Abstract
BackgroundVerbal autopsy (VA) is one method to obtain valid estimates of causes of death in the absence of valid medical records. We tested the reliability and validity of a VA questionnaire developed for a cohort study in Golestan Province in northeastern Iran.MethodA modified version of the WHO adult verbal autopsy was used to assess the cause of death in the first 219 Golestan Cohort Study (GCS) subjects who died. The GCS cause of death was determined by two internists who independently reviewed all available medical records. Two other internists (“reviewers”) independently reviewed only the VA answers and classified the cause of death into one of nine general categories; they repeated this evaluation one month later. The reliability of the VA was measured by calculating intra-reviewer and inter-reviewer kappa statistics. The validity of the VA was measured using the GCS cause of death as the gold standard.ResultsVA showed both good validity (sensitivity, specificity, PPV, and NPV all above 0.81) and reliability (kappa>0.75) in determining the general cause of death independent of sex and place of residence. The overall multi-rater agreement across four reviews was 0.84 (95%CI: 0.78–0.89). The results for identifying specific cancer deaths were also promising, especially for upper GI cancers (kappa = 0.95). The multi-rater agreement in cancer subgroup was 0.93 (95%CI: 0.85–0.99).ConclusionsVA seems to have good reliability and validity for determining the cause of death in a large-scale adult follow up study in a predominantly rural area of a middle-income country.
Highlights
Accurate information on overall and cause-specific mortality is essential to prioritize the activities of health systems and to efficiently invest scarce public health and medical care resources [1,2,3]
Verbal autopsy (VA) seems to have good reliability and validity for determining the cause of death in a large-scale adult follow up study in a predominantly rural area of a middle-income country
The standard method to determine the cause of death is certification by an attending physician, based on valid medical documents, but this approach may yield unreliable results in many low- and middle-income countries, especially in rural and suburban areas
Summary
Accurate information on overall and cause-specific mortality is essential to prioritize the activities of health systems and to efficiently invest scarce public health and medical care resources [1,2,3] The availability of such information is important for epidemiologic studies. The standard method to determine the cause of death is certification by an attending physician, based on valid medical documents, but this approach may yield unreliable results in many low- and middle-income countries, especially in rural and suburban areas This is mainly due to the lack of infrastructure and the high cost of collecting the data, which limit access to information from diagnostic tests and post-mortem pathology services.
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