Sensitivity and Specificity of the National Death Index for Multiple Causes of Death in People With HIV

Objectives Inaccuracies in cause-of-death information in death certificates can reduce the validity of national death statistics and result in poor targeting of resources to reduce morbidity and mortality in people with HIV. Our objective was to measure the sensitivity, specificity, and agreement between multiple causes of deaths from death certificates obtained from the National Death Index (NDI) and causes determined by expert physician review. Methods Physician specialists determined the cause of death using information collected from the medical records of 50 randomly selected HIV-infected people who died in San Francisco from July 1, 2016, through May 31, 2017. Using expert review as the gold standard, we measured sensitivity, specificity, and agreement. Results The NDI had a sensitivity of 53.9% and a specificity of 66.7% for HIV deaths. The NDI had a moderate sensitivity for non–AIDS-related infectious diseases and non–AIDS-related cancers (70.6% and 75.0%, respectively) and high specificity for these causes (100.0% and 94.7%, respectively). The NDI had low sensitivity and high specificity for substance abuse (27.3% and 100.0%, respectively), heart disease (58.3% and 86.8%, respectively), hepatitis B/C (33.3% and 97.7%, respectively), and mental illness (50.0% and 97.8%, respectively). The measure of agreement between expert review and the NDI was lowest for HIV (κ = 0.20); moderate for heart disease (κ = 0.45) and hepatitis B/C (κ = 0.40); high for non–AIDS-related infectious diseases (κ = 0.76) and non–AIDS-related cancers (κ = 0.72); and low for all other causes of death (κ < 0.35). Conclusions Our findings support education and training of health care providers to improve the accuracy of cause-of-death information on death certificates.

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Causes of death in Serbia since the mid-20th century

Stanovnistvo ◽

10.2298/stnv1201089m ◽

2012 ◽

Vol 50 (1) ◽

pp. 89-106

Author(s):

Ivan Marinkovic

Keyword(s):

Cardiovascular Diseases ◽

Infectious Diseases ◽

20Th Century ◽

Cause Of Death ◽

21St Century ◽

Causes Of Death ◽

Total Population ◽

Total Mortality ◽

Population Mortality ◽

Circulatory Diseases

The structure of the leading causes of death in Serbia has considerably changed in the last half century. Diseases which presented the main threat to the population a few decades ago are now at the level of a statistical error. On the one side are causes which drastically changed their share in total mortality in this time interval, while others have shown stability and persistence among the basic causes of death. Acute infectious diseases "have been replaced" with chronic noninfectious diseases, due to the improvement of general and health conditions. One of the consequences of such changes is increased life expectancy and a larger share of older population which resulted in cardiovascular diseases and tumors to dominate more and more in total mortality. Convergent trends in the structure of the leading causes of death in Serbia from the middle of the 20th century are the reasons why there are considerably fewer diseases and causes with a significant rate in total population mortality at the beginning of the 21st century. During the 1950s, there were five groups of diseases and causes which participated individually with more than 10% of population mortality (infectious diseases, heart and circulatory diseases, respiratory diseases, some perinatal conditions and undefined states) while at the beginning of the new century there were only two such groups (cardiovascular diseases and tumors). Identical trends exist in all European countries, as well as in the rest of the developed world. The leading causes of death in Serbia are cardiovascular diseases. An average of somewhat over 57.000 people died annually in the period from 2007 - 2009, which represents 55.5% of total population mortality. Women are more numerous among the deceased and this difference is increasing due to population feminization. The most frequent cause of death in Serbia, after heart and circulatory diseases, are tumors, which caused 21,415 deaths in 2009. Neoplasms are responsible for one fifth of all deaths. Their number has doubled in three decades, from 9,107 in 1975 to about 20,000 at the beginning of the 21st century, whereby tumors have become the fastest growing cause of death. Least changes in absolute number of deaths in the last half century were marked among violent deaths. Observed by gender, men are in average three times more numerous among violent deaths than women. In the middle of the 20th century in Serbia, one third of the deaths caused by violence were younger than 25 and as many as one half were younger than 35 years old. Only one tenth (11%) of total number of violent deaths were from the age group of 65 or older. At the end of the first decade of the 21st century (2009), the share of population younger than 25 in the total number of violent deaths was decreased four times (and amounted to 8%). At the same time, the rate of those older than 65 or more quadrupled (amounted to 39%).

