TY - JOUR
T1 - Evaluation of Mortality Data from the Social Security Administration Death Master File for Clinical Research
AU - Navar, Ann Marie
AU - Peterson, Eric D.
AU - Steen, Dylan L.
AU - Wojdyla, Daniel M.
AU - Sanchez, Robert J.
AU - Khan, Irfan
AU - Song, Xue
AU - Gold, Matthew E.
AU - Pencina, Michael J.
N1 - Funding Information:
Funding/Support: This study was funded by
Funding Information:
receiving grants from Regeneron and Sanofi during the conduct of the study; additional research grants to her institution from Regeneron, Sanofi, Amgen, Janssen, and Amarin during the conduct of the study outside of the submitted work; and personal fees from Regeneron, Sanofi, Amgen, Astra Zeneca, NovoNordisk, and Amarin outside of the submitted work. Dr Peterson reported receiving grants and personal fees from Sanofi and grants from Regeneron during the conduct of the study as well as grants and personal fees from AstraZeneca, Amgen, and Merck outside of the submitted work. Dr Steen reported receiving personal fees from Sanofi during the conduct of the study as well as other from Novo Nordisk and grants from Amgen outside of the submitted work. Dr Sanchez reported receiving other from Regeneron during the conduct of the study and outside of the submitted work. Dr Khan reported receiving other from Sanofi during the conduct of the study. Dr Song reported receiving other from Sanofi during the conduct of the study and outside of the submitted work. Dr Pencina reported receiving grants from Sanofi/Regeneron during the conduct of the study as well as grants from Amgen, personal fees from Merck, and personal fees from Boehringer Ingelheim outside of the submitted work. No other disclosures were reported.
Publisher Copyright:
© 2019 American Medical Association. All rights reserved.
PY - 2019/4
Y1 - 2019/4
N2 - Importance: Despite its documented undercapture of mortality data, the US Social Security Administration Death Master File (SSDMF) is still often used to provide mortality end points in retrospective clinical studies. Changes in death data reporting to SSDMF in 2011 may have further affected the reliability of mortality end points, with varying consequences over time and by state. Objective: To evaluate the reliability of mortality rates in the SSDMF in a cohort of patients with atherosclerotic cardiovascular disease (ASCVD). Design, Setting, and Participants: This observational analysis used the IBM MarketScan Medicare and commercial insurance databases linked to mortality information from the SSDMF. Adults with ASCVD who had a clinical encounter between January 1, 2012, and December 31, 2013, at least 2 years of follow-up, and from states with 1000 or more eligible adults with ASCVD were included in the study. Data analysis was conducted between April 18 and May 21, 2018. Main Outcomes and Measures: Kaplan-Meier analyses were conducted to estimate state-level mortality rates for adults with ASCVD, stratified by database (commercial or Medicare). Constant hazards of mortality by state were tested, and individual state Kaplan-Meier curves for temporal changes were evaluated. For states in which the hazard of death was constant over time, mortality rates for adults with ASCVD were compared with state-level, age group-specific overall mortality rates in 2012, as reported by the National Center for Health Statistics (NCHS). Results: This study of mortality data of 667516 adults with ASCVD included 274005 adults in the commercial insurance database cohort (171 959 male [62.8%] and median [interquartile range (IQR)] age of 58 [52-62] years) and 393511 in the Medicare database cohort (245 366 male [62.4%] and median [IQR] age of 76 [70-83] years). Of the 41 states included, 11 states (26.8%) in the commercial cohort and 18 states (43.9%) in the Medicare cohort had a change in the hazard of death after 2012. Among states with constant hazard, state-level mortality rates using the SSDMF ranged widely, from 0.06 to 1.30 per 100 person-years (commercial cohort) and from 0.83 to 6.07 per 100 person-years (Medicare cohort). Variability between states in mortality estimates for adults with ASCVD using SSDMF data greatly exceeded variability in overall mortality from the NCHS. No correlation was found between NCHS mortality estimates and those from the SSDMF (ρ = 0.29 [P =.06] for age 55-64 years; ρ = 0.18 [P =.27] for age 65-74 years). Conclusions and Relevance: The SSDMF appeared to markedly underestimate mortality rates, with variable undercapture among states and over time; this finding suggests that SSDMF data are not reliable and should not be used alone by researchers to estimate mortality rates.
AB - Importance: Despite its documented undercapture of mortality data, the US Social Security Administration Death Master File (SSDMF) is still often used to provide mortality end points in retrospective clinical studies. Changes in death data reporting to SSDMF in 2011 may have further affected the reliability of mortality end points, with varying consequences over time and by state. Objective: To evaluate the reliability of mortality rates in the SSDMF in a cohort of patients with atherosclerotic cardiovascular disease (ASCVD). Design, Setting, and Participants: This observational analysis used the IBM MarketScan Medicare and commercial insurance databases linked to mortality information from the SSDMF. Adults with ASCVD who had a clinical encounter between January 1, 2012, and December 31, 2013, at least 2 years of follow-up, and from states with 1000 or more eligible adults with ASCVD were included in the study. Data analysis was conducted between April 18 and May 21, 2018. Main Outcomes and Measures: Kaplan-Meier analyses were conducted to estimate state-level mortality rates for adults with ASCVD, stratified by database (commercial or Medicare). Constant hazards of mortality by state were tested, and individual state Kaplan-Meier curves for temporal changes were evaluated. For states in which the hazard of death was constant over time, mortality rates for adults with ASCVD were compared with state-level, age group-specific overall mortality rates in 2012, as reported by the National Center for Health Statistics (NCHS). Results: This study of mortality data of 667516 adults with ASCVD included 274005 adults in the commercial insurance database cohort (171 959 male [62.8%] and median [interquartile range (IQR)] age of 58 [52-62] years) and 393511 in the Medicare database cohort (245 366 male [62.4%] and median [IQR] age of 76 [70-83] years). Of the 41 states included, 11 states (26.8%) in the commercial cohort and 18 states (43.9%) in the Medicare cohort had a change in the hazard of death after 2012. Among states with constant hazard, state-level mortality rates using the SSDMF ranged widely, from 0.06 to 1.30 per 100 person-years (commercial cohort) and from 0.83 to 6.07 per 100 person-years (Medicare cohort). Variability between states in mortality estimates for adults with ASCVD using SSDMF data greatly exceeded variability in overall mortality from the NCHS. No correlation was found between NCHS mortality estimates and those from the SSDMF (ρ = 0.29 [P =.06] for age 55-64 years; ρ = 0.18 [P =.27] for age 65-74 years). Conclusions and Relevance: The SSDMF appeared to markedly underestimate mortality rates, with variable undercapture among states and over time; this finding suggests that SSDMF data are not reliable and should not be used alone by researchers to estimate mortality rates.
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U2 - 10.1001/jamacardio.2019.0198
DO - 10.1001/jamacardio.2019.0198
M3 - Article
C2 - 30840023
AN - SCOPUS:85062683639
VL - 4
SP - 375
EP - 379
JO - JAMA Cardiology
JF - JAMA Cardiology
SN - 2380-6583
IS - 4
ER -