assessing verbal autopsy as a complement to vital registration
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GHME 2013 Conference Session: Verbal Autopsy Date: June 18 2013 Presenter: Andrea Stewart Institute: Institute for Health Metrics and Evaluation (IHME), University of WashingtonTRANSCRIPT
Assessing verbal autopsy as a complement to vital registrationA data-driven simulation study
Andrea Stewart, Post-Bachelor FellowJune 18, 2013
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Presentation outline
โข Uses of verbal autopsy (VA)
โข Potential uses of new VA methods
โข Creation of a simulation of incomplete vital registration (VR) complemented with VA estimates
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Presentation outline
โข Uses of verbal autopsy (VA)
โข Potential uses of new VA methods
โข Creation of a simulation of incomplete vital registration (VR) complemented with VA estimates
4
Uses of verbal autopsy
Photo by Peter Biro/The IRC. ยฉ2011 International Rescue Committee.
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Presentation outline
โข Uses of Verbal Autopsy (VA)
โข Potential uses of new VA methods
โข Creation of a simulation of incomplete vital registration (VR) complemented with VA estimates
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Advancements in VA science
โข Automated methods for collection and analysis
โข Less time
โข Fewer resources
โข More accurate
Could we use VA in routine national data
collection?
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Presentation outline
โข Uses of Verbal Autopsy (VA)
โข Potential uses of new VA methods
โข Creation of a simulation of incomplete vital registration (VR) complemented with VA estimates
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Simulation setting โ the data
โข Need data that has:
o VR estimates (death certificates)
o VA estimates (analyzed by Tariff)
o Known cause of death (based on stringent diagnostic criteria)
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Population Health Metrics Research Consortium gold standards
VA Tariff method results
Death certificate
Gold standard diagnosis
1,288 VAs from Morelos, Mexico
x 500 test data sets of varying cause composition
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Metrics
โข Cause-specific mortality fractions (CSMFs)
โข Measure of accuracy
โข Change in that metric across situations
% Accuracy change=( ๐ด๐๐ h๐ค๐๐ก ๐๐ดโ๐ด๐๐ ๐๐๐๐๐๐๐๐๐ก๐
๐ด๐๐๐๐๐๐๐๐๐๐๐ก๐)ร100%
๐ถ๐๐๐น๐ด๐๐๐ข๐๐๐๐ฆ=1โโ๐=1
๐
ยฟ๐ถ๐๐๐น ๐๐ก๐๐ข๐โ๐ถ๐๐๐น ๐
๐๐๐๐โจยฟ
2(1โ๐๐๐๐๐๐ข๐(๐ถ๐๐๐น ๐๐ก๐๐ข๐))
ยฟ
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Data โ mortality registries from Morelos
โข Mortality registries provide the proportion of deaths by age, sex, and cause of death that occur in health facilities
โข %
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Simulation setting โ the data
Using Morelos probabilities -
Deaths in facility Deaths out of facility
622 observations with: Death certificateVerbal autopsy
Gold-standard diagnosis
666 observations with: Death certificateVerbal autopsy
Gold-standard diagnosis
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Simulation setting โ incomplete vital registration
Deaths in facility Deaths out of facility
Use death certificate data for
60%
Use death certificate data for 10%
No death certificate
No death certificate
Deaths in facility Deaths out of facility
Gold-standard diagnosis
Gold-standard diagnosis
vs.
๐๐ข๐ก๐๐ข๐ก : ๐ด๐๐๐๐๐๐๐๐๐๐๐ก๐
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Simulation setting โ add VA estimates
vs.