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Gastrointestinal Manifestations in Mucopolysaccharidosis Type III: Review of Death Certificates and the Literature

Journal of Clinical Medicine ◽

10.3390/jcm10194445 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4445

Author(s):

Sophie Thomas ◽

Uma Ramaswami ◽

Maureen Cleary ◽

Medeah Yaqub ◽

Eva M. Raebel

Keyword(s):

Cause Of Death ◽

Causes Of Death ◽

Clinical Feature ◽

Mucopolysaccharidosis Type ◽

Death Certificates ◽

Type Iii ◽

Mucopolysaccharidosis Type Iii ◽

Gi Symptoms ◽

Tract Infections ◽

Mps Iii

Background: Mucopolysaccharidosis type III (MPS III, Sanfilippo disease) is a life-limiting recessive lysosomal storage disorder caused by a deficiency in the enzymes involved in degrading glycosaminoglycan heparan sulfate. MPS III is characterized by progressive deterioration of the central nervous system. Respiratory tract infections have been reported as frequent and as the most common cause of death, but gastrointestinal (GI) manifestations have not been acknowledged as a cause of concern. The aim of this study was to determine the incidence of GI problems as a primary cause of death and to review GI symptoms reported in published studies. Methods: Causes of death from 221 UK death certificates (1957–2020) were reviewed and the literature was searched to ascertain reported GI symptoms. Results: GI manifestations were listed in 5.9% (n = 13) of death certificates. Median (IQR) age at death was 16.7 (5.3) years. Causes of death included GI failure, GI bleed, haemorrhagic pancreatitis, perforation due to gastrostomies, paralytic ileus and emaciation. Twenty-one GI conditions were reported in 30 studies, mostly related to functional GI disorders, including diarrhoea, dysphagia, constipation, faecal incontinence, abdominal pain/distension and cachexia. Conclusions: GI manifestations may be an under-recognized but important clinical feature of MPS III. Early recognition of GI symptoms and timely interventions is an important part of the management of MPS III patients.

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Mortality in free-ranging Eurasian brown bears (Ursus arctos arctos) in Spain (1998-2018)

10.21203/rs.2.21646/v1 ◽

2020 ◽

Author(s):

Ana Balseiro ◽

Luis José Royo ◽

Elena Gayo ◽

Ramón Balsera ◽

Olga Alarcia ◽

...

Keyword(s):

Infectious Diseases ◽

Cause Of Death ◽

Causes Of Death ◽

Ursus Arctos ◽

Mushroom Poisoning ◽

Human Intervention ◽

Pathological Findings ◽

Brown Bears ◽

Traumatic Lesions ◽

Free Ranging

Abstract Background This work summarizes the confirmed causes of death of twenty-five free-ranging Eurasian brown bears ( Ursus arctos arctos ) from the Cantabrian mountain range submitted for necropsy in Asturias and Castilla y León (northwestern Spain) from 1998 to 2018. Results Causes of death were classified based on (i) pathological findings and (ii) caused by “human intervention” or “non human intervention”. In four cases (16%) it was not possible to determine the cause of death due to the bad preservation of found remains or insufficient tissue availability. Based on pathological findings seven out of the 21 (33.3%) brown bears in which the cause of death could be determined died due to infectious diseases (clostridiosis n =4 or infectious canine hepatitis n =3), two (9.5%) due to exertional (degenerative) myopathy (one of those bears also showed clostridiosis) and one due to strychnine poisoning (4.8%), neoplasia (4.8%) or mushroom poisoning (4.8%). The remaining animals died due to traumatic lesions (including fights or infanticide), shooting or wire snare. Mortality data was also classified by deaths caused by “human intervention” or “non human intervention”. The death of one bear showing exertional myopathy after handling was not ascribed to any of the former classifications. Six out of the 20 (30%) brown bears died as a consequence of “human intervention” due to illegal hunting (wire snare hunting n =3 or shooting n =2) and, strychnine poisoning ( n =1). In contrast, fourteen (14/20, 70%) brown bears died by “non-human intervention”; nine of them (9/20, 45%) due to traumatic lesions (fights n =4, traumas n =3 or infanticide n =2), three (3/20, 15%) due to infectious canine hepatitis caused by canine adenovirus type 1 (CAdV-1) infection, one (1/20, 5%) due to cholangiocarcinoma and another one (5%) due to mushroom poisoning. Conclusions This study shows that the main causes of death in Eurasian brown bears are those caused by infectious diseases. In contrast to previous data on free-ranging bears for the first time infectious diseases appear as an important cause of death. These data are valuable and may help in the conservation and management of this recovering population.

