Causes of death in Tonga: quality of certification and implications for statistics

Carter, Karen; Hufanga, Sione; Rao, Chalapati; ‘Akau’ola, S; Lopez, Alan D; Rampatige, Rasika; Taylor, Richard

doi:10.1186/1478-7954-10-4

Cited by 20 publications

(22 citation statements)

References 9 publications

(13 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unfortunately, even in countries where hospital data are the only source of cause-of-death information, data quality is rarely evaluated. Research in different countries has repeatedly identified substantial misclassification of the cause of death of people who die in hospitals – with attendant implications for the use of cause-of-death data in informing policy 14 – 20 …”

Section: Introductionmentioning

confidence: 99%

Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers

Rampatige

Mikkelsen²,

Hernández

et al. 2014

Bull. World Health Organ.

Self Cite

View full text Add to dashboard Cite

ObjectiveTo systematically review the reliability of hospital data on cause of death and encourage periodic reviews of these data using a standard method.MethodsWe searched Google Scholar, Pubmed and Biblioteca Virtual de la Salud for articles in English, Spanish and Portuguese that reported validation studies of data on cause of death. We analysed the results of 199 studies that had used medical record reviews to validate the cause of death reported on death certificates or by the vital registration system.FindingsThe screened studies had been published between 1983 and 2013 and their results had been reported in English (n = 124), Portuguese (n = 25) or Spanish (n = 50). Only 29 of the studies met our inclusion criteria. Of these, 13 had examined cause of death patterns at the population level – with a view to correcting cause-specific mortality fractions – while the other 16 had been undertaken to identify discrepancies in the diagnosis for specific diseases before and after medical record review. Most of the selected studies reported substantial misdiagnosis of causes of death in hospitals. There was wide variation in study methodologies. Many studies did not describe the methods used in sufficient detail to be able to assess the reproducibility or comparability of their results.ConclusionThe assumption that causes of death are being accurately reported in hospitals is unfounded. To improve the reliability and usefulness of reported causes of death, national governments should do periodic medical record reviews to validate the quality of their hospital cause of death data, using a standard.

show abstract

Section: Introductionmentioning

confidence: 99%

Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers

Rampatige

Mikkelsen²,

Hernández

et al. 2014

Bull. World Health Organ.

Self Cite

View full text Add to dashboard Cite

show abstract

“…While the high proportion of NCDs in adults from the health facility data may in part be attributed to reporting of non-specific causes such as "heart problem" and "heart-stopped", that this pattern is reflected in the hospital separation and medical certificate data adds to the evidence that mortality burden from NCDs is significant. The high proportion of deaths attributed to NCDs such as cardiovascular disease and diabetes in adults aged 15-59 is consistent with patterns seen in other PICTs (such as Fiji, Nauru and Tonga (93,112,347)), where NCDs have contributed to high premature adult mortality and subsequently limited improvements in LE.…”

Section: As Vanuatu Continues To Improve Data Collection and Further supporting

confidence: 79%

“…al. (2) were derived from demographic analysis of the most recent census; both of which were based on model life tables derived from a single 335 parameter input (child survival) in the absence of any better data sources; and as such are most likely to be based on an under-estimation of adult mortality (93,112,347).…”