Deaths in facility Deaths out of facility
Use death certificate data for
60%
Use death certificate data for 10%
Use verbal autopsy data for remaining
90%Use verbal autopsy data for remaining
40%
Deaths in facility Deaths out of facility
Gold-standard diagnosis
Gold-standard diagnosis
๐๐ข๐ก๐๐ข๐ก : ๐ด๐๐ h๐ค๐๐ก ๐๐ด
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Simulation setting
โข Do this for each of the simulated scenarioso 0%-100% deaths with DC in facility
o 0%-100% deaths with DC out of facility
โข Calculate change in CSMF accuracy for each scenario
Accuracy change=( ๐ด๐๐ h๐ค๐๐ก ๐๐ดโ ๐ด๐๐๐๐๐๐๐๐๐๐๐ก๐
๐ด๐๐๐๐๐๐๐๐๐๐๐ก๐)ร100
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ResultsPercent change in CSMF accuracy when adding VA
% of out-of-facility deaths with death certificates 0 10 20 30 40 50 60 70 80 90 100
% of in-facility deaths with
death certificates
0 27.5 24.3 20.1 17.4 14.5 11.4 10.4 8.9 7.2 6.010 29.1 24.7 21.7 18.0 15.4 12.3 9.6 9.0 7.9 5.7 5.320 26.3 21.8 19.1 15.9 13.7 10.9 8.4 7.8 6.8 5.1 4.330 23.1 19.5 16.6 13.8 11.8 9.5 6.9 6.1 5.3 3.8 3.640 20.2 17.1 14.3 11.7 9.8 7.5 5.2 4.7 4.0 2.6 2.350 17.5 14.9 12.4 10.0 8.0 6.0 4.1 3.9 2.9 1.9 1.760 15.5 12.7 10.3 7.9 6.7 5.0 3.3 3.1 2.3 1.0 0.870 13.3 10.5 8.3 6.2 4.9 3.4 2.1 2.0 1.3 0.6 0.380 11.2 8.8 7.4 5.1 4.0 2.6 1.2 1.2 0.8 -0.1 0.290 9.6 7.9 6.2 3.9 2.7 1.8 0.6 0.6 0.2 -0.2 -0.1
100 8.5 7.0 5.3 3.2 2.2 0.8 0.3 0.2 0.3 -0.2 0.0
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ResultsPercent change in CSMF accuracy when adding VA
% of out-of-facility deaths with death certificates 0 10 20 30 40 50 60 70 80 90 100
% of in-facility deaths with
death certificates
0 27.5 24.3 20.1 17.4 14.5 11.4 10.4 8.9 7.2 6.010 29.1 24.7 21.7 18.0 15.4 12.3 9.6 9.0 7.9 5.7 5.320 26.3 21.8 19.1 15.9 13.7 10.9 8.4 7.8 6.8 5.1 4.330 23.1 19.5 16.6 13.8 11.8 9.5 6.9 6.1 5.3 3.8 3.640 20.2 17.1 14.3 11.7 9.8 7.5 5.2 4.7 4.0 2.6 2.350 17.5 14.9 12.4 10.0 8.0 6.0 4.1 3.9 2.9 1.9 1.760 15.5 12.7 10.3 7.9 6.7 5.0 3.3 3.1 2.3 1.0 0.870 13.3 10.5 8.3 6.2 4.9 3.4 2.1 2.0 1.3 0.6 0.380 11.2 8.8 7.4 5.1 4.0 2.6 1.2 1.2 0.8 -0.1 0.290 9.6 7.9 6.2 3.9 2.7 1.8 0.6 0.6 0.2 -0.2 -0.1
100 8.5 7.0 5.3 3.2 2.2 0.8 0.3 0.2 0.3 -0.2 0.0
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ResultsPercent change in CSMF accuracy when adding VA
% of out-of-facility deaths with death certificates 0 10 20 30 40 50 60 70 80 90 100
% of in-facility deaths with
death certificates
