Effect of misclassification of causes of death in verbal autopsy: can it be adjusted?
Effect of misclassification of causes of death in verbal autopsy: can it be adjusted?
复制标题
DOI：
10.1093/ije/30.3.509
复制
发表时间：
2001-06-01
影响因子：
7.7
通讯作者：
Quigley, M
中科院分区：
文献类型：
--
作者：
Chandramohan, D;Setel, P;Quigley, M
背景口头尸检(VA)是一种根据亲属的症状和体征信息间接确定死因的方法。这种方法已经在几个环境中被用于评估特定原因的死亡率。然而，由于对死因的错误分类，VA获得的特定死因死亡率估计很容易产生偏差。克服VA这一局限性的一种方法是使用VA工具的灵敏度和特异度调整原因特定死亡率分数(CSMF)的粗略VA估计。本文探讨了从医院验证研究中获得的VA数据的敏感性和特异性，以调整从人口监测系统获得的VA数据中错误分类错误的影响。方法利用坦桑尼亚、埃塞俄比亚和加纳进行的796名成人VA的多中心验证研究数据，探讨死亡原因在验证研究人群中的分布和错误分类模式对VA敏感性和特异性的影响。从坦桑尼亚莫罗戈罗农村地区的人口监测系统获得了六种原因(急性发热病、腹泻疾病、结核病/艾滋病、心血管疾病、直接产妇原因和伤害)的CSMF的Va估计数。通过使用验证研究获得的VA的敏感度和特异值来调整这些错误分类错误，所提出的模型用于纠正发病率调查中错误分类错误的影响。结果根据死因分布的不同，三个验证研究地点的VA的敏感度和特异度不同。这些差异是由不同地点之间错误分类的程度和模式的差异所解释的。当这些敏感度和特异度的估计被应用于具有相似死因结构的人口监测系统的数据时，CSMF的粗略和调整后的VA估计之间的差异在3%到83%之间。结论基于医院的验证研究获得的敏感度和特异度的估计必须谨慎地用作调整由VA产生的CSMF的错误分类错误的事实上的金标准。不可能使用来自特定地点验证研究的敏感度和特异度估计来调整VA数据中的错误分类，这些数据来自具有显著不同的原因特定死亡率模式的人群。
Background Verbal autopsy (VA) is an indirect method of ascertaining cause of death from information about symptoms and signs obtained from bereaved relatives. This method has been used in several settings to assess cause-specific mortality. However, cause-specific mortality estimates obtained by VA are susceptible to bias due to misclassification of causes of death. One way of overcoming this limitation of VA is to adjust the crude VA estimate of cause-specific mortality fractions (CSMF) using the sensitivity and specificity of the VA tool. This paper explores the application of sensitivity and specificity of VA data obtained from a hospital-based validation study for adjusting the effect of misclassification error in VA data obtained from a demographic surveillance system.Method Data from a multi-centre validation study of 796 adult VA, conducted in Tanzania, Ethiopia and Ghana, were used to explore the effect of distribution of causes of death in the validation study population and the pattern of misclassification on the sensitivity and specificity of VA. VA estimates of CSMF for six causes (acute febrile illness, diarrhoeal diseases, TB/AIDS, cardiovascular disorders, direct maternal causes and injures) were obtained from a demographic surveillance system in Morogoro Rural District in Tanzania. These were adjusted for misclassification error by using sensitivity and specificity values of VA obtained from the validation study in a model proposed for correcting the effect of misclassification error in morbidity prevalence surveys.Results Sensitivity and specificity of VA differed between the three validation study sites depending on the distribution of causes of death. These differences were explained by variations in the level and pattern of misclassification between sites. When these estimates of sensitivity and specificity were applied to data from the demographic surveillance system with a comparable structure of causes of death the difference between crude and adjusted VA estimates of CSMF ranged from 3 to 83%.Conclusion Estimates of sensitivity and specificity obtained from hospital-based validation studies must be used cautiously as a de facto, 'gold standard' for adjusting the misclassification error in CSMF derived from VA. It is not possible to use sensitivity and specificity estimates derived from a location-specific validation study to adjust for misclassification in VA data from populations with substantially different patterns of cause-specific mortality.