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Cause of death of lower limb amputees

Prosthetics and Orthotics International ◽

10.3109/03093649209164325 ◽

1992 ◽

Vol 16 (2) ◽

pp. 129-132 ◽

Cited By ~ 13

Author(s):

C. P. U. Stewart ◽

A. S. Jain

Keyword(s):

Heart Disease ◽

General Population ◽

Cerebrovascular Disease ◽

Cause Of Death ◽

Lower Limb ◽

Causes Of Death ◽

Knee Amputation ◽

Comprehensive Database ◽

Lower Limb Amputees

A study was carried out on the cause of death of 100 lower limb amputees who had been admitted to the Dundee Limb Fitting Centre, Tayside, Scotland for prosthetic management or wheelchair training. A comprehensive database has been established in the Centre for 25 years and the database is updated regularly. The date of death was collected and recorded. One hundred sequential deaths were investigated to review the cause of their death and compare this with the recorded causes of death for the Tayside population for the year of study. Ninety three per cent had an amputation for vascular related causes, with 73% having a below-knee amputation and 17% above-knee. Heart disease was the most frequent recorded cause of death (51%) of the amputee whereas only 28.1% of the Tayside group died from this pathology (p<0.01). Carcinomatosis was reported as a cause of death in 14% of the amputees and 23.5% of the Tayside group. Cerebrovascular disease caused death in 6% of the amputees and in 12.3% of the Tayside group (both p<0.01). These findings confirm earlier suggestions that vascular amputees die from heart disease more often than the general population.

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Gambaran Penyebab Kematian Utama di Kabupaten Bekasi Provinsi Jawa Barat 2011

Buletin Penelitian Kesehatan ◽

10.22435/bpk.v47i1.169 ◽

2019 ◽

Vol 47 (1) ◽

pp. 29-38

Author(s):

Kristina Kristina ◽

Lamria Pangaribuan ◽

Hendrik Hendrik

Keyword(s):

Infant Mortality ◽

Infectious Diseases ◽

Cause Of Death ◽

Causes Of Death ◽

Control Model ◽

Health Programs ◽

Age Group ◽

Perinatal Deaths ◽

Health Control ◽

Model Based

AbstractDeath can be caused by a number of diseases such as infectious diseases, disease not causing injury. Thepattern of death and cause of death is one indicator used to assess health programs. Objective: to findout the images of the causes and causes of death in 2011 in Bekasi Regency. Methods: Articles are thesubsequent analysis of the study of the Health Control Model Based on Death Registrations and Causesof Death in 12 Districts / Cities in Indonesia. The method is an analysis of national agriculture in 2011.Population: all death events in Bekasi Regency. Samples: deaths of residents of Bekasi Regency who diedin 2011. Instruments used: 1) AV1 Questionnaire, to collect information on perinatal deaths, namely fetal/ infant mortality with a womb age of more than 22 weeks until the age of 6 days and advanced neonataldeaths, 7 days old infants up to 27 days. 2). The AV2 questionnaire, collected information on death,aged 28 days and five years, 5 years. 3) AV3 Questionnaire, collect the 5-year death report above andthe Death Cause Information Form (FKPK). Results: The number of deaths obtained in 2011 was 5,011deaths. As many as 82.7% of deaths were at home and 15.6% were hospitalized. Most deaths were in men(56.1%) compared to women (43.9%). The cause of death due to adolescents is not higher (61.4%) thanother causes. Space deaths increase sharply in the group 65 years and above. The cause of stroke wasdeath in Bekasi Regency in 2011. Conclusion: The main causes of the age group IUFD + 0-6 days werepremature. Diarrhea is the leading cause of death in the age group 29 months -4 years. TB is the leadingcause of death in women and number two in men aged 15-44 years. Stroke is the leading cause of deathin the age group 55-64 years, 65 years and over and in men aged 45-54 years. Keywords: death, stroke, cause of death, primary AbstrakKematian dapat disebabkan beberapa hal seperti penyakit menular, penyakit tidak menular maupun karenakecelakaan. Pola kematian dan penyebab kematian merupakan salah satu indikator yang digunakanuntuk menilai program kesehatan.Tujuan:mengetahui gambaran kematian dan penyebab kematian utamatahun 2011 di Kabupaten Bekasi. Metode:Artikel ini merupakan hasil analisis lanjut dari studi ModelPengendalian Kesehatan Berbasis Registrasi Kematian dan Penyebab Kematian di 12 Kabupaten/Kotadi Indonesia. Metode studi merupakan analisis regresi kematian tahun 2011. Populasi: semua kejadiankematian di Kabupaten Bekasi. Sampel: kematian penduduk Kabupaten Bekasi yang meninggal tahun2011. Instrumen yang digunakan: 1) Kuesioner AV1, untuk mengumpulkan informasi kematian perinatalyaitu kematian janin/bayi dengan umur kandungan lebih dari 22 minggu sampai dengan umur 6 hari dankematian neonatal lanjut, bayi berumur 7 hari sampai dengan 27 hari. 2). Kuesioner AV2, mengumpulkaninformasi kematian bayi berumur 28 hari sampai dibawah 5 tahun. 3) Kuesioner AV3, mengumpulkaninformasi kematian berusia 5 tahun keatas dan Formulir Keterangan Penyebab Kematian (FKPK). Hasil:Jumlah kematian yang didapatkan pada tahun 2011 adalah 5.011 kematian. Sebanyak 82,7% kematianterjadi di rumah dan 15,6% di rumah sakit. Kematian paling banyak pada laki-laki (56,1%) dibandingperempuan (43,9%). Penyebab kematian akibat penyakit tidak menular lebih tinggi (61,4%) dibandingkanpenyebab lain. Angka kematian meningkat tajam pada kelompok 65 tahun ke atas. Penyakit strokepenyebab kematian utamadi Kabupaten Bekasi tahun 2011. Kesimpulan: Penyebab kematian utama padakelompok umur IUFD +0-6 hari adalah karena prematur. Diare merupakan penyebab kematian utamapada kelompok umur 29 bulan-4 tahun. TBC merupakan penyebab kematian utama pada perempuandan nomor dua pada laki-laki umur 15-44 tahun. Stroke adalah penyebab kematian utama pada kelompokumur 55-64 tahun, 65 tahun ke atas dan pada laki-laki kelompok umur 45-54 tahun. Kata kunci: kematian, stroke, penyebab kematian, utama

