Monitoring progress with national and subnational health goals by integrating verbal autopsy and medically certified cause of death data

IntroductionThe measurement of progress towards many Sustainable Development Goals (SDG) and other health goals requires accurate and timely all-cause and cause of death (COD) data. However, existing guidance to countries to calculate these indicators is inadequate for populations with incomplete death registration and poor-quality COD data. We introduce a replicable method to estimate national and subnational cause-specific mortality rates (and hence many such indicators) where death registration is incomplete by integrating data from Medical Certificates of Cause of Death (MCCOD) for hospital deaths with routine verbal autopsy (VA) for community deaths.MethodsThe integration method calculates population-level cause-specific mortality fractions (CSMFs) from the CSMFs of MCCODs and VAs weighted by estimated deaths in hospitals and the community. Estimated deaths are calculated by applying the empirical completeness method to incomplete death registration/reporting. The resultant cause-specific mortality rates are used to estimate SDG Indicator 23: mortality between ages 30 and 70 years from cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. We demonstrate the method using nationally representative data in Myanmar, comprising over 42 000 VAs and 7600 MCCODs.ResultsIn Myanmar in 2019, 89% of deaths were estimated to occur in the community. VAs comprised an estimated 70% of community deaths. Both the proportion of deaths in the community and CSMFs for the four causes increased with older age. We estimated that the probability of dying from any of the four causes between 30 and 70 years was 0.265 for men and 0.216 for women. This indicator is 50% higher if based on CSMFs from the integration of data sources than on MCCOD data from hospitals.ConclusionThis integration method facilitates country authorities to use their data to monitor progress with national and subnational health goals, rather than rely on estimates made by external organisations. The method is particularly relevant given the increasing application of routine VA in country Civil Registration and Vital Statistics systems.

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Premature Mortality in Canada

University of Toronto Journal of Public Health ◽

10.33137/utjph.v1i1.33812 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Catherine Liang ◽

Emmalin Buajitti ◽

Laura Rosella

Keyword(s):

Cause Of Death ◽

Descriptive Analysis ◽

Premature Mortality ◽

Mortality Rates ◽

Vital Statistics ◽

Income Quintile ◽

Mortality Trends ◽

Premature Deaths ◽

Central Canada ◽

Over Time

Introduction: Premature mortality (deaths before age 75) is a well-established metric of population health and health system performance. In Canada, underlying differences between provinces/territories present a need for stratified mortality trends. Methods: Using data from the Canadian Vital Statistics Database, a descriptive analysis of sex-specific adult premature deaths over 1992-2015 was conducted by province, census divisions (CD), socioeconomic status (SES), age, and underlying cause of death. Premature mortality rates were calculated as the number of deaths per 100,000 individuals aged 18 to 74, per 8-year era. SES was measured using the income quintile of the neighbourhood of residence. Absolute and relative inequalities were respectively summarized using slope and relative indices of inequality, produced via unadjusted linear regression of the mortality rate on income rank. Results: Premature mortality in Canada declined by 21% for males and 13% for females between 1992-1999 and 2008-2015. The greatest reductions were in Central Canada, while Newfoundland saw notable increases. CD-level improvements appeared mostly in the southern half of Canada. As of 2008-2015, Newfoundland, Nova Scotia, and Nunavut had the highest mortality rates. Low area-level income was associated with higher mortality. SES inequalities grew over time. Newfoundland’s between-quintile differences rose from 1292 to 2389 deaths per 100k males, or 1.33 to 2.12-fold, and 586 to 1586 per 100k females, or 1.24 to 1.74-fold. In 2008-2015, mortality rates of the bottom quintile in Manitoba and Saskatchewan were more than 2.5 times those of the top. Mortality increased with age, and varied regionally. Low mortality in Central Canada and BC, and high mortality in the Territories were consistent across eras and sexes. Cause of death distributions shifted with age and sex, with more external deaths in younger males. Conclusion: Improvements were seen in adult premature mortality rates over time, but were unequal across geographies. Evidence exists for growing socioeconomic disparities in mortality.

