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

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

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

2021 ◽  
Vol 6 (5) ◽  
pp. e005387
Author(s):  
Tim Adair ◽  
Sonja Firth ◽  
Tint Pa Pa Phyo ◽  
Khin Sandar Bo ◽  
Alan D Lopez
Keyword(s):  
Cause Of Death ◽  
Verbal Autopsy ◽  
Integration Method ◽  
Mortality Rates ◽  
Vital Statistics ◽  
Death Registration ◽  
Chronic Respiratory Diseases ◽  
Health Goals ◽  
Specific Mortality ◽  
Four Causes

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.

scholarly journals Use of verbal autopsy and social autopsy in humanitarian crises

2018 ◽  
Vol 3 (3) ◽  
pp. e000640 ◽  
Author(s):  
Lisa-Marie Thomas ◽  
Lucia D’Ambruoso ◽  
Dina Balabanova
Keyword(s):  
Community Involvement ◽  
Verbal Autopsy ◽  
Causes Of Death ◽  
Vital Statistics ◽  
Vulnerable Groups ◽  
Specific Information ◽  
Holistic View ◽  
Registration System ◽  
Social Autopsy ◽  
Humanitarian Crises

IntroductionTwo billion people live in countries affected by conflict, violence and fragility. These are exceptional situations in which mortality shifts dramatically and in which civil registration and vital statistics systems are often weakened or cease to function. Verbal autopsy and social autopsy (VA and SA) are methods used to assign causes of death and understand the contexts in which these occur, in settings where information is otherwise unavailable. This review sought to explore the use of VA and SA in humanitarian crises, with a focus on how these approaches are used to inform policy and programme responses.MethodsA rapid scoping review was conducted on the use of VA and SA in humanitarian crises in low and middle-income countries since 1991. Drawing on a maximum variation approach, two settings of application (‘application contexts’) were selected and investigated via nine semi-structured expert interviews.ResultsVA can determine causes of death in crisis-affected populations where no other registration system is in place. Combined with SA and active community involvement, these methods can deliver a holistic view of obstacles to seeking and receiving essential healthcare, yielding context-specific information to inform appropriate responses. The contexts in which VA and SA are used require adaptations to standard tools, and new mobile developments in VA raise specific ethical considerations. Furthermore, collecting and sythesising data in a timely, continuous manner, and ensuring coordination and communication between agencies, is important to realise the potential of these approaches.ConclusionVA and SA are valuable research methods to foster evidence-informed responses for populations affected by humanitarian crises. When coordinated and communicated effectively, data generated through these methods can help to identify levels, causes and circumstances of deaths among vulnerable groups, and can enable planning and allocating resources effectively, potentially improving health system resilience to future crises.

scholarly journals Analysis of Causes of Death Among Brought-in-Dead Cases in a Third-Level Hospital in Lusaka, Republic of Zambia, Using the Tariff Method 2.0 for Verbal Autopsy: A Cross-Sectional Study

2019 ◽  
Author(s):  
Yuta Yokobori ◽  
Jun Matsuura ◽  
Yasuo Sugiura ◽  
Charles Mutemba ◽  
Martin Nyahoda ◽  
...  
Keyword(s):  
Verbal Autopsy ◽  
Causes Of Death ◽  
Vital Statistics ◽  
Capital City ◽  
Cross Sectional ◽  
Registration System ◽  
Death Notification ◽  
Hospital Deaths ◽  
Tariff Method ◽  
Level Hospital

Abstract Background Over one third of deaths in Zambian health facilities involve someone who has already died before arrival (i.e., brought in dead [BiD]), and in most BiD cases, the causes of death (CoD) have not been fully analyzed. Therefore, this study aimed to analyze the CoD of BiD cases using the Tariff Method 2.0 for automated verbal autopsy (VA), which is called SmartVA.Methods The target site was one third-level hospital in the Republic of Zambia’s capital city. All BiD cases aged 13 years and older at this facility from January to August 2017 were included. The deceased’s closest relatives were interviewed using a structured VA questionnaire (Population Health Metrics Research Consortium Shortened Questionnaire) and the data were analyzed using the SmartVA to determine the CoD at the individual and population level. The CoDs were compared with description on the death notification forms by using t-test and Cohen’s kappa coefficient.Results Approximately 1500 cases were included (average age = 47.2 years, 61.8% males). The top CoD were infectious diseases, including acquired immunodeficiency syndrome, tuberculosis, and malaria, followed by non-communicable diseases, such as stroke, cardiovascular diseases, and diabetes mellitus (DM). The comparison with the CoD distribution among hospital deaths showed that the trends were similar except for DM, which was greater among hospital deaths, and malaria and accident, which were less frequent in the main CoD. The proportion of cases with a determined CoD was significantly higher when using the SmartVA (75%) than the death notification form (61%). A proportion (42.7%) of the CoD-determined cases matched in both sources, with a low concordance rate (kappa coefficient = 0.1385).Conclusions The CoD of the BiD cases were successfully analyzed using the SmartVA for the first time in Zambia. While there many erroneous descriptions on the death notification form, the SmartVA could determine the CoD among more BiD cases. Since the information on the death notification form is reflected in the national vital statistics, more accurate and complete CoD data are required. In order to strengthen the death registration system with accurate CoD, it will be useful to embed the SmartVA in Zambia’s health information system.

