Validation of verbal autopsy procedures for adult deaths in China
Validation of verbal autopsy procedures for adult deaths in China
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DOI：
10.1093/ije/dyi181
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发表时间：
2006-06-01
影响因子：
7.7
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
Yang, Gonghuan;Rao, Chalapati;Lopez, Alan D.
背景在中国，死亡原因的生命登记不完整，医疗证明的覆盖率很低。关于主要死亡原因的信息将继续依靠死因推断方法。一个新的国际VA形式正在考虑在中国的数据收集，但它首先需要验证，以确定其操作特性。由一个医生小组审查了代表中国城市人口的6个城市的3290例死亡（主要是成年人）的详细医疗记录和临床证据，并由专家进行编码，以建立一个参考的潜在死因。另外，使用结构化症状问卷对死者家属进行了访谈，并为每个匹配病例准备了单独的死亡证明（2102）。VA程序的有效性采用敏感性、特异性和阳性预测值的标准测量标准进行评估。VA方法在识别成人死亡的几种主要原因（包括中风、几个主要癌症部位（肺、肝、胃、食道和结直肠））和交通事故）造成的死亡方面表现相当出色。在检测中国主要公共卫生关注的几种原因（包括缺血性心脏病、慢性阻塞性肺疾病、糖尿病和肺结核）的死亡时，灵敏度不太令人满意，尤其是在诊断病毒性肝炎、高血压和肾脏疾病的死亡时。VA是一种不精确的工具，用于检测成人死亡的主要原因。然而，许多错误分类通常发生在广泛的病因组（例如CVD，呼吸系统疾病和肝脏疾病）中。此外，错误分类的补偿模式似乎表明，至少在中国城市，该方法产生的人口水平的特定原因估计是合理可靠的。这些结果表明，这些方法在中国农村的可能效用，以支持低覆盖率的死亡原因的医疗认证，由于获得卫生设施有。
Background. Vital registration of causes of death in China is incomplete with poor coverage of medical certification. Information on the leading causes of mortality will continue to rely on verbal autopsy (VA) methods. A new international VA form is being considered for data collection in China, but it first needs to be validated to determine its operating characteristics.Methods. Detailed medical records and clinical evidence for 3290 deaths (mostly adults) among residents of six cities representative of the urban Chinese population were reviewed by a panel of physicians and coded by experts to establish a reference underlying cause of death. Independently, families of the deceased were interviewed using a structured symptomatic questionnaire and a separate death certificate was prepared for each matching case (2102). Validity of the VA procedure was assessed using standard measurement criteria of sensitivity, specificity, and positive predictive value.Results. VA methods perform reasonably well in identifying deaths from several leading causes of adult deaths including stroke, several major cancer sites (lung, liver, stomach, oesophagus, and colorectal), and transport accidents. Sensitivity was less satisfactory in detecting deaths from several causes of major public health concern in China including ischaemic heart disease, chronic obstructive pulmonary disease, diabetes, and tuberculosis, and was particularly poor in diagnosing deaths from viral hepatitis, hypertension, and kidney diseases.Conclusions. VA is an imprecise tool for detecting leading causes of death among adults. However, much of the misclassification generally occurs within broad cause groups (e.g. CVD, respiratory diseases, and liver diseases). Moreover, compensating patterns of misclassification would appear to suggest that, in urban China at least, the method yields population-level cause-specific estimates that are reasonably reliable. These results suggest the possible utility of these methods in rural China, to back up the low coverage of medical certification of cause of death owing to poor access to health facilities there.