.9, I28-I28.8, I30-I31.1, I31.8-I37.8, I38-I41.9, I42.1-I42.8, I43-I43.9, I47-I48.9, I51.0-I51.4, I60-I63.9, I65-I66.9, I67.0-I67.3, I67.5-I67.6, I68.0-I68.2, I69.0-I69.3, I70.2-I70.8, I71-I73.9, I77-I83.9, I86-I89.0, I89.9, I98, K75.1 Garbage: Level-1: I26-I26.9, I31.2-I31.4, I37.9, I46-I46.9, I50-I50.9, I51.7, I67.4, I76, I95-I95.1, I95.8-I95.9, Level-2: I10-I10.9, I15-I15.9, I27-I27.0, I27.2-I27.9, I28.9, I70-I70.1, I70.9, I74-I75.8 Level-3: I00.0, I03-I04., I14-I14., I16-I19, I29-I29.9, I44-I45.9, I49-I49.9, I51, I51.6, I51.8-I59, I90-I94, I96-I96.9, I98.4-I98.8, I99 Level-4: I42-I42.0, I42.9, I51.5, I64-I64.9, I67, I67.8-I68, I68.8-I69, I69.4-I69.9 | All CVD |
Cardiovascular diseases | B33.2, G45-G46.8, I01-I01.9, I02.0, I05-I09.9, I11-I11.9, I20-I25.9, I28-I28.8, I30-I31.1, I31.8-I37.8, I38-I41.9, I42.1-I42.8, I43-I43.9, I47-I48.9, I51.0-I51.4, I60-I63.9, I65-I66.9, I67.0-I67.3, I67.5-I67.6, I68.0-I68.2, I69.0-I69.3, I70.2-I70.8, I71-I73.9, I77-I83.9, I86-I89.0, I89.9, I98, K75.1 | CVD |
Cardiomyopathy and myocarditis | B33.2, I40-I41.9, I42.1-I42.8, I43-I43.9, I51.4 | All cardiomyopathies |
Alcoholic cardiomyopathy | I42.6 | ACM |
Garbage codes in ICD-10 category of circulatory diseases | Level-1: I26-I26.9, I31.2-I31.4, I37.9, I46-I46.9, I50-I50.9, I51.7, I67.4, I76, I95-I95.1, I95.8-I95.9, Level-2: I10-I10.9, I15-I15.9, I27-I27.0, I27.2-I27.9, I28.9, I70-I70.1, I70.9, I74-I75.8 Level-3: I00.0, I03-I04., I14-I14., I16-I19, I29-I29.9, I44-I45.9, I49-I49.9, I51, I51.6, I51.8-I59, I90-I94, I96-I96.9, I98.4-I98.8, I99 Level-4: I42-I42.0, I42.9, I51.5, I64-I64.9, I67, I67.8-I68, I68.8-I69, I69.4-I69.9 | CVD garbage codes |
Heart failure garbage codes | I50 | HF garbage code |
Appendix A.1.2. Description of Sensitivity Analyses
15–49 Year Olds | 50–64 Year Olds | 65+ Year Olds | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
% ACM | % HF Garbage Codes | APC | % ACM | % HF Garbage Codes | APC | % ACM | % HF Garbage Codes | APC | ||
Women | % ACM | 1 | 1 | 1 | ||||||
% HF Garbage codes | −0.15 | 1 | −0.24 | 1 | −0.19 | 1 | ||||
APC | 0.26 | −0.17 | 1 | 0.34 | −0.14 | 1 | 0.21 | −0.01 | 1 | |
Men | % ACM | 1 | 1 | 1 | ||||||
% HF Garbage codes | −0.24 | 1 | −0.29 | 1 | −0.21 | 1 | ||||
APC | 0.30 | −0.15 | 1 | 0.35 | −0.15 | 1 | 0.21 | −0.10 | 1 |
- f() = Poisson function with log link function and Poisson distributed data
- ACMc = percentage of all cardiovascular deaths which were coded to alcohol cardiomyopathy, by country
- α = constant
- HF = percentage of all cardiovascular deaths which were coded to heart failure
- β1 = slope coefficient describing the association between HF and ACMc
- β2 = slope coefficient describing the association between the polynomial HF2 and ACMc (not included among young females)
- β3 = slope coefficient describing the association between the polynomial HF3 and ACMc (not included among young females)
