Occupation recorded on certificates of death compared with self-report: the Atherosclerosis Risk in Communities (ARIC) Study

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Abstract

Death certificates are a potential source of sociodemographic data for decedents in epidemiologic research. However, because this information is provided by the next-of-kin or other proxies, there are concerns about validity. Our objective was to assess the agreement of job titles and occupational categories derived from death certificates with that self-reported in mid and later life.

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Methods
Occupation was abstracted from 431 death certificates from North Carolina Atherosclerosis Risk in Communities Study participants who died between 1987 and 2001. Occupations were coded according to 1980 Bureau of Census job titles and then grouped into six 1980 census occupational categories. This information was compared with the self-reported occupation at midlife as reported at the baseline examination (1987├óÔé¼ÔÇ£89). We calculated percent agreement using standard methods. Chance-adjusted agreement was assessed by kappa coefficients, with 95% confidence intervals.

Results
Agreement between death certificate and self-reported job titles was poor (32%), while 67% of occupational categories matched the two sources. Kappa coefficients ranged from 0.53 for technical/sales/administrative jobs to 0.68 for homemakers. Agreement was lower, albeit nonsignificant, for women (kappa = 0.54, 95% Confidence Interval, CI = 0.44├óÔé¼ÔÇ£0.63) than men (kappa = 0.62, 95% CI = 0.54├óÔé¼ÔÇ£0.69) and for African-Americans (kappa = 0.47, 95% CI = 0.34├óÔé¼ÔÇ£0.61) than whites (kappa = 0.63, 95% CI = 0.57├óÔé¼ÔÇ£0.69) but varied only slightly by educational attainment.

Conclusion
While agreement between self- and death certificate reported job titles was poor, agreement between occupational categories was good. This suggests that while death certificates may not be a suitable source of occupational data where classification into specific job titles is essential, in the absence of other data, it is a reasonable source for constructing measures such as occupational SES that are based on grouped occupational data.

Background
Data from death certificates are used to monitor age, race and gender variations in mortality in the United States, US 1,2. While sociodemographic information on death certificates is obtained from next of kin or other proxies, studies have indicated high validity of such information when compared with other official documents 3. In the late 1980s the National Center for Health Statistics implemented guidelines to standardize data collected on death certificates across the US 4. As a result information related to employment (job title and industry) and educational attainment is available on certificates of death, which facilitates the monitoring of socioeconomic related trends and rates of mortality across the US In addition, information of employment and education on death certificates is useful in epidemiologic studies when SES is not available from other sources. However, the comparability of such data to that from self-report is not well established.

Studies assessing the agreement of educational attainment from death certificate with that obtained by self- report have reported that death certificates record higher 5,6 and lower 7 levels of education than that obtained by self-report. However, there is high agreement between death certificate-derived educational attainment and that obtained from self-report when data are grouped into ordered categories 5-7. To our knowledge, the comparability of death certificate-based occupational measures of SES to those obtained by self-report has not been assessed. The purpose of the current study was to compare the agreement of death certificate-based job titles and associated occupational categories with those self-reported in midlife in the Atherosclerosis Risk in Communities (ARIC) Study. We examined agreement overall, and by race, gender, age and educational attainment.

Methods
Details of the design and procedures of the ARIC Study are presented elsewhere 8. Briefly, at inception (1987├óÔé¼ÔÇ£1989), a biracial cohort of 15,792 middle-aged men and women was sampled from four communities in the United States (Washington County, MD; Forsyth County, NC; north western suburbs of Minneapolis, MN; and Jackson, MS). Institutional review board approval was obtained by each participating field center and the coordinating center. Written informed consent was obtained from each study participant.

 

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