Assessment of vital status in Department of Veterans Affairs national databases: Comparison with state death certificates

PURPOSE: To determine the extent to which Department of Veterans Affairs (VA) database vital status information agrees with Washington state death certificates. METHODS: Using each data source, vital status was determined for 19,481 Washington state resident veterans hospitalized in Washington VA hospitals from 1994 to 1997, and for 33,602 Washington state resident Veterans who were seen as outpatients during 1997. RESULTS: The agreement between VA and Washington state records was excellent for hospitalized veterans (kappa = 0.91, P < 0.0001). Three thousand one hundred-eight individuals (86.2% of all deaths) appeared in both files. Of those deaths missing in the VPI files, 71% had no service-connected disability, VA pension, or other compensation. Among outpatients, agreement between the death files was very good (kappa = 0.82, p < 0.001). Three hundred seventy-two individuals (69.8% of all deaths) appeared in both fires. Of those deaths missing in the VA files, 63% had no service-connected disability or VA pension or other compensation. CONCLUSIONS: The VA death fries are a valid source of vital status information for veterans hospitalized in recent years. For veterans having exclusively outpatient visits, however, the VA files miss a substantial proportion of deaths. For these patients, alternative means of vital status ascertainment are warranted. Ann Epidemiol 2001;11:286-291. (C) 2001 Elsevier Science Inc. All rights reserved.