title: Validation of verbal autopsy procedures for adult deaths in China.
abstract: BACKGROUND
  Vital registration of causes of death in China is incomplete with poor coverage of medical certification. Information on the leading causes of mortality will continue to rely on verbal autopsy (VA) methods. A new international VA form is being considered for data collection in China, but it first needs to be validated to determine its operating characteristics.
  
  
  METHODS
  Detailed medical records and clinical evidence for 3290 deaths (mostly adults) among residents of six cities representative of the urban Chinese population were reviewed by a panel of physicians and coded by experts to establish a reference underlying cause of death. Independently, families of the deceased were interviewed using a structured symptomatic questionnaire and a separate death certificate was prepared for each matching case (2102). Validity of the VA procedure was assessed using standard measurement criteria of sensitivity, specificity, and positive predictive value.
  
  
  RESULTS
  VA methods perform reasonably well in identifying deaths from several leading causes of adult deaths including stroke, several major cancer sites (lung, liver, stomach, oesophagus, and colorectal), and transport accidents. Sensitivity was less satisfactory in detecting deaths from several causes of major public health concern in China including ischaemic heart disease, chronic obstructive pulmonary disease, diabetes, and tuberculosis, and was particularly poor in diagnosing deaths from viral hepatitis, hypertension, and kidney diseases.
  
  
  CONCLUSIONS
  VA is an imprecise tool for detecting leading causes of death among adults. However, much of the misclassification generally occurs within broad cause groups (e.g. CVD, respiratory diseases, and liver diseases). Moreover, compensating patterns of misclassification would appear to suggest that, in urban China at least, the method yields population-level cause-specific estimates that are reasonably reliable. These results suggest the possible utility of these methods in rural China, to back up the low coverage of medical certification of cause of death owing to poor access to health facilities there.
authors.affiliation: Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, 5, Dong Dan San Tiao, 100005 Beijing, China.
authors.forename: Gonghuan
authors.initials: G
authors.lastname: Yang
authors.forename: Chalapati
authors.initials: C
authors.lastname: Rao
authors.forename: Jiemin
authors.initials: J
authors.lastname: Ma
authors.forename: Lijun
authors.initials: L
authors.lastname: Wang
authors.forename: Xia
authors.initials: X
authors.lastname: Wan
authors.forename: Guillermo
authors.initials: G
authors.lastname: Dubrovsky
authors.forename: Alan D
authors.initials: AD
authors.lastname: Lopez
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D001344:Autopsy / Q000379:methods*; D002423:Cause of Death; D002681:China / Q000453:epidemiology; D005195:Family Relations; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D014504:Urban Health; D014798:Vital Statistics