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Discrepancy between Clinical and Postmortem Diagnosis of Dogs in a Veterinary Medical Teaching Hospital

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.79773 ◽

2017 ◽

Vol 45 (1) ◽

pp. 5

Author(s):

William Torres Blanca ◽

Lygia Fernandes Gundim ◽

Thaís De Almeida Moreira ◽

Taís Meziara Wilson ◽

Alessandra Aparecida Medeiros-Ronchi

Keyword(s):

Infectious Disease ◽

Heart Disease ◽

Infectious Diseases ◽

Cause Of Death ◽

Systemic Disease ◽

Human Study ◽

Malignant Neoplasms ◽

Neoplastic Disease ◽

Postmortem Diagnosis ◽

Discrepancy Rate

Background: The postmortem examination offers the opportunity to study the processes involved in disease. Although a portion of veterinary medical professionals and students consider the necropsy as a diagnostic tool of purely academic interest, it can provide valuable assistance in formulating health strategies in order to prevent and control animal diseases. The number of necropsies performed in general is higher in universities where the cost is subsidized. In veterinary medicine, studies intended to assess the frequency of necropsy and the discrepancy between clinical and postmortem diagnosis of dogs are rare. The main purpose of the necropsy is to discover the cause of death of dogs, by defining a possible etiology and pathogenesis in order to reach a diagnosis.Material, Methods & Results: We used medical records and necropsy records to define the clinical and postmortem diagnosis, respectively. Data relating to deaths was recorded as the number of euthanized dogs and natural deaths in 2014. From the information cause of death, these were categorized as infectious disease, cardiac, gastrointestinal, renal, pulmonary, neurological, metabolic or endocrine disease, neoplastic disease, trauma, or systemic disease. We used the Binomial discrepancy in the comparison of the rates between different years and also to verify the association between discrepancy and the correlation between clinical and postmortem diagnosis of dogs with euthanasia and natural death, with statistical significance (P < 0.05). In 2009, 56.81% (25/44) of cases included in the study had a concordance between the clinical and postmortem diagnosis, while 43.19% (19/44) were discordant. In 2014, it was observed that 71.70% (76/106) of the diagnosis was confirmed with the necropsy, while 28.30% (30/106) were discordant. The disagreement rate was higher in 2009 (P < 0.05) and there was a reduction of 14.89% in the disagreement rate between 2009 and 2014. Regarding the cause of death, infectious diseases, gastrointestinal disease, and heart disease were the categories in which the discrepancy was higher. It was found that in the group of dogs euthanized, the discrepancy rate was lower compared with the group of dogs that had anatural death (P < 0.05).Discussion: The disagreement rate can be considered high when compared with a veterinary study and similar to those observed in a human study. Decrease in the discrepancy rate in the years, as observed by other authors, that can be attributed to improvements and expansion of diagnostic services of the hospital and better training of veterinarians. The difficulty in determining the etiology of infectious diseases is associated with lack of specific diagnostic tests and the high cost of available tests, which often is not bank rolled by the tutor. Dogs in this study were rarely submitted to diagnostics tests such as electrocardiogram or echocardiogram which explains the high discordance in the diagnosis of heart disease. Distemper is an infectious disease of great importance regarding euthanized animals, especially in cases that progress to central nervous system injuries with extremely poor prognosis and wind up having euthanasia indication. Another common cause of domestic animals euthanasia indication is the occurrence malignant neoplasms, which depends on the progression of the disease and psychological and social conditions of the owner. The results generated herein suggests that infectious, gastrointestinal and cardiac diseases origin tend to have a greater discordance between clinical and postmortem diagnosis, however this rate is decreasing due to improved infrastructure of veterinary centers with better professionals qualification.