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Derivation and Validation of Risk Scores for Cause-Specific Mortality using Verbal Autopsy Data

10.21203/rs.3.rs-477828/v1 ◽

2021 ◽

Author(s):

Tshifhiwa Nkwenika ◽

Samuel Manda

Keyword(s):

Verbal Autopsy ◽

Causes Of Death ◽

Roc Curves ◽

Vital Statistics ◽

Error Rates ◽

Risk Scores ◽

False Positive Error ◽

Specific Mortality ◽

Developmental Policies ◽

Burden Of Diseases

Abstract BackgroundDeaths certification remains a challenge mostly in the low-resources countries which results in poor availability and incompleteness of vital statistics. In such sceneries, public health and developmental policies concerning the burden of diseases are limited in their derivation and application. The study aimed at developing and evaluating appropriate cause-specific mortality risk scores using Verbal Autopsy (VA) data. MethodsA logistic regression model was used to identify independent predictors of NCDs, AIDS/TB, and CDs specific causes of death. Risk scores were derived using a point scoring system. Receiver operating characteristic (ROC) curves were used to validate the models by matching the number of reported deaths to the number of deaths predicted by the models. ResultsThe models provided accurate prediction results with sensitivities of 86%, 46%, and 40% and false-positive error rates of 44%, 11%, and 12% for NCDs, AIDS/TB, and CDs respectively. ConclusionThis study has shown that, in low- and medium-income countries, simple risk scores using information collected using verbal autopsy questionnaire could be adequately used to assign causes of death for Non-Communicable Diseases and AIDS/TB

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Verbal autopsy in health policy and systems: a literature review

BMJ Global Health ◽

10.1136/bmjgh-2017-000639 ◽

2018 ◽

Vol 3 (2) ◽

pp. e000639 ◽

Cited By ~ 12

Author(s):

Lisa-Marie Thomas ◽

Lucia D’Ambruoso ◽

Dina Balabanova

Keyword(s):

Health Policy ◽

Literature Review ◽

Cause Of Death ◽

Verbal Autopsy ◽

Policy Development ◽

Data Extraction ◽

Evidence Base ◽

Vital Statistics ◽

Middle Income ◽

Health Policy And Systems

IntroductionEstimates suggest that one in two deaths go unrecorded globally every year in terms of medical causes, with the majority occurring in low and middle-income countries (LMICs). This can be related to low investment in civil registration and vital statistics (CRVS) systems. Verbal autopsy (VA) is a method that enables identification of cause of death where no other routine systems are in place and where many people die at home. Considering the utility of VA as a pragmatic, interim solution to the lack of functional CRVS, this review aimed to examine the use of VA to inform health policy and systems improvements.MethodsA literature review was conducted including papers published between 2010 and 2017 according to a systematic search strategy. Inclusion of papers and data extraction were assessed by three reviewers. Thereafter, thematic analysis and narrative synthesis were conducted in which evidence was critically examined and key themes were identified.ResultsTwenty-six papers applying VA to inform health policy and systems developments were selected, including studies in 15 LMICs in Africa, Asia, the Middle East and South America. The majority of studies applied VA in surveillance sites or programmes actively engaging with decision makers and governments in different ways and to different degrees. In the papers reviewed, the value of continuous collection of cause of death data, supplemented by social and community-based investigations and underpinned by electronic data innovations, to establish a robust and reliable evidence base for health policies and programmes was clearly recognised.ConclusionVA has considerable potential to inform policy, planning and measurement of progress towards goals and targets. Working collaboratively at sub-national, national and international levels facilitates data collection, aggregation and dissemination linked to routine information systems. When used in partnerships between researchers and authorities, VA can help to close critical information gaps and guide policy development, implementation, evaluation and investment in health systems.

