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Johnson SC, Cunningham M, Dippenaar IN, Sharara F, Wool EE, Agesa KM, Han C, Miller-Petrie MK, Wilson S, Fuller JE, Balassyano S, Bertolacci GJ, Davis Weaver N, Lopez AD, Murray CJL, Naghavi M. Public health utility of cause of death data: applying empirical algorithms to improve data quality. BMC Med Inform Decis Mak 2021; 21:175. [PMID: 34078366 PMCID: PMC8170729 DOI: 10.1186/s12911-021-01501-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Accurate, comprehensive, cause-specific mortality estimates are crucial for informing public health decision making worldwide. Incorrectly or vaguely assigned deaths, defined as garbage-coded deaths, mask the true cause distribution. The Global Burden of Disease (GBD) study has developed methods to create comparable, timely, cause-specific mortality estimates; an impactful data processing method is the reallocation of garbage-coded deaths to a plausible underlying cause of death. We identify the pattern of garbage-coded deaths in the world and present the methods used to determine their redistribution to generate more plausible cause of death assignments. METHODS We describe the methods developed for the GBD 2019 study and subsequent iterations to redistribute garbage-coded deaths in vital registration data to plausible underlying causes. These methods include analysis of multiple cause data, negative correlation, impairment, and proportional redistribution. We classify garbage codes into classes according to the level of specificity of the reported cause of death (CoD) and capture trends in the global pattern of proportion of garbage-coded deaths, disaggregated by these classes, and the relationship between this proportion and the Socio-Demographic Index. We examine the relative importance of the top four garbage codes by age and sex and demonstrate the impact of redistribution on the annual GBD CoD rankings. RESULTS The proportion of least-specific (class 1 and 2) garbage-coded deaths ranged from 3.7% of all vital registration deaths to 67.3% in 2015, and the age-standardized proportion had an overall negative association with the Socio-Demographic Index. When broken down by age and sex, the category for unspecified lower respiratory infections was responsible for nearly 30% of garbage-coded deaths in those under 1 year of age for both sexes, representing the largest proportion of garbage codes for that age group. We show how the cause distribution by number of deaths changes before and after redistribution for four countries: Brazil, the United States, Japan, and France, highlighting the necessity of accounting for garbage-coded deaths in the GBD. CONCLUSIONS We provide a detailed description of redistribution methods developed for CoD data in the GBD; these methods represent an overall improvement in empiricism compared to past reliance on a priori knowledge.
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Affiliation(s)
| | - Matthew Cunningham
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Ilse N Dippenaar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Fablina Sharara
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Eve E Wool
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Kareha M Agesa
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Chieh Han
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Molly K Miller-Petrie
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Shadrach Wilson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - John E Fuller
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Shelly Balassyano
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Gregory J Bertolacci
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alan D Lopez
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
- Department of Health Metrics Sciences, Director of Subnational Burden of Disease Estimation, Institute for Health Metrics and Evaluation School of Medicine, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA, 98121, USA.
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Naghavi M, Richards N, Chowdhury H, Eynstone-Hinkins J, Franca E, Hegnauer M, Khosravi A, Moran L, Mikkelsen L, Lopez AD. Improving the quality of cause of death data for public health policy: are all 'garbage' codes equally problematic? BMC Med 2020; 18:55. [PMID: 32146899 PMCID: PMC7061466 DOI: 10.1186/s12916-020-01525-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/11/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Mohsen Naghavi
- Institute of Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Seattle, WA, 98121, USA
| | - Nicola Richards
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Hafiz Chowdhury
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
| | | | - Elisabeth Franca
- University of Minas Gerais, Belo Horizonte, Minas Gerias, 31270-901, Brazil
| | - Michael Hegnauer
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Ardeshir Khosravi
- Ministry of Health and Medical Education, District 2, Eyvanak Blvd, Tehran, Iran
| | - Lauren Moran
- Australian Bureau of Statistics, 295 Ann Street, Brisbane, QLD, 4000, Australia
| | - Lene Mikkelsen
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
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Abstract
The Sustainable Development Goal (SDG) agenda offers a major impetus to consolidate and accelerate development in civil registration and vital statistics (CRVS) systems. Strengthening CRVS systems is an SDG outcome in itself. Moreover, CRVS systems are the best - if not essential - source of data to monitor and guide health policy debates and to assess progress towards numerous SDG targets and indicators. They also provide the necessary documentation and proof of identity for service access and are critical for disaster preparedness and response. While there has been impressive global momentum to improve CRVS systems over the past decade, several challenges remain. This article collection provides an overview of recent innovations, progress, viewpoints and key areas in which action is still required - notably around the need for better systems and procedures to notify the fact of death and to reliably diagnose its cause, both for deaths in hospital and elsewhere.