scholarly journals Analysis of Causes of Death Among Brought-in-Dead Cases in a Third-Level Hospital in Lusaka, Republic of Zambia, Using the Tariff Method 2.0 for Verbal Autopsy: A Cross-Sectional Study

2019 ◽  
Author(s):  
Yuta Yokobori ◽  
Jun Matsuura ◽  
Yasuo Sugiura ◽  
Charles Mutemba ◽  
Martin Nyahoda ◽  
...  
Keyword(s):  
Verbal Autopsy ◽  
Causes Of Death ◽  
Vital Statistics ◽  
Capital City ◽  
Cross Sectional ◽  
Registration System ◽  
Death Notification ◽  
Hospital Deaths ◽  
Tariff Method ◽  
Level Hospital

Abstract Background Over one third of deaths in Zambian health facilities involve someone who has already died before arrival (i.e., brought in dead [BiD]), and in most BiD cases, the causes of death (CoD) have not been fully analyzed. Therefore, this study aimed to analyze the CoD of BiD cases using the Tariff Method 2.0 for automated verbal autopsy (VA), which is called SmartVA.Methods The target site was one third-level hospital in the Republic of Zambia’s capital city. All BiD cases aged 13 years and older at this facility from January to August 2017 were included. The deceased’s closest relatives were interviewed using a structured VA questionnaire (Population Health Metrics Research Consortium Shortened Questionnaire) and the data were analyzed using the SmartVA to determine the CoD at the individual and population level. The CoDs were compared with description on the death notification forms by using t-test and Cohen’s kappa coefficient.Results Approximately 1500 cases were included (average age = 47.2 years, 61.8% males). The top CoD were infectious diseases, including acquired immunodeficiency syndrome, tuberculosis, and malaria, followed by non-communicable diseases, such as stroke, cardiovascular diseases, and diabetes mellitus (DM). The comparison with the CoD distribution among hospital deaths showed that the trends were similar except for DM, which was greater among hospital deaths, and malaria and accident, which were less frequent in the main CoD. The proportion of cases with a determined CoD was significantly higher when using the SmartVA (75%) than the death notification form (61%). A proportion (42.7%) of the CoD-determined cases matched in both sources, with a low concordance rate (kappa coefficient = 0.1385).Conclusions The CoD of the BiD cases were successfully analyzed using the SmartVA for the first time in Zambia. While there many erroneous descriptions on the death notification form, the SmartVA could determine the CoD among more BiD cases. Since the information on the death notification form is reflected in the national vital statistics, more accurate and complete CoD data are required. In order to strengthen the death registration system with accurate CoD, it will be useful to embed the SmartVA in Zambia’s health information system.

Forensic science evidence: Naive estimates of false positive error rates and reliability

2020 ◽  
Author(s):  
Kristy Martire ◽  
Agnes Bali ◽  
Kaye Ballantyne ◽  
Gary Edmond ◽  
Richard Kemp ◽  
...  
Keyword(s):  
Forensic Science ◽  
False Positive ◽  
Error Rates ◽  
Forensic Sciences ◽  
Positive Error ◽  
False Positive Error ◽  
Reliability Estimates ◽  
Positive Report ◽  
Science Evidence ◽  
Science Disciplines

We do not know how often false positive reports are made in a range of forensic science disciplines. In the absence of this information it is important to understand the naive beliefs held by potential jurors about forensic science evidence reliability. It is these beliefs that will shape evaluations at trial. This descriptive study adds to our knowledge about naive beliefs by: 1) measuring jury-eligible (lay) perceptions of reliability for the largest range of forensic science disciplines to date, over three waves of data collection between 2011 and 2016 (n = 674); 2) calibrating reliability ratings with false positive report estimates; and 3) comparing lay reliability estimates with those of an opportunity sample of forensic practitioners (n = 53). Overall the data suggest that both jury-eligible participants and practitioners consider forensic evidence highly reliable. When compared to best or plausible estimates of reliability and error in the forensic sciences these views appear to overestimate reliability and underestimate the frequency of false positive errors. This result highlights the importance of collecting and disseminating empirically derived estimates of false positive error rates to ensure that practitioners and potential jurors have a realistic impression of the value of forensic science evidence.

scholarly journals Trends in mortality from external causes in the Republic of Seychelles between 1989 and 2018

