J Neurol Neurosurg Psychiatry 76:498-502 doi:10.1136/jnnp.2004.039370
  • Paper

Population based mortality and quality of death certification in progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome)

  1. U Nath1,
  2. R Thomson2,
  3. R Wood2,
  4. Y Ben-Shlomo3,
  5. A Lees4,
  6. C Rooney5,
  7. D Burn1
  1. 1Department of Neurology, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
  2. 2School of Population and Health Sciences (Epidemiology and Public Health), University of Newcastle upon Tyne
  3. 3Department of Social Medicine, Bristol University, Bristol, UK
  4. 4Sara Koe PSP Centre and Institute of Neurology, Queen Square, London WC1, UK
  5. 5Office of National Statistics, London, UK
  1. Correspondence to:
 Dr David J Burn
 Regional Neurosciences Centre, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK;
  • Received 16 February 2004
  • Accepted 27 July 2004
  • Revised 9 July 2004


Objective: To estimate the mortality of progressive supranuclear palsy (PSP) and to assess the quality of death certification in patients with PSP who died in England and Wales.

Methods: An analysis was conducted of ICD-9 (International Classification of Diseases, version 9) coded deaths obtained through the Office of National Statistics over an eight year period.

Results: The crude annual mortality rate was 1.77 (95% confidence interval, 1.64 to 1.90) cases per million, using the mid-1996 population estimate for England and Wales. Annual mortality increased over time, possibly as a result of increased incidence or increased awareness of the disorder. Forty nine death certificates from deceased patients previously diagnosed clinically showed that the commonest proximate cause of death was pneumonia, occurring in 45% of cases (22/49). The underlying cause of death was cited as pneumonia in 14% of cases (7/49). PSP was mentioned in only 65% of death certificates (32/49). Eight of the 49 cases (16%) underwent necropsy and results were available for five of these cases. PSP was confirmed pathologically in four; the remaining case was diagnosed as Parkinson’s disease.

Conclusions: Further research is needed to establish the reasons for the observed increase in mortality. Determining the population mortality rate for PSP using the ICD-9 coding system is problematic but is likely to improve following the introduction of ICD-10 updated codes and coding rules.


  • Competing interests: none declared

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