Cause-specific mortality estimates for Malaysia in 2013: results from a national sample verification study using medical record review and verbal autopsy

Abstract

Background: Mortality indicators are essential for monitoring population health. Although Malaysia has a functional death registration system, the quality of information on causes of death still needs improvement, since approximately 30% of deaths are classified to poorly defined causes. This study was conducted to verify registered causes in a sample of deaths in 2013 and utilise the findings to estimate cause-specific mortality indicators for Malaysia in 2013. Methods: This is a cross-sectional study involving a nationally representative sample of 14,497 deaths distributed across 19 districts. Registered causes of deaths were verified using standard medical record review protocols for hospital deaths, and locally adapted international standard verbal autopsy procedures for deaths outside hospitals. The findings were used to measure the validity and reliability of the registration data, as well as to establish plausible cause-specific mortality fractions for hospital and non-hospital deaths, which were subsequently used as the basis for estimating national cause-specific mortality indicators. Results: The overall response rate for the study was 67%. Verified causes of 5041 hospital deaths and 3724 deaths outside hospitals were used to derive national mortality estimates for 2013 by age, sex and cause. The study was able to reclassify most of the ill-defined deaths to a specific cause. The leading causes of deaths for males were Ischaemic Heart Disease (15.4%), Cerebrovascular diseases (13.7%), Chronic Obstructive Pulmonary Disease (8.5%) and Road Traffic Accident (8.0%). Among females, the leading causes were Cerebrovascular diseases (18.3%), Ischaemic Heart Disease (12.7%), Lower Respiratory Infections (11.5%) and Diabetes Mellitus (7.2%). Conclusions: Investigation of registered causes of death using verbal autopsy and medical record review yielded adequate information to enable estimation of cause-specific mortality indicators in Malaysia. Strengthening the national mortality statistics system must be made a priority as it is a core data source for policy and evaluation of the public health and healthcare sectors in Malaysia.

Empiricism in non-communicable disease mortality measurement for the Asia-Pacific: lost in translation

“…For example, a recent analysis for Malaysia showed statistically significant differences between age-standardised cause-specific mortality rates for 7 out of 10 leading causes in males and females, when comparing estimates from a nationally representative epidemiological study with IHME estimates for Malaysia. 39 Similar differences have also been observed for European countries with high quality mortality data, and have been the subject of debate in the international public health community. [40][41][42] At another level too, since the IHME COD estimates are derived through indirect standardisation, the results are not directly comparable across different countries, particularly when there are differences in population age structure.…”

Elements of a strategic approach for strengthening national mortality statistics programmes

“…The quality of causes of death could be assessed for the proportions assigned codes for ill-defined causes and for plausibility of age-sex patterns by cause. Validity and reliability of causes of death could be directly evaluated through epidemiological studies that compare registered causes of death against information from clinical records, or from household VA interviews 46 52 53…”

“…Findings from these vital statistics data quality assessments can help locate gaps and weaknesses in data capture, data management and information flow which need to be resolved to improve data quality 39 40. The empirically derived estimates of completeness and patterns of misclassification of causes of death in registration data can be used for statistical adjustments and analyses to derive corrected mortality indicators 35 53 54. In principle, such local empirically derived mortality indicators have greater practical and political relevance for policy analysis and programme evaluation in national contexts, as compared with indicators reported from global estimation exercises.…”

“…Countries with ‘partial’ data could first undertake a thorough data quality evaluation followed by an operations research study to estimate registration completeness as well as accuracy of causes of death 51 63 64. The study outcomes could be used to derive mortality indicator estimates, as achieved in Thailand and Malaysia 53 54. Observations from operations research on CRVS weaknesses can guide interventions to strengthen data capture and compilation.…”

Strengthening Mortality Statistics for Health Programs in Malaysia: Lessons from the Field

“…For deaths in the sample that had occurred in hospitals, available medical records were reviewed to validate registered causes. The study findings were utilized to adjust the data gaps in the registration data and derive the first-ever empirical national cause-specific mortality estimates for Malaysia [11].…”