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Causes of Death and Comorbidities in Patients with COVID-19

10.1101/2020.06.15.20131540 ◽

2020 ◽

Cited By ~ 4

Author(s):

Sefer Elezkurtaj ◽

Selina Greuel ◽

Jana Ihlow ◽

Edward Michaelis ◽

Philip Bischoff ◽

...

Keyword(s):

Septic Shock ◽

Heart Disease ◽

Cause Of Death ◽

Causes Of Death ◽

Pulmonary Infection ◽

Diffuse Alveolar Damage ◽

Chronic Health Conditions ◽

Health Conditions ◽

Fatal Disease ◽

Increased Risk

ABSTRACTInfection by the new corona virus strain SARS-CoV-2 and its related syndrome COVID-19 has caused several hundreds of thousands of deaths worldwide. Patients of higher age and with preexisting chronic health conditions are at an increased risk of fatal disease outcome. However, detailed information on causes of death and the contribution of comorbidities to death yet is missing. Here, we report autopsy findings on causes of death and comorbidities of 26 decedents that had clinically presented with severe COVID-19. We found that septic shock and multi organ failure was the most common immediate cause of death, often due to suppurative pulmonary infection. Respiratory failure due to diffuse alveolar damage presented as the most immediate cause of death in fewer cases. Several comorbidities, such as hypertension, ischemic heart disease, and obesity were present in the vast majority of patients. Our findings reveal that causes of death were directly related to COVID-19 in the majority of decedents, while they appear not to be an immediate result of preexisting health conditions and comorbidities. We therefore suggest that the majority of patients had died of COVID-19 with only contributory implications of preexisting health conditions to the mechanism of death.

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The Role of COVID-19 in the Death of SARS-CoV-2–Positive Patients: A Study Based on Death Certificates

Journal of Clinical Medicine ◽

10.3390/jcm9113459 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3459 ◽

Cited By ~ 1

Author(s):

Francesco Grippo ◽

Simone Navarra ◽

Chiara Orsi ◽

Valerio Manno ◽

Enrico Grande ◽

...

Keyword(s):

Heart Disease ◽

Cause Of Death ◽

Hypertensive Heart Disease ◽

International Classification Of Diseases ◽

Death Certificates ◽

Respiratory Complications ◽

Classification Of Diseases ◽

Underlying Cause Of Death ◽

And Gender ◽

Low Prevalence

Background: Death certificates are considered the most reliable source of information to compare cause-specific mortality across countries. The aim of the present study was to examine death certificates of persons who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to (a) quantify the number of deaths directly caused by coronavirus 2019 (COVID-19); (b) estimate the most common complications leading to death; and (c) identify the most common comorbidities. Methods: Death certificates of persons who tested positive for SARS-CoV-2 provided to the National Surveillance system were coded according to the 10th edition of the International Classification of Diseases. Deaths due to COVID-19 were defined as those in which COVID-19 was the underlying cause of death. Complications were defined as those conditions reported as originating from COVID-19, and comorbidities were conditions independent of COVID-19. Results: A total of 5311 death certificates of persons dying in March through May 2020 were analysed (16.7% of total deaths). COVID-19 was the underlying cause of death in 88% of cases. Pneumonia and respiratory failure were the most common complications, being identified in 78% and 54% of certificates, respectively. Other complications, including shock, respiratory distress and pulmonary oedema, and heart complications demonstrated a low prevalence, but they were more commonly observed in the 30–59 years age group. Comorbidities were reported in 72% of certificates, with little variation by age and gender. The most common comorbidities were hypertensive heart disease, diabetes, ischaemic heart disease, and neoplasms. Neoplasms and obesity were the main comorbidities among younger people. Discussion: In most persons dying after testing positive for SARS-CoV-2, COVID-19 was the cause directly leading to death. In a large proportion of death certificates, no comorbidities were reported, suggesting that this condition can be fatal in healthy persons. Respiratory complications were common, but non-respiratory complications were also observed.

