Verbal Autopsy Paper Series in BMC Medicine

Verbal autopsy is the best way forward for tackling gaps in global mortality data

A series of papers published in BMC Medicine has analyzed the performance of verbal autopsy (VA) cause of death (COD) assignment methods, including the largest comparison to date of physician- and automated-coding.

Several computer-coded (CCVA) methods were compared to physician coding (PCVA) on five datasets from various countries, comprising over 24,000 deaths. Automated methods matched physician coding only about half the time on individual COD-assignment, though performed better at reproducing physician-derived cause-specific mortality fractions (CSMFs) at the population level.

The performance of the Million Death Study, which is based on physician coding, was also assessed in relation to simple and appropriate metrics. Results indicated that population-level assignment by physicians, which was consistent between resamples and which followed plausible age and sex patterns, was reliable. This study also helped define performance criteria that can be applied to other VA-based national surveys.

Given the discrepancy between PCVA and CCVA methods, the authors argue there is little basis to replace current physician coding. More importantly, the series emphasizes that, overall, verbal autopsy is a reliable and valid method for generating population-level COD data. Countries which lack robust COD data must therefore focus on implementing large, national surveys of mortality.

Access the full papers and additional materials here:

Full BMC series on verbal autopsy methods.

BMC Med blog entry from Prof Prabhat Jha and Lukasz Aleksandrowicz: More countries need to count their dead.

Individual papers:

  1. Reliable direct measurement of causes of death in low- and middle-income countries
    Jha P
    BMC Medicine 2014, 12:19

  2. Performance of four computer-coded verbal autopsy methods for cause of death assignment compared with physician coding on 24,000 deaths in low- and middle-income countries
    Desai N, Aleksandrowicz L, Miasnikof P, Lu Y, Leitao J, Byass P, Tollman S, Mee P, Alam D, Rathi S, Singh A, Kumar R, Ram F, Jha P
    BMC Medicine 2014, 12:20

  3. Performance criteria for verbal autopsy-based systems to estimate national causes of death: development and application to the Indian Million Death Study
    Aleksandrowicz L, Malhotra V, Dikshit R, Gupta P, Kumar R, Sheth J, Rathi S, Suraweera W, Miasnikof P, Jotkar R, Sinha D, Awasthi S, Bhatia P, Jha P
    BMC Medicine 2014, 12:21

  4. Comparison of physician-certified verbal autopsy with computer-coded verbal autopsy for cause of death assignment in hospitalized patients in low- and middle-income countries: systematic review
    Leitao J, Desai N, Aleksandrowicz L, Miasnikof P, Tollman S, Alam D, Lu Y, Rathi S, Singh A, Suraweera W, Ram F, Jha P
    BMC Medicine 2014, 12:22

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