Section: Summary Measures Of Mortalitymentioning

confidence: 99%

Mortality and cause of death in the Pacific

Carter¹

Self Cite

View full text Add to dashboard Cite

Accurate data on mortality levels and causes of death is critical to assist governments to improve the health of their populations; by identifying priority areas for intervention, leveraging resources for such interventions, and to monitor the impact and effectiveness of health programs. To date, there has been little data available to agencies on mortality and causes of death in the Pacific Islands, and there is significant disparity in published estimates, with many considered implausible. Further, there are indications that improvements in life expectancy (LE) across the region have stagnated in contrast to previously published estimates, most likely as a consequence of premature adult mortality from non-communicable diseases (NCDs).In this research, routine vital registration collections from Pacific Island countries are examined to determine whether these data can improve our understanding of mortality and causes of death in the region. The work presents a review of available data, examines the potential flaws and biases in the data collections, and examines the methods best suited to working with the identified collections to generate valid, reliable estimates of mortality level and cause of death, disaggregated by age group and sex. Due to the scale and diversity of the Pacific Islands, six countries representing a broad range of population size, level of development, and all three sub-regions were selected for review. These were: Nauru, Fiji, Kiribati, Palau, Tonga and Vanuatu.Reporting systems were evaluated to identify potential impacts on the quality and completeness of available data using an assessment framework that considers the ii societal, administrative and system (administrative, technical and ownership) influences on the reporting system. Substantially more data was found to be available than has been previously analysed or published. Medical certificates of death are completed for some deaths in all of the study countries, and are required for all deaths in Nauru, Fiji, Tonga and Palau.Analytical strategies for deriving estimates of mortality level by age and sex were selected from available approaches based on the system assessments, data available and level of migration. Methods employed included direct calculation of mortality level and evaluation of trends over time (Nauru and Palau), evaluation of published data to establish plausible trends (Fiji and Tonga), direct demographic methods to assess completeness -the Brass Growth Balance analysis (Fiji), and capture-recapture analyses (Tonga and Kiribati). Only Vanuatu had insufficient data from routine collection systems to reliably generate mortality estimates. Findings from the use of model life tables in comparison to mortality estimates from empirical data in the other study countries were therefore reviewed to evaluate the plausibility of published estimates of mortality level from Vanuatu.Estimates of cause-specific mortality were calculated directly from the medical certificate data for Palau where the system review in...

show abstract

“…Diagnostic uncertainty is commonly encountered by health care providers in sub-Saharan Africa given the limited access to resources needed to evaluate patients. Research from several countries (South Africa [21], Mexico [22], China [23] and Tonga [24]) has identified substantial misclassification of in-hospital causes of death. While it is wellknown that lacking a diagnosis leads to delay in appropriate care and subsequently increases the risk of death [25,26], we are not familiar with other studies conducted within sub-Saharan Africa which report both the rate of unknown diagnoses during hospitalization and its influence on mortality.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward

Diaz

Hu²,

Fenton

et al. 2020

BMC Neurol

View full text Add to dashboard Cite

Background: While the burden of neurologic illness in developing countries is increasing, less is known about mortality among patients admitted to sub-Saharan African hospitals with neurologic disease. We sought to characterize the rate and patient-level predictors of in-hospital mortality in a Ugandan Neurology ward.cc. Methods: Data was prospectively collected on 335 patients admitted to the Neurology ward of Mulago Hospital, Kampala, Uganda. Kaplan-Meier survival curves and multivariate COX proportional hazard modeling were used to assess survival. Results: Within our sample (n = 307), 35.8% received no diagnosis at time of hospital admission. Stroke (27.3%), head trauma (19.6%), and malaria (16.0%) were the most common diagnoses. Among the 56 (18.5%) patients who died during the index hospitalization, the most common diagnosis at admission and at death was stroke. Adjusted regression analysis showed that patients without a diagnosis at time of death (HR = 7.01 [2.42-20.35], p < .001) and those with diagnoses of infections (HR = 5.21 [2.16-12.58], p = <.001), stroke (HR = 2.69 [1.20-6.04], p = .017), or head trauma (HR = 3.39, [1.27-9.07], p = 0.15) had worse survival. Conclusions: In-hospital mortality affected nearly 20% of the cohort, with worse survival among those without a diagnosis and with infections, stroke, head trauma. Future work should identify reasons for increased mortality among these high-risk groups and implement targeted interventions.

show abstract

Causes of death in Tonga: quality of certification and implications for statistics

Cited by 20 publications

References 9 publications

Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers

Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers

Mortality and cause of death in the Pacific

Prevalence of and characteristics associated with in-hospital mortality in a Ugandan neurology ward

Contact Info

Product

Resources

About