Worldwide data on causes of death: a systematic assessment of quality and availability of vital registration

Abstract

BackgroundTimely, accurate, and unbiased data are essential to evidence-based global health policy and research. Perhaps the most widely applied data pertain to causes of death (CoD), a highly informative indicator of population health. Consequently, an accurate understanding of the availability and quality of vital registration (VR) systems is indispensable to health policy makers and researchers alike. Using the CoD database from the Global Burden of Disease 2010 Study, we measured the quality of available VR data for 187 countries worldwide. MethodsUsing 2555 site-years of VR data covering 126 countries from 1980 to 2010, we developed a composite index of data quality that incorporated completeness, level of detail, pattern of misclassification of CoD, deaths of unknown age or sex, deaths coded to medically impossible CoD given age or sex, and timeliness of data reporting. This index was applied to the CoD database, providing estimates of overall data quality for 126 countries. FindingsData from VR have improved over time, but vary between and within regions. 39 countries currently have data from 2010 available, and 76 countries have data from 2009. Generally, countries from North America, Europe, Central America and high-income Asia–Pacific were found to have the highest quality data, while countries from south Asia and east Asia were estimated to have lower quality VR data. Further, many countries from sub-Saharan Africa and southeast Asia still have no available VR data. Considerable heterogeneity in VR quality was found in the Caribbean and eastern Europe/central Asia. Countries from the north Africa/Middle East region and Latin America demonstrated substantial improvements in data quality since 1990. InterpretationMetrics about the quality and availability of data from VR systems have important implications for policy and research. With improved information about where death certificates are reliably filled out and reported and where they are not, data collection efforts and health information system strengthening can be focused on areas of high need. High-quality and timely data on population health is critical as research to inform evidence-based policies and funding decisions continues to be of increasing importance in global health. FundingBill & Melinda Gates Foundation.