Use of Multiple Causes in the Classification of Deaths from Cardiovascular-Renal Disease

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Abstract
This report describes an attempt to classify deaths from cardiovascular-renal disease in rubrics said to give both an etiological and an anatomical description of cause of death. Data used in the study were obtained from multiple-cause cards prepared by the New York City Department of Health for 4768 deaths occurring in 4 of the city''s 5 boroughs during January, 1954. They relate to only 2587 certificates on which underlying cause of death, selected by the conventional rules, was some cardiovascular-renal disease. Using 3 admittedly not-wholly correct assumptions, it proved possible to classify as to etiology and anatomical involvement 99% of the certificates on which at least 2 cardiovascular-renal conditions were mentioned, and 86.5% of the certificates on which only a single cause was mentioned. Comparison of the results of the proposed classification with those of the conventional International Statistical Classification reveals (1) an increase in number of deaths with hypertensive etiology, and (2) that an etiological association can be shown for more than 3/4 of the deaths ascribed by the conventional rules to cerebral vascular lesions. The proportion of deaths unclassified as to etiology was particularly high in cause-of-death groups involving nephritis. Advantages which may materialize are simpler coding rules for this group of diseases and answers to many consumer questions which cannot be answered with the conventional classification.

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