l Data System (42%) compared with the National Death Index (22%). Background Cause-specific mortality data from the United States Renal Data System (USRDS) form the basis for identifying cardiovascular disease (CVD), specifically sudden cardiac death (SCD), as the leading cause of death for patients on dialysis. Death certificate data from the National Death Index (NDI) is the epidemiological standard for assessing causes of death for the US population. The cause of death has not been compared between the USRDS and the NDI. Methods Among 39,507 adults starting dialysis in the United States, we identified 6436 patients who died between 2003 and 2009. We classified the cause of death as SCD, non-SCD CVD, cancer, infection, and others and compared the USRDS data with those from the NDI. Results The median age at the time of death was 70 years, 44% were female, and 30% were non-Hispanic Black individuals. The median time from dialysis initiation to death was 1.2 years. Most of the deaths occurred in hospital (N=4681, 73%). The overall concordance in cause of death between the two national registries was 42% (κ=0.23; 95% confidence interval, 0.22 to 0.24). CVD, including SCD and non-SCD CVD, accounted for 67% of deaths per the USRDS but only 52% per the NDI; this difference was mainly driven by the larger proportion of SCD in the USRDS (42%) versus the NDI (22%). Of the 2962 deaths reported as SCD by the USRDS, only 35% were also classified as SCD by the NDI. Out-of-hospital deaths were more likely to be classified as SCD in the USRDS (60%) versus the NDI (29%), compared with in-hospital deaths (41% in the USRDS; 25% in the NDI). Conclusions Significant discordance exists in the causes of death for patients on dialysis reported by the USRDS and the NDI. Our findings underscore the urgent need to integrate NDI data into the USRDS registry and enhance the accuracy of cause-of-death reporting....

中文翻译：

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美国透析患者心源性猝死报告：美国肾脏数据系统与全国死亡指数数据的比较


l 数据系统 （42%） 与国家死亡指数 （22%） 的比较。背景 来自美国肾脏数据系统 （USRDS） 的死因特异性死亡率数据构成了确定心血管疾病 （CVD），特别是心源性猝死 （SCD） 作为透析患者主要死亡原因的基础。来自国家死亡指数 （NDI） 的死亡证明数据是评估美国人口死因的流行病学标准。尚未比较 USRDS 和 NDI 之间的死因。方法 在美国 39,507 名开始透析的成年人中，我们确定了 6436 年至 2003 年间死亡的 2009 名患者。我们将死因分为 SCD 、非 SCD CVD 、癌症、感染等，并将 USRDS 数据与 NDI 数据进行比较。结果 死亡时的中位年龄为 70 岁，44% 为女性，30% 为非西班牙裔黑人。从透析开始到死亡的中位时间为 1.2 年。大多数死亡发生在医院 （N=4681， 73%）。两个国家登记处之间死因的总体一致性为 42% （κ=0.23;95% 置信区间，0.22 至 0.24）。CVD，包括 SCD 和非 SCD CVD，占 USRDS 死亡人数的 67%，但根据 NDI 仅占 52%;这种差异主要是由于 USRDS 中 SCD 的比例较大 （42%） 与 NDI （22%） 相比。在 USRDS 报告的 2962 例 SCD 死亡病例中，只有 35% 也被 NDI 归类为 SCD。与院内死亡 （USRDS 中为 41%;NDI 中为 25%） 相比，USRDS 中院外死亡 （60%） 与 NDI （29%） 相比更有可能被归类为 SCD。结论 USRDS 和 NDI 报告的透析患者的死因存在显着不一致。 我们的研究结果强调了将 NDI 数据整合到 USRDS 登记册中并提高死因报告准确性的迫切需要。