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Cancer Mortality among Persons with Human Immunodeficiency Virus Infection in New York City, 2001–2015

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx162.135 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S58-S58

Author(s):

Chitra Ramaswamy ◽

Emily Westheimer ◽

Sarah Braunstein

Keyword(s):

New York ◽

New York City ◽

Cause Of Death ◽

York City ◽

Cancer Mortality ◽

Mortality Rates ◽

Vital Statistics ◽

Cd4 Count ◽

Transmission Risk ◽

The Mean

Abstract Background With the prolonged life-span of persons with HIV (PWH) due to anti-retroviral therapy, their cancer burden has increased. Cancer continues to be a leading cause of death among PWH. Studying cancer mortality can inform and guide the development of cancer screening and prevention strategies for PWH. Methods We analyzed data for all persons > = 13 years who were diagnosed with HIV from 2001 to 2015 and reported to the New York City (NYC) HIV surveillance registry (HSR). Using the HSR and the underlying cause of death obtained from the NYC vital statistics registry and the National Death Index, we examined age-specific and age-standardized mortality rates from cancer and compared time trends of deaths due to HIV-related8 cancer to deaths from non-HIV-related cancers. Results There were 34,190 deaths reported among 154,688 PWH of whom nearly half (n = 16,804; 49.1%) died due to HIV (excluding HIV-related cancers). Among all deaths, HIV was the leading cause, followed by cancer (both HIV and non-HIV-related) (n = 5,271; 15.4%) and cardiovascular disease (n = 3,724, 10.9%). The top three causes of non-HIV-related cancer deaths were lung cancer (n = 1,040; 19.7%), liver cancer (n = 552; 10.5%), and colorectal cancer (n = 315; 5.6%). Although the mortality rate among PWH decreased over time (24.4 to 13.9 per 1,000 person-years from 2001 to 2015), the proportion of deaths attributable to all cancers increased (10.6% in 2001 to 19.9% in 2015, p < .0001). This increase was driven by non-HIV-related cancers (6.1% of all deaths in 2001 to 15.8% in 2015, p < .0001). The mean age increased from 2001 to 2015 among the dead (46 to 56 years) and among the censored (35 to 49 years). After controlling for demographic factors, transmission risk, and last CD4 count, the hazard ratio for cancer deaths was higher among people who inject drugs (HR = 1.5; 95% CI = 1.4–1.7) and those with last CD4 count < 200 (HR = 9.3; 95% CI = 8.3–10.5). Conclusion Although mortality rates are decreasing in PWH, deaths due to non-HIV-related cancers are increasing. The upward trend in the mean age suggests that aging may be contributing to this increase. Routine screening for liver and colon cancers along with smoking cessation may reduce lung, liver and colon cancer deaths. Disclosures All authors: No reported disclosures.

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Changes in the quality of cause-of-death statistics in Brazil: garbage codes among registered deaths in 1996-2016

10.21203/rs.3.rs-38584/v1 ◽

2020 ◽

Author(s):

Elisabeth França ◽

Lenice Harumi Ishitani ◽

Renato Teixeira ◽

Bruce B. Duncan ◽

Fatima Marinho ◽

...

Keyword(s):