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Comparing Underlying and Contributory Cause of Death in Registry Data With End-of-Life Proxy Interviews: Findings From The Irish Longitudinal Study on Ageing (TILDA)

Journal of Applied Gerontology ◽

10.1177/0733464820935295 ◽

2020 ◽

pp. 073346482093529

Author(s):

Mark Ward ◽

Peter May ◽

Charles Normand ◽

Rose Anne Kenny ◽

Anne Nolan

Keyword(s):

Longitudinal Study ◽

End Of Life ◽

Cause Of Death ◽

Causes Of Death ◽

Community Dwelling ◽

Death Certificates ◽

Nationally Representative ◽

Underlying Cause Of Death ◽

Kappa Agreement ◽

Level Of Agreement

Cause of death is an important outcome in end-of-life (EOL) research. However, difficulties in assigning cause of death have been well documented. We compared causes of death in national death registrations with those reported in EOL interviews. Data were from The Irish Longitudinal Study on Ageing (TILDA), a nationally representative sample of community-dwelling adults aged 50 years and older. The kappa agreement statistic was estimated to assess the level of agreement between two methods: cause of death reported in EOL interviews and those recorded in official death registrations. There was moderate agreement between underlying cause of death recorded on death certificates and those reported in EOL interviews. Discrepancies in reporting in EOL interviews were systematic with better agreement found among younger decedents and where the EOL informant was the decedents’ partner/spouse. We have shown that EOL interviews may have limited utility if the main goal is to understand the predictors and antecedents of different causes of death.

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Does recall time matter in verbal autopsies? Evidence from urban informal settlements in Nairobi, Kenya

Wellcome Open Research ◽

10.12688/wellcomeopenres.16243.1 ◽

2020 ◽

Vol 5 ◽

pp. 217

Author(s):

Donnie Mategula ◽

Judy Gichuki

Keyword(s):

Infectious Diseases ◽

Cause Of Death ◽

Causes Of Death ◽

Secondary Analysis ◽

P Value ◽

Regression Methods ◽

Recall Time ◽

Informal Setting ◽

Independent Variable ◽

Hiv Aids

Background: To assign a cause of death to non-medically certified deaths, verbal autopsies (VAs) are widely used to determine the cause of death. The time difference between the death and the VA interview, also referred to as recall time, varies depending on social and operational factors surrounding the death. We investigated the effect of recall time on the assignment of causes of death by VA. Methods: This is a secondary analysis of 2002-2015 survey data of the Nairobi Urban Health Demographic Surveillance System (NUHDSS). The independent variable recall time was derived from the date of death and the date when the VA was conducted. Univariate and multivariate logistic regression methods were used to calculate odds ratios of assigning a cause of death in defined categories of recall time. Results: There were 6218 deaths followed up between 2002 and 2016, out of which 5495 (88.3%) had VAs done. Recall time varied from 1-3001 days (mean 115.5 days, sd216.8). Majority of the VAs (45.7%) were conducted between 1-3 months after death. The effect of recall time varied for different diseases. Compared to VAs conducted between 1-3 months, there was a 24% higher likelihood of identifying HIV/AIDS as the cause of death for VAs conducted 4-6 months after death (AOR 1.24; 95% CI 1.01-1.54; p-value = 0.043) and a 40% increased chance of identifying other infectious diseases as the cause of death for VAs conducted <1 month after death (AOR 1.4; 95% CI 1.02-1.92, p-value = 0.024). Conclusions: Recall time affected the assignment of VA cause of death for HIV/AIDS, other infectious diseases and maternal/neonatal causes. Our analysis indicates that in the urban informal setting, VAs should be conducted from one month up to 6 months after the death to improve the probability of accurately assigning the cause of death.

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