- APC = Alcohol per capita consumption
- β4 = slope coefficient describing the association between APC and ACMc
- γr = country-specific random intercept
- εc = standard error
- TGcrt = percentage of deaths within the given garbage code’s universe which were coded to a
- given target group, by country
- α = constant
- Garcrt = percentage of deaths within the given garbage code’s universe which were coded to a given set of garbage codes
- β1 = slope coefficient describing the association between Garcrt and TGcrt
- β2 = slope coefficient describing the association between the interaction Agecrt and Garcrt
- γr = region-specific random intercept (or super-region if the random effect on region is not
- significant)
- θr = region-specific random slope (or super-region if the random effect on region is not
- significant)
- εct = standard error, normally distributed and calculated by bootstrapping
Appendix A.2. Results
Appendix A.2.1. Mortality Rates of Registered and Estimated Deaths
Women | Men | Both Sexes | |||||||
---|---|---|---|---|---|---|---|---|---|
Registered | Estimated | Ratio | Registered | Estimated | Ratio | Registered | Estimated | Ratio | |
15–19 | 0.00 | 0.01 | NA | 0.00 | 0.03 | NA | 0.00 | 0.02 | NA |
20–24 | 0.00 | 0.02 | NA | 0.01 | 0.06 | 6.6 | 0.00 | 0.04 | 8.5 |
25–29 | 0.01 | 0.03 | 3.9 | 0.04 | 0.16 | 3.5 | 0.03 | 0.10 | 3.6 |
30–34 | 0.01 | 0.06 | 5.3 | 0.11 | 0.36 | 3.3 | 0.06 | 0.21 | 3.5 |
35–39 | 0.01 | 0.09 | 6.7 | 0.23 | 0.68 | 3.0 | 0.12 | 0.39 | 3.2 |
40–44 | 0.05 | 0.17 | 3.4 | 0.34 | 1.25 | 3.7 | 0.19 | 0.71 | 3.7 |
45–49 | 0.10 | 0.31 | 3.1 | 0.56 | 2.04 | 3.6 | 0.33 | 1.17 | 3.6 |
50–54 | 0.10 | 0.46 | 4.7 | 0.83 | 3.10 | 3.7 | 0.46 | 1.76 | 3.8 |
55–59 | 0.16 | 0.73 | 4.6 | 1.00 | 4.70 | 4.7 | 0.57 | 2.66 | 4.7 |
60–64 | 0.22 | 0.95 | 4.2 | 1.16 | 6.02 | 5.2 | 0.67 | 3.38 | 5.0 |
65–69 | 0.14 | 1.03 | 7.2 | 1.14 | 6.88 | 6.0 | 0.61 | 3.79 | 6.2 |
70–74 | 0.14 | 1.15 | 8.3 | 0.95 | 7.96 | 8.4 | 0.51 | 4.26 | 8.4 |
75–79 | 0.09 | 1.32 | 15.5 | 0.69 | 8.80 | 12.7 | 0.35 | 4.58 | 13.1 |
80–84 | 0.09 | 1.44 | 15.4 | 0.56 | 8.59 | 15.2 | 0.28 | 4.32 | 15.2 |
85–99 | 0.05 | 2.39 | 45.5 | 0.32 | 9.50 | 29.4 | 0.14 | 4.72 | 33.4 |
Women | Men | Both Sexes | |||||||
---|---|---|---|---|---|---|---|---|---|
Registered | Estimated | Ratio | Registered | Estimated | Ratio | Registered | Estimated | Ratio | |
15–19 | 1.3 | 2.8 | 2.2 | 2.1 | 4.1 | 1.9 | 1.7 | 3.5 | 2.0 |
20–24 | 1.9 | 4.1 | 2.1 | 3.8 | 6.6 | 1.7 | 2.9 | 5.3 | 1.8 |
25–29 | 3.0 | 5.8 | 1.9 | 6.1 | 10.3 | 1.7 | 4.6 | 8.1 | 1.8 |
30–34 | 4.9 | 9.2 | 1.9 | 10.6 | 17.5 | 1.7 | 7.7 | 13.4 | 1.7 |
35–39 | 8.7 | 15.3 | 1.8 | 19.0 | 30.0 | 1.6 | 13.8 | 22.7 | 1.6 |
40–44 | 15.5 | 26.0 | 1.7 | 36.0 | 53.9 | 1.5 | 25.7 | 39.9 | 1.6 |
45–49 | 26.7 | 43.9 | 1.6 | 63.6 | 94.3 | 1.5 | 45.0 | 68.9 | 1.5 |
50–54 | 43.4 | 71.2 | 1.6 | 109.8 | 162.1 | 1.5 | 76.0 | 116.0 | 1.5 |