Cause Of Death ◽

State Level ◽

Mortality Rates ◽

Vital Statistics ◽

Inverse Association ◽

Socioeconomic Groups ◽

Temporal Relationships ◽

Icd 10 ◽

Level 1

Abstract Background: Registered causes in vital statistics classified as garbage codes (GC) are considered indicators of quality of cause-of-death data. Our aim was to describe temporal changes in this quality in Brazil, and the leading GCs according to levels assembled for the Global Burden of Disease (GBD) study. We also assessed socioeconomic differences in the burden of different levels of GCs at a regional level. Methods: We extracted data from the Brazilian Mortality Information System from 1996 to 2016. All three and four digit ICD-10 codes considered as GC were selected and classified into four categories, according to the GBD study proposal. GCs levels 1 and 2 are the most damaging unusable codes, or major GCs. Proportionate distribution of deaths by GC levels according selected variables were performed. Age-standardized mortality rates after correction of underreporting of deaths were calculated to investigate temporal relationships as was the linear association adjusted for completeness between GC rates in states and the Sociodemographic Index (SDI) from the GBD study, for 1996-2005 and 2006-2016. We classified Brazilian states into three classes of development by applying tertiles cutoffs in the SDI state‐level estimates. Results: Age-standardized mortality rates due to GCs in Brazil decreased from 1996 to 2016, particularly level 1 GCs. The most important GC groups were ill-defined causes (level 1) in 1996, and pneumonia unspecified (level 4) in 2016. At state level, there was a significant inverse association between SDI and the rate of level 1-2 GCs in 1996-2005, but both SDI and completeness had a non-expected significant direct association with levels 3-4. In 2006-2016, states with higher SDIs tended to have lower rates of all types of GCs. Mortality rates due to major GCs decreased in all three SDI classes in 1996-2016, but GCs levels 3-4 decreased only in the high SDI category. States classified in the low or medium SDI groups were responsible for the most important decline of major GCs. Conclusion: Occurrence of major GCs are associated with socioeconomic determinants over time in Brazil. Their reduction with decreasing disparity in rates between socioeconomic groups indicates progress in reducing inequalities and strengthening cause-of-death statistics in the country.

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Pelaksanaan Registrasi Kematian dan Penyebab Kematian di Kota Ambon Tahun 2014

Media Penelitian dan Pengembangan Kesehatan ◽

10.22435/mpk.v29i1.394 ◽

2019 ◽

Vol 29 (1) ◽

pp. 1-12

Author(s):

Eva Sulistiowati ◽

Kartika Handayani

Keyword(s):

Focus Group ◽

Cause Of Death ◽

Focus Group Discussion ◽

Causes Of Death ◽

Comprehensive Evaluation ◽

Public Awareness ◽

Group Discussion ◽

Vital Statistics ◽

Death Registration ◽

Registration System

Abstract The registration system of death and cause of death as part of a good Civil Registration and Vital Statistics System (CRVS) form the basis for planning, monitoring and evaluating development programs. Ambon City as one of the development areas for recording death and causes of death since 2010 shows results that are still under-estimated (below 7 permill). Evaluation of the implementation process is needed to find out the obstacles. The qualitative methods include in-depth interviews, Focus Group Discussion (FGD) and collecting secondary data as supporting data. The analysis is part of the Comprehensive Evaluation Study on the Development of the Death Registration System and the Causes of Death in 14 districts/cities in Indonesia in 2014, carried out by triangulation and thematically compiled. The results obtained that the system of birth and death registration in the city of Ambon is already well-organized: there are regional regulations regarding the administration of population administration even though they have not included information on causes of death; the difference in vital registration data from various agencies; limited human resources, funds, facilities and infrastructure; and public awareness to report births/deaths still low. To increase the coverage of death registration and causes of death, it is necessary: local government regulations that include the cause of death; formation of joint committees and “one data” vital statistics; Autopsy Verbal (AV) workshop/training; utilization of funds from the Regional Revenue and Expenditure Budget and Health Operational Costs optimally; cooperation with community leaders (Muhabet) and socialization to the community. Abstrak Sistem registrasi kematian dan penyebab kematian sebagai bagian dari Sistem Registrasi Sipil dan Statistik Vital (Civil Registrations and Vital Statistics/CRVS) yang baik menjadi dasar untuk perencanaan, monitoring, dan evaluasi program pembangunan. Kota Ambon sebagai salah satu daerah pengembangan kegiatan pencatatan kematian dan penyebab kematian sejak tahun 2010, menunjukkan hasil yang masih under estimate (dibawah 7 permil). Evaluasi proses pelaksanaan diperlukan untuk mengetahui kendala yang dihadapi. Metode yang digunakan kualitatif meliputi wawancara mendalam, Focus Group Discussion (FGD) dan mengumpulkan data sekunder sebagai data pendukung. Analisis merupakan bagian dari Studi Evaluasi Menyeluruh Pengembangan Sistem Registrasi Kematian dan Penyebab Kematian di 14 kabupaten/kota di Indonesia Tahun 2014, dilakukan dengan triangulasi dan disusun secara tematik. Hasil yang diperoleh bahwa sistem pencatatan kelahiran dan kematian di Kota Ambon sudah tersistem dan tertata cukup baik, ada peraturan daerah tentang penyelenggaraan administrasi kependudukan walaupun belum mencakup keterangan penyebab kematian; adanya perbedaan data registrasi vital dari berbagai instansi; keterbatasan sumber daya manusia, dana, sarana prasarana; serta kesadaran masyarakat untuk melaporkan kejadian kelahiran/kematian yang masih rendah. Untuk meningkatkan cakupan registrasi kematian dan penyebab kematian, diperlukan: regulasi pemerintah daerah yang menyertakan penyebab kematian; pembentukan komite bersama dan “one data” statistik vital; workshop/pelatihan Autopsy Verbal (AV); pemanfaatan dana Anggaran Pendapatan dan Belanja Daerah (APBD) dan Biaya Operasional Kesehatan (BOK) secara optimal; kerjasama dengan tokoh masyarakat (Muhabet), dan sosialisasi kepada masyarakat.

