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Verbal autopsy of 48 000 adult deaths attributable to medical causes in Chennai (formerly Madras), India.

Gajalakshmi V, Peto R, Kanaka S, Balasubramanian S - BMC Public Health (2002)

Bottom Line: The VA reduced the proportion of deaths attributed to unspecified medical causes and unknown causes from 37% to 7% in early adult life and middle age (25-69 yrs) and has yielded fewer unspecified causes (only 10%) than the death certificate.VA is practicable for deaths in early adult life or middle age and is of more limited value in old age.A systematic program of VA of a representative sample of deaths could assign broad causes not only to deaths in childhood (as has previously been established) but also to deaths in early adult life and middle age.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Epidemiology, Cancer Institute (WIA), Chennai, India. gaja_1@hotmail.com

ABSTRACT

Background: In the city of Chennai, India, registration of the fact of death is almost complete but the cause of death is often inadequately recorded on the death certificate. A special verbal autopsy (VA) study of 48 000 adult deaths in Chennai during 1995-97 was conducted to arrive at the probable underlying cause of death and to measure cause specific mortality rates for Chennai.

Methods: Trained non-medical graduates with at least 15 years of formal education interviewed the surviving family members or an associate of the deceased to write a report on the complaints, symptoms, signs, duration and treatment details of illness prior to death. Each report was reviewed centrally by two physicians independently. The reliability was assessed by comparing deaths attributed to cancer by VA with records in Vital Statistics Department and Chennai Cancer Registry.

Results: The VA reduced the proportion of deaths attributed to unspecified medical causes and unknown causes from 37% to 7% in early adult life and middle age (25-69 yrs) and has yielded fewer unspecified causes (only 10%) than the death certificate. The sensitivity of VA to identify cancer was 94% in the age group 25-69.

Conclusion: VA is practicable for deaths in early adult life or middle age and is of more limited value in old age. A systematic program of VA of a representative sample of deaths could assign broad causes not only to deaths in childhood (as has previously been established) but also to deaths in early adult life and middle age.

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Mentions: The total number of deaths attributed by the VSD to medical causes among adults aged 25 and over during 1995–97 in Chennai was 66 877 (M: 38 649, F: 28 228) of which 75% (50 387) of them were recorded as having taken place at home. Of the total deaths attributed to medical causes by VSD, 18 520 could not be traced, because the address in the vital statistics department was missing or inadequate, the house no longer existed or the occupants had moved house after death. (The training programs for the Birth and Death clerks in the Chennai Vital Statistics Department have subsequently focused on the importance of collecting the complete address with pincode, which would help in tracing the house for any population study in Chennai). For the remaining 48 357 deaths, the spouse (or close associate) was interviewed to determine the probable underlying cause (Flow chart 1, Figure 1). Table 1 shows that the causes of death assigned by the VSD were similar for those traced and those not traced for verbal autopsy. Table 2 shows that the VA reduced the percentage of deaths attributed to unspecified medical causes in each age group. VA is practicable in early adult life and middle age and is of more limited value in old age (≥ 70 yrs).


Verbal autopsy of 48 000 adult deaths attributable to medical causes in Chennai (formerly Madras), India.

Gajalakshmi V, Peto R, Kanaka S, Balasubramanian S - BMC Public Health (2002)

Figure
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC113750&req=5

Figure 1: Figure
Mentions: The total number of deaths attributed by the VSD to medical causes among adults aged 25 and over during 1995–97 in Chennai was 66 877 (M: 38 649, F: 28 228) of which 75% (50 387) of them were recorded as having taken place at home. Of the total deaths attributed to medical causes by VSD, 18 520 could not be traced, because the address in the vital statistics department was missing or inadequate, the house no longer existed or the occupants had moved house after death. (The training programs for the Birth and Death clerks in the Chennai Vital Statistics Department have subsequently focused on the importance of collecting the complete address with pincode, which would help in tracing the house for any population study in Chennai). For the remaining 48 357 deaths, the spouse (or close associate) was interviewed to determine the probable underlying cause (Flow chart 1, Figure 1). Table 1 shows that the causes of death assigned by the VSD were similar for those traced and those not traced for verbal autopsy. Table 2 shows that the VA reduced the percentage of deaths attributed to unspecified medical causes in each age group. VA is practicable in early adult life and middle age and is of more limited value in old age (≥ 70 yrs).

Bottom Line: The VA reduced the proportion of deaths attributed to unspecified medical causes and unknown causes from 37% to 7% in early adult life and middle age (25-69 yrs) and has yielded fewer unspecified causes (only 10%) than the death certificate.VA is practicable for deaths in early adult life or middle age and is of more limited value in old age.A systematic program of VA of a representative sample of deaths could assign broad causes not only to deaths in childhood (as has previously been established) but also to deaths in early adult life and middle age.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Epidemiology, Cancer Institute (WIA), Chennai, India. gaja_1@hotmail.com

ABSTRACT

Background: In the city of Chennai, India, registration of the fact of death is almost complete but the cause of death is often inadequately recorded on the death certificate. A special verbal autopsy (VA) study of 48 000 adult deaths in Chennai during 1995-97 was conducted to arrive at the probable underlying cause of death and to measure cause specific mortality rates for Chennai.

Methods: Trained non-medical graduates with at least 15 years of formal education interviewed the surviving family members or an associate of the deceased to write a report on the complaints, symptoms, signs, duration and treatment details of illness prior to death. Each report was reviewed centrally by two physicians independently. The reliability was assessed by comparing deaths attributed to cancer by VA with records in Vital Statistics Department and Chennai Cancer Registry.

Results: The VA reduced the proportion of deaths attributed to unspecified medical causes and unknown causes from 37% to 7% in early adult life and middle age (25-69 yrs) and has yielded fewer unspecified causes (only 10%) than the death certificate. The sensitivity of VA to identify cancer was 94% in the age group 25-69.

Conclusion: VA is practicable for deaths in early adult life or middle age and is of more limited value in old age. A systematic program of VA of a representative sample of deaths could assign broad causes not only to deaths in childhood (as has previously been established) but also to deaths in early adult life and middle age.

Show MeSH
Related in: MedlinePlus