55–59 | 70.1 | 114.5 | 1.6 | 176.3 | 265.9 | 1.5 | 121.8 | 188.2 | 1.6 |
60–64 | 112.6 | 188.1 | 1.7 | 270.1 | 414.3 | 1.5 | 188.0 | 296.4 | 1.6 |
65–69 | 181.5 | 304.2 | 1.7 | 386.3 | 600.0 | 1.6 | 278.1 | 443.8 | 1.6 |
70–74 | 320.1 | 549.8 | 1.7 | 588.2 | 950.7 | 1.6 | 442.5 | 732.9 | 1.7 |
75–79 | 604.2 | 1039.4 | 1.7 | 954.0 | 1552.5 | 1.6 | 756.8 | 1263.3 | 1.7 |
80–84 | 1162.5 | 2008.5 | 1.7 | 1632.0 | 2699.4 | 1.6 | 1351.4 | 2286.5 | 1.7 |
85–99 | 3112.1 | 5667.5 | 1.8 | 3538.3 | 6178.5 | 1.8 | 3251.8 | 5835.0 | 1.8 |
Women | Men | Both Sexes | |||||||
---|---|---|---|---|---|---|---|---|---|
Registered | Estimated | Ratio | Registered | Estimated | Ratio | Registered | Estimated | Ratio | |
15–19 | 0.1 | 0.3 | 2.3 | 0.3 | 0.6 | 2.5 | 0.2 | 0.5 | 2.4 |
20–24 | 0.1 | 0.4 | 4.1 | 0.2 | 0.8 | 3.5 | 0.2 | 0.6 | 3.7 |
25–29 | 0.2 | 0.5 | 3.3 | 0.4 | 1.2 | 3.1 | 0.3 | 0.8 | 3.2 |
30–34 | 0.2 | 0.6 | 3.7 | 0.5 | 1.6 | 3.4 | 0.3 | 1.1 | 3.5 |
35–39 | 0.3 | 0.9 | 3.6 | 0.8 | 2.4 | 3.1 | 0.5 | 1.6 | 3.2 |
40–44 | 0.3 | 1.2 | 3.7 | 1.0 | 3.6 | 3.7 | 0.7 | 2.4 | 3.7 |
45–49 | 0.5 | 1.7 | 3.7 | 1.4 | 5.2 | 3.7 | 1.0 | 3.5 | 3.7 |
50–54 | 0.6 | 2.5 | 4.2 | 1.9 | 7.6 | 4.0 | 1.3 | 5.0 | 4.0 |
55–59 | 0.8 | 3.9 | 4.8 | 2.4 | 11.1 | 4.7 | 1.6 | 7.4 | 4.7 |
60–64 | 1.1 | 5.5 | 5.1 | 2.8 | 14.7 | 5.3 | 1.9 | 9.9 | 5.2 |
65–69 | 1.3 | 8.1 | 6.4 | 3.2 | 19.1 | 6.0 | 2.2 | 13.3 | 6.1 |
70–74 | 1.9 | 13.4 | 7.0 | 3.4 | 26.9 | 8.0 | 2.6 | 19.6 | 7.6 |
75–79 | 2.9 | 25.2 | 8.7 | 4.5 | 42.1 | 9.4 | 3.6 | 32.6 | 9.1 |
80–84 | 5.5 | 50.4 | 9.2 | 6.1 | 67.4 | 11.1 | 5.7 | 57.3 | 10.0 |
85–99 | 13.2 | 150.9 | 11.5 | 13.4 | 151.1 | 11.3 | 13.2 | 151.0 | 11.4 |
Appendix A.2.2. Sensitivity Analyses: ACM and Heart Failure Deaths
15- to 49-Years-Old | 50- to 64-Years-Old | 65 Years or Older | ||||
---|---|---|---|---|---|---|
Women | Men | Women | Men | Women | Men | |
Fixed effects (standard error) | ||||||
Intercept | 1.11 (0.38) * | 3.43 (0.22) ** | -0.03 (0.54) | 3.03 (0.2) ** | −1.81 (0.48) ** | 1.24 (0.26) ** |
First order polynomial of % HF garbage code deaths | 7.87 (0.48) ** | 8.09 (0.27) ** | 8.19 (0.53) ** | 9.05 (0.21) ** | 6.94 (1.08) ** | 9.39 (0.31) ** |
Second order polynomial of % HF garbage code deaths 1 | / | 1.96 (0.2) ** | 4.01 (0.41) ** | 2.06 (0.15) ** | 2.75 (1.26) | 2.49 (0.27) ** |
Third order polynomial of % HF garbage code deaths 1 | / | −3.3 (0.21) ** | −3.03 (0.4) ** | −3.92 (0.13) ** | −4.63 (0.71) ** | −2.21 (0.19) ** |
Alcohol per capita consumption | 0.02 (0.01) | 0.02 (0.002) ** | −0.02 (0.01) | 0.01 (0.002) ** | −0.04 (0.02) | −0.01 (0.003) ** |
Random effects | ||||||
Standard deviation of country-level intercepts | 3.07 | 1.88 | 3.73 | 1.72 | 3.29 | 2.23 |
R-square 2 | 0.772 | 0.815 | 0.868 | 0.732 | 0.333 | 0.475 |
Mean (standard deviation) of dependent variable | 0.7% (2.1%) | 1.5% (2.9%) | 0.3% (0.7%) | 0.8% (1.2%) | 0.02% (0.06%) | 0.1% (0.2%) |
