Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam

Hoa Phuong Nguyen · Sue Walker · Peter Hill · Chalapati Rao

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Insurance, Mortality, Demography, Risk Management Medical Coding and Health Information Autopsy Techniques and Outcomes

Abstract

BACKGROUND: Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. METHODS: This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). RESULTS: The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. CONCLUSIONS: Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death can be minimized. Therefore, future studies should evaluate validity of MRs as a gold standard for VA studies in contexts similar to the Vietnamese context.

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References

2010Verbal Autopsy: Methods in Transition 1994Verbal Autopsies for Adult Deaths: Issues in their Development and Validation 2005Validation of verbal autopsy procedures for adult deaths in China 2017Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS): system-level considerations 2010Cause-of-death ascertainment for deaths that occur outside hospitals in Thailand: application of verbal autopsy methods 2003Applying verbal autopsy to determine cause of death in rural Vietnam 2012Mortality measures from sample-based surveillance: evidence of the epidemiological transition in Viet Nam 2010Mortality patterns in Vietnam, 2006: Findings from a national verbal autopsy survey

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2022Validation studies of verbal autopsy methods: a systematic review

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