0 27.5 24.3 20.1 17.4 14.5 11.4 10.4 8.9 7.2 6.010 29.1 24.7 21.7 18.0 15.4 12.3 9.6 9.0 7.9 5.7 5.320 26.3 21.8 19.1 15.9 13.7 10.9 8.4 7.8 6.8 5.1 4.330 23.1 19.5 16.6 13.8 11.8 9.5 6.9 6.1 5.3 3.8 3.640 20.2 17.1 14.3 11.7 9.8 7.5 5.2 4.7 4.0 2.6 2.350 17.5 14.9 12.4 10.0 8.0 6.0 4.1 3.9 2.9 1.9 1.760 15.5 12.7 10.3 7.9 6.7 5.0 3.3 3.1 2.3 1.0 0.870 13.3 10.5 8.3 6.2 4.9 3.4 2.1 2.0 1.3 0.6 0.380 11.2 8.8 7.4 5.1 4.0 2.6 1.2 1.2 0.8 -0.1 0.290 9.6 7.9 6.2 3.9 2.7 1.8 0.6 0.6 0.2 -0.2 -0.1
100 8.5 7.0 5.3 3.2 2.2 0.8 0.3 0.2 0.3 -0.2 0.0
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ResultsPercent change in CSMF accuracy when adding VA
% of out-of-facility deaths with death certificates 0 10 20 30 40 50 60 70 80 90 100
% of in-facility deaths with
death certificates
0 27.5 24.3 20.1 17.4 14.5 11.4 10.4 8.9 7.2 6.010 29.1 24.7 21.7 18.0 15.4 12.3 9.6 9.0 7.9 5.7 5.320 26.3 21.8 19.1 15.9 13.7 10.9 8.4 7.8 6.8 5.1 4.330 23.1 19.5 16.6 13.8 11.8 9.5 6.9 6.1 5.3 3.8 3.640 20.2 17.1 14.3 11.7 9.8 7.5 5.2 4.7 4.0 2.6 2.350 17.5 14.9 12.4 10.0 8.0 6.0 4.1 3.9 2.9 1.9 1.760 15.5 12.7 10.3 7.9 6.7 5.0 3.3 3.1 2.3 1.0 0.870 13.3 10.5 8.3 6.2 4.9 3.4 2.1 2.0 1.3 0.6 0.380 11.2 8.8 7.4 5.1 4.0 2.6 1.2 1.2 0.8 -0.1 0.290 9.6 7.9 6.2 3.9 2.7 1.8 0.6 0.6 0.2 -0.2 -0.1
100 8.5 7.0 5.3 3.2 2.2 0.8 0.3 0.2 0.3 -0.2 0.0
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ResultsPercent change in CSMF accuracy when adding VA
% of out-of-facility deaths with death certificates 0 10 20 30 40 50 60 70 80 90 100
% of in-facility deaths with
death certificates
0 27.5 24.3 20.1 17.4 14.5 11.4 10.4 8.9 7.2 6.010 29.1 24.7 21.7 18.0 15.4 12.3 9.6 9.0 7.9 5.7 5.320 26.3 21.8 19.1 15.9 13.7 10.9 8.4 7.8 6.8 5.1 4.330 23.1 19.5 16.6 13.8 11.8 9.5 6.9 6.1 5.3 3.8 3.640 20.2 17.1 14.3 11.7 9.8 7.5 5.2 4.7 4.0 2.6 2.350 17.5 14.9 12.4 10.0 8.0 6.0 4.1 3.9 2.9 1.9 1.760 15.5 12.7 10.3 7.9 6.7 5.0 3.3 3.1 2.3 1.0 0.870 13.3 10.5 8.3 6.2 4.9 3.4 2.1 2.0 1.3 0.6 0.380 11.2 8.8 7.4 5.1 4.0 2.6 1.2 1.2 0.8 -0.1 0.290 9.6 7.9 6.2 3.9 2.7 1.8 0.6 0.6 0.2 -0.2 -0.1
100 8.5 7.0 5.3 3.2 2.2 0.8 0.3 0.2 0.3 -0.2 0.0
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Conclusion
In this preliminary simulation environment, adding VA estimates to incomplete VR scenarios improved CSMF accuracy much of the time.
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Future directions
โข Update simulation environment to better reflect specific VR coverage scenarios
โข Re-analyze the VAs assigned to โout of facility,โ dropping questions determined to be related to โhealth care experienceโ