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Anne Abio ◽  
Pascal Bovet ◽  
Joachim Didon ◽  
Till Bärnighausen ◽  
Masood Ali Shaikh ◽  
...  
Keyword(s):  
Causes Of Death ◽  
Road Traffic ◽  
Marked Change ◽  
Total Mortality ◽  
Mortality Rates ◽  
Vital Statistics ◽  
African Region ◽  
Road Traffic Injuries ◽  
External Causes ◽  
Over Time

AbstractData on injury-related mortality are scarce in the African region. Mortality from external causes in the Seychelles was assessed, where all deaths are medically certified and the population is regularly enumerated. The four fields for underlying causes of death recorded were reviewed in the national vital statistics register. The age-standardised mortality rates were estimated (per 100,000 person-years) from external causes in 1989–1998, 1999–2008, and 2009–2018. Mortality rates per 100,000 person-years from external causes were 4–5 times higher among males than females, and decreased among males over the three 10-year periods (127.5, 101.4, 97.1) but not among females (26.9, 23.1, 26.9). The contribution of external causes to total mortality did not change markedly over time (males 11.6%, females 4.3% in 1989–2018). Apart from external deaths from undetermined causes (males 14.6, females 2.4) and “other unintentional injuries” (males 14.1, females 8.0), the leading external causes of death in 2009–2018 were drowning (25.9), road traffic injuries (18.0) and suicide (10.4) among males; and road traffic injuries (4.6), drowning (3.4) and poisoning (2.6) among females. Mortality from broad categories of external causes did not change consistently over time but rates of road traffic injuries increased among males. External causes contributed approximately 1 in 10 deaths among males and 1 in 20 among females, with no marked change in cause-specific rates over time, except for road traffic injuries. These findings emphasise the need for programs and policies in various sectors to address this large, but mostly avoidable health burden.

scholarly journals Using verbal autopsy to measure causes of death: the comparative performance of existing methods

BMC Medicine ◽  
2014 ◽  
Vol 12 (1) ◽  
Author(s):  
Christopher JL Murray ◽  
Rafael Lozano ◽  
Abraham D Flaxman ◽  
Peter Serina ◽  
David Phillips ◽  
...  
Keyword(s):  
Verbal Autopsy ◽  
Causes Of Death ◽  
Comparative Performance

Comparison of Bleeding Risk Scores in Elderly Patients Receiving Extended Anticoagulation with Vitamin K Antagonists for Venous Thromboembolism

2021 ◽  
Author(s):  
Andrea N. Frei ◽  
Odile Stalder ◽  
Andreas Limacher ◽  
Marie Méan ◽  
Christine Baumgartner ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Elderly Patients ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Predictive Performance ◽  
Roc Curves ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Likelihood Ratios ◽  
Risk Categories

Abstract Background In elderly patients with venous thromboembolism (VTE), the decision to extend anticoagulation beyond 3 months must be weighed against the bleeding risk. We compared the predictive performance of 10 clinical bleeding scores (VTE-BLEED, Seiler, Kuijer, Kearon, RIETE, ACCP, OBRI, HEMORR2HAGES, HAS-BLED, ATRIA) in elderly patients receiving extended anticoagulation for VTE. Methods In a multicenter Swiss cohort study, we analyzed 743 patients aged ≥65 years who received extended treatment with vitamin K antagonists after VTE. The outcomes were the time to a first major and clinically relevant bleeding. For each score, we classified patients into two bleeding risk categories (low/moderate vs. high). We calculated likelihood ratios and the area under the receiver operating characteristic (ROC) curve for each score. Results Over a median anticoagulation duration of 10.1 months, 45 patients (6.1%) had a first major and 127 (17.1%) a clinically relevant bleeding. The positive likelihood ratios for predicting major bleeding ranged from 0.69 (OBRI) to 2.56 (Seiler) and from 1.07 (ACCP) to 2.36 (Seiler) for clinically relevant bleeding. The areas under the ROC curves were poor to fair and varied between 0.47 (OBRI) and 0.70 (Seiler) for major and between 0.52 (OBRI) and 0.67 (HEMORR2HAGES) for clinically relevant bleeding. Conclusion The predictive performance of most clinical bleeding risk scores does not appear to be sufficiently high to identify elderly patients with VTE who are at high risk of bleeding and who may therefore not be suitable candidates for extended anticoagulation.

scholarly journals Life expectancy and mortality in 363 cities of Latin America

2021 ◽  
Author(s):  
Usama Bilal ◽  
◽  
Philipp Hessel ◽  
Carolina Perez-Ferrer ◽  
Yvonne L. Michael ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Latin America ◽  
Life Expectancy ◽  
Latin American ◽  
Causes Of Death ◽  
Urban Environments ◽  
Noncommunicable Diseases ◽  
Modifiable Factors ◽  
Specific Mortality ◽  
Latin American Countries

AbstractThe concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.

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