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GBD Disease Definition | Absolute Number of Deaths | Age-Standardized Mortality Rate 1 | ||||
---|---|---|---|---|---|---|
Women | Men | Both sexes | Women | Men | Both sexes | |
Cardiovascular diseases | ||||||
Registered 2 | 1,396,965 | 1,469,004 | 2,865,969 | 89.1 | 148.3 | 116.1 |
Estimated 2 | 2,459,266 | 2,386,248 | 4,845,514 | 154.9 | 239.3 | 193.6 |
Ratio 3 | 1.8 | 1.6 | 1.7 | 1.7 | 1.6 | 1.7 |
Cardiomyopathy and myocarditis | ||||||
Registered 2 | 8,240 | 11,938 | 20,178 | 0.6 | 1.4 | 1.0 |
Estimated 2 | 66,730 | 75,616 | 142,346 | 4.4 | 8.0 | 6.1 |
Ratio 3 | 8.1 | 6.3 | 7.1 | 6.8 | 5.9 | 6.2 |
Alcoholic Cardiomyopathy | ||||||
Registered 2 | 538 | 3,345 | 3,883 | 0.1 | 0.4 | 0.2 |
Estimated 2 | 3,589 | 18,894 | 22,483 | 0.3 | 2.1 | 1.2 |
Ratio 3 | 6.7 | 5.6 | 5.8 | 5.8 | 5.4 | 5.3 |
Cardiovascular garbage codes | ||||||
Registered 2 | 963,461 | 780,529 | 1,743,990 | 58.4 | 77.1 | 67.2 |
Estimated 2 | / | / | / | / | / | / |
Ratio 3 | / | / | / | / | / | / |
Heart failure garbage codes | ||||||
Registered 2 | 283,222 | 209,033 | 492,255 | 15.8 | 20.0 | 17.8 |
Estimated 2 | / | / | / | / | / | / |
Ratio 3 | / | / | / | / | / | / |
Women | Men | |
---|---|---|
All Adults | 0.796 (0.697 to 0.866) ** | 0.917 (0.872 to 0.946) ** |
By age group | ||
15–19 | NA | NA |
20–24 | NA | 0.968 (0.95 to 0.979) ** |
25–29 | 0.212 (−0.012 to 0.416) | 0.985 (0.977 to 0.991) ** |
30–34 | 0.42 (0.217 to 0.589) ** | 0.988 (0.981 to 0.992) ** |
35–39 | 0.731 (0.607 to 0.821) ** | 0.956 (0.932 to 0.972) ** |
40–44 | 0.779 (0.672 to 0.854) ** | 0.963 (0.942 to 0.976) ** |
45–49 | 0.955 (0.93 to 0.971) ** | 0.941 (0.908 to 0.962) ** |
50–54 | 0.956 (0.932 to 0.972) ** | 0.764 (0.652 to 0.844) ** |
55–59 | 0.815 (0.723 to 0.879) ** | 0.777 (0.67 to 0.853) ** |
60–64 | 0.899 (0.845 to 0.935) ** | 0.901 (0.848 to 0.936) ** |
65–69 | 0.305 (0.087 to 0.495) * | 0.545 (0.366 to 0.685) ** |
70–74 | 0.513 (0.326 to 0.661) ** | 0.73 (0.605 to 0.82) ** |
75–79 | 0.184 (−0.042 to 0.391) | 0.618 (0.458 to 0.74) ** |
80–84 | 0.099 (−0.127 to 0.316) | 0.158 (−0.069 to 0.369) |
85–99 | 0.025 (−0.2 to 0.247) | 0.136 (−0.091 to 0.349) |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Manthey, J.; Rehm, J. Mortality from Alcoholic Cardiomyopathy: Exploring the Gap between Estimated and Civil Registry Data. J. Clin. Med. 2019, 8, 1137. https://doi.org/10.3390/jcm8081137
Manthey J, Rehm J. Mortality from Alcoholic Cardiomyopathy: Exploring the Gap between Estimated and Civil Registry Data. Journal of Clinical Medicine. 2019; 8(8):1137. https://doi.org/10.3390/jcm8081137
Chicago/Turabian StyleManthey, Jakob, and Jürgen Rehm. 2019. "Mortality from Alcoholic Cardiomyopathy: Exploring the Gap between Estimated and Civil Registry Data" Journal of Clinical Medicine 8, no. 8: 1137. https://doi.org/10.3390/jcm8081137