Estimating Causes of Out-of-Hospital Deaths in China: Application of SmartVA Methods

Jinlei Qi,Xinying Zeng,Maigeng Zhou,Tim Adair,Deirdre Mclaughlin,Jiangmei Liu,Hang Li,Lijun Wang,Alan D Lopez,Yunning Liu,Peng Yin,Hafizur R Chowdhury,Sonja Firth,Renee Sorchik,Jinling You

doi:10.2139/ssrn.3489312

Abstract

Background: Most deaths in China occur at home, making it difficult to collect reliable cause of death (CoD) information. Verbal autopsy (VA) was applied using the SmartVA tool to a sample of home deaths in China to explore its feasibility as a means of improving the quality of CoD data. Methods: The study was carried out in 22 districts in 9 provinces, located in north-east, central, and western areas of China during 2017 and 2018. Trained interviewers selected suitable respondents in each household to collect information using the Population Health Metrics Research Consortium (PHMRC) shortened and validated electronic VA questionnaire on tablets. The CoD was diagnosed from the interview data using the SmartVA-Analyze 2.0 software (Tariff 2.0). Findings: Non-communicable diseases (NCDs) dominated the leading causes of death in all age groups and for both sexes. After redistribution of undetermined causes, stroke (24%), ischemic heart diseases (IHD) (21%), chronic respiratory diseases (11%), and lung cancer (6%) were the leading causes of death. The cause fractions for level-one cause categories and ranking of specific causes were similar between SmartVA and results from the Global Burden of Disease (GBD) study. Interpretation: Evidence from this large pilot study suggests that SmartVA can be a valuable tool to improve the quality and standardization of CoD information across China. Funding Statement: Bloomberg Data for Health Initiative. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The ethics committee from the National Center for Chronic Non-Communicable Disease Control and Prevention (NCNCD) of the Chinese Center for Disease Control and Prevention approved the study. Verbal informed consent was obtained and recorded for all participants.

Highlights

Most deaths in China occur at home, making it difficult to collect reliable cause of death (CoD) information
We present uncertainty intervals (UI) of the cause-specific mortality fractions from Global Burden of Disease (GBD) estimates [28]
Smart verbal autopsy (SmartVA) attributed a lower proportion of deaths to Non-communicable diseases (NCDs) compared with the GBD 2017 China estimates and GBD estimates for 9 provinces (Table 5). This pilot study was conducted to determine whether SmartVA could be an appropriate and effective tool for Verbal autopsy (VA) in China in terms of training and implementation and obtaining reliable CoD data

Summary

Introduction

Most deaths in China occur at home, making it difficult to collect reliable cause of death (CoD) information. And reliable information on mortality and causes of death (CoD) are essential for the development of national health policy [1, 2]. It provides a major benefit for death surveillance, CoD data are either unavailable or often of sub-standard quality in many lowand middle-income countries [3, 4]. A disease surveillance points (DSP) system provides crucial information on mortality conditions in China, covering 340 million people (approximately 24.3% of the country’s population) [5]. 75% of deaths occur at home, and a further

Methods

Results

Discussion

Conclusion