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Abstract P096: Trends in Heart Disease Mortality Among Mississippi Adults Over a Three Decade Period, 1980 Through 2013

Circulation ◽

10.1161/circ.133.suppl_1.p096 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Vincent L. Mendy ◽

Rodolfo Vargas ◽

Lamees El-sadek ◽

Abigail Gamble

Keyword(s):

Heart Disease ◽

Cause Of Death ◽

International Classification Of Diseases ◽

Mortality Rates ◽

Vital Statistics ◽

Annual Percent Change ◽

Percent Change ◽

Classification Of Diseases ◽

Icd 10 ◽

Underlying Cause Of Death

Background: Heart disease (HD) mortality has declined in Mississippi over recent decades however it remains as the leading cause of death among Mississippians. Trends in Mississippi HD mortality have not been thoroughly explored. This study examined trends in HD mortality from 1980 through 2013 among Mississippi adults (≥ 25 years) and further assessed trends by race and sex. Methods and Results: Data from Mississippi Vital Statistics (1980 through 2013) were used to calculate age-specific HD mortality rates for Mississippi adults. Cases were identified using underlying cause of death codes from the International Classification of Diseases, Tenth Revision (ICD-10), including I00-I09, I11, I13, and I20-I51. Joinpoint software was used to calculate the average annual percent change in HD mortality rates for the overall population and by race, sex, and race and sex. Overall, the age-adjusted HD mortality rates among Mississippi adults decreased by 36.5% between 1980 and 2013 with an average annual percent change of -1.60% (95% CI -2.0 to -1.3). During this period, HD mortality rates decreased annually on average by -1.30% (95% CI -1.98 to -0.69) for black adults; by -1.60% (95% CI -1.74 to -1.46) for white adults; by -1.30% (95% CI -1.5 to -1.1) for all females, and by -1.90% (95% -2.2 to -1.5) for all males. Conclusions: Between 1980 and 2013 a continual decrease in HD mortality among Mississippi adults was observed. Disparities in the magnitude of the decrease in HD mortality existed by race and sex.

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Socioeconomic Disparities in All-Cause and Cause-Specific Mortality Rates among Municipalities in Japan, 1999–2019

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249213 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9213

Author(s):

Tasuku Okui

Keyword(s):