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Affiliation(s)
- Alan D Lopez
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia.
| | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia
| | - Nicola Richards
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia
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Mikkelsen L, Iburg KM, Adair T, Fürst T, Hegnauer M, von der Lippe E, Moran L, Nomura S, Sakamoto H, Shibuya K, Wengler A, Willbond S, Wood P, Lopez AD. Assessing the quality of cause of death data in six high-income countries: Australia, Canada, Denmark, Germany, Japan and Switzerland. Int J Public Health 2020; 65:17-28. [PMID: 31932856 DOI: 10.1007/s00038-019-01325-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess the policy utility of national cause of death (COD) data of six high-income countries with highly developed health information systems. METHODS National COD data sets from Australia, Canada, Denmark, Germany, Japan and Switzerland for 2015 or 2016 were assessed by applying the ANACONDA software tool. Levels, patterns and distributions of unusable and insufficiently specified "garbage" codes were analysed. RESULTS The average proportion of unusable COD was 18% across the six countries, ranging from 14% in Australia and Canada to 25% in Japan. Insufficiently specified codes accounted for a further 8% of deaths, on average, varying from 6% in Switzerland to 11% in Japan. The most commonly used garbage codes were Other ill-defined and unspecified deaths (R99), Heart failure (I50.9) and Senility (R54). CONCLUSIONS COD certification errors are common, even in countries with very advanced health information systems, greatly reducing the policy value of mortality data. All countries should routinely provide certification training for hospital interns and raise awareness among doctors of their public health responsibility to certify deaths correctly and usefully for public health policy.
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Affiliation(s)
- Lene Mikkelsen
- Bloomberg Data for Health Initiative, University of Melbourne, Melbourne, Australia
| | | | - Tim Adair
- Bloomberg Data for Health Initiative, University of Melbourne, Melbourne, Australia
| | - Thomas Fürst
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lauren Moran
- Australian Bureau of Statistics, Canberra, Australia
| | - Shuhei Nomura
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruka Sakamoto
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenji Shibuya
- University Institute of Population Health, King's College London, London, UK
| | - Annelene Wengler
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | | | - Alan D Lopez
- Bloomberg Data for Health Initiative, University of Melbourne, Melbourne, Australia.
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Foreman KJ, Naghavi M, Ezzati M. Improving the usefulness of US mortality data: new methods for reclassification of underlying cause of death. Popul Health Metr 2016; 14:14. [PMID: 27127419 PMCID: PMC4848792 DOI: 10.1186/s12963-016-0082-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 03/29/2016] [Indexed: 02/08/2023] Open
Abstract
Background Mortality data are affected by miscertification of the medical cause of death deaths and changes to cause of death classification systems. We present both mappings of ICD9 and ICD10 to a unified list of causes, and a new statistical model for reducing the impact of misclassification of cause of death. Methods We propose a Bayesian mixed-effects multinomial logistic model that can be run on individual record level death certificates to reclassify “garbage-coded” deaths onto causes that are more meaningful for public health purposes. The model uses information on the contributing causes of death and demographic characteristics of each decedent to make informed predictions of the underlying cause of death. We apply our method to death certificate data in the US from 1979 to 2011, creating more directly comparable series of cause-specific mortality for 25 major causes of death. Results We find that many death certificates coded to garbage codes contain other information that provides strong clues about the valid underlying cause of death. In particular, a plausible underlying cause often appears in the contributing causes of death, implying that it may be incorrect ordering of the causal chain and not missed cause assignment that leads to many garbage-coded deaths. We present an example that redistributes 48 % of heart failure deaths to other cardiovascular diseases, 25 % to ischemic heart disease, and 15 % to chronic respiratory diseases. Conclusions Our methods take advantage of more detailed micro-level data than is typically considered in garbage code redistribution algorithms, making it a useful tool in circumstances in which detailed death certificate data needs to be aggregated for public health purposes. We find that this method gives different redistribution results than commonly used methods that only consider population-level proportions. Electronic supplementary material The online version of this article (doi:10.1186/s12963-016-0082-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kyle J Foreman
- Department of Epidemiology and Biostatistics, Imperial College London, 10 Elephant Lane, SE16-4JD London, UK
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, Imperial College London, 10 Elephant Lane, SE16-4JD London, UK
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