Mortality Rates ◽

Vital Statistics ◽

Socioeconomic Disparities ◽

Standardized Mortality Ratio ◽

Low Ses ◽

All Cause Mortality ◽

Specific Mortality ◽

Cause Of Deaths ◽

Mortality Ratio ◽

The Difference

Differences in all-cause and cause-specific mortality rates depending on municipal socioeconomic status (SES) in Japan have not been revealed over the last 20 years. This study exposes the difference in 1999 and 2019 using the Vital Statistics. All of the municipalities were grouped into five quintiles based on their SES, and standardized mortality ratio (SMR) of each municipal quintile compared with all of Japan was calculated for all-cause mortality and representative cause of deaths. As a result, although SMR for all-cause mortality for women tended to be lower in low SES quintiles in 1999, the reverse phenomenon was observed in 2019. Additionally, although SMR for all-cause of mortality for men was the lowest in the highest SES quintiles already in 1999, the difference in the SMR for all-cause mortality rates between the lowest and highest SES quintiles increased in 2019. The improvement of the SMR in the highest SES quintile and the deterioration in the lowest was also observed in representative types of cancer, heart disease, stroke, pneumonia, liver disease, and renal failure for men and women. Therefore, this study indicates a disparity in mortality depending on municipal SES enlarged in the last 20 years.

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Variation in Cause-Specific Mortality Rates in Italy during the First Wave of the COVID-19 Pandemic: A Study Based on Nationwide Data

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph19020805 ◽

2022 ◽

Vol 19 (2) ◽

pp. 805

Author(s):

Enrico Grande ◽

Ugo Fedeli ◽

Marilena Pappagallo ◽

Roberta Crialesi ◽

Stefano Marchetti ◽

...

Keyword(s):

Cause Of Death ◽

Causes Of Death ◽

Mortality Rates ◽

Cerebrovascular Diseases ◽

Suicide Mortality ◽

Lombardy Region ◽

Epidemic Area ◽

Specific Mortality ◽

External Causes Of Death ◽

External Causes

Italy was a country severely hit by the first coronavirus disease 2019 (COVID-19) pandemic wave in early 2020. Mortality studies have focused on the overall excess mortality observed during the pandemic. This paper investigates the cause-specific mortality in Italy from March 2020 to April 2020 and the variation in mortality rates compared with those in 2015–2019 regarding sex, age, and epidemic area. Causes of death were derived from the national cause-of-death register. COVID-19 was the leading cause of death among males and the second leading cause among females. Chronic diseases, such as diabetes and hypertensive, ischemic heart, and cerebrovascular diseases, with decreasing or stable mortality rates in 2015–2019, showed a reversal in the mortality trend. Moreover, mortality due to pneumonia and influenza increased. No increase in neoplasm mortality was observed. Among external causes of death, mortality increased for accidental falls but reduced for transport accidents and suicide. Mortality from causes other than COVID-19 increased similarly in both genders and more at ages 65 years or above. Compared with other areas in Italy, the Lombardy region showed the largest excess in mortality for all leading causes. Underdiagnosis of COVID-19 at the beginning of the pandemic may, to some extent, explain the mortality increase for some causes of death, especially pneumonia and other respiratory diseases.

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Evaluation of civil registration and vital statistics system in the Maldives: Focus on mortality statistics

Statistical Journal of the IAOS ◽

10.3233/sji-200748 ◽

2020 ◽

Vol 36 (4) ◽

pp. 933-941

Author(s):

Sofoora Kawsar Usman ◽

Sheena Moosa

Keyword(s):

Cause Of Death ◽

Causes Of Death ◽

Time Lag ◽

International Classification Of Diseases ◽

Vital Statistics ◽

Mortality Data ◽

Death Registration ◽

Quality Of Data ◽

Civil Registration

An efficient Civil Registration and Vital Statistics (CRVS) system is a development imperative. Data on death registration and causes of death are important for measuring health outcomes. This paper evaluates the completeness and quality of data on death registration and causes of death (CoD) based on analysis of the registration records on death and causes of death for the period 2009–2018. Using established methods and approaches, we observed that CRVS system performed well on death registration completeness, quality of age and sex reporting. However, the quality of cause of death data was poor with 50% of the International Classification of Diseases (ICD) codes classified as “major garbage codes” and significant time lag was observed in the transmission and production of vital statistics. The CRVS system in Maldives is complete with all deaths occurring within its territory registered and causes of death recorded. The two areas that require attention are the time taken for publication of vital statistics and quality of cause of death reporting. Appropriate re-engineering of the existing business process can build real-time mortality data, and regular quality assessment of death certificates with feedback to health facilities can bring sustained improvements in quality of vital statistics.

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