title: Verbal autopsy: reliability and validity estimates for causes of death in the Golestan Cohort Study in Iran.
abstract: BACKGROUND
  Verbal autopsy (VA) is one method to obtain valid estimates of causes of death in the absence of valid medical records. We tested the reliability and validity of a VA questionnaire developed for a cohort study in Golestan Province in northeastern Iran.
  
  
  METHODS
  A modified version of the WHO adult verbal autopsy was used to assess the cause of death in the first 219 Golestan Cohort Study (GCS) subjects who died. The GCS cause of death was determined by two internists who independently reviewed all available medical records. Two other internists ("reviewers") independently reviewed only the VA answers and classified the cause of death into one of nine general categories; they repeated this evaluation one month later. The reliability of the VA was measured by calculating intra-reviewer and inter-reviewer kappa statistics. The validity of the VA was measured using the GCS cause of death as the gold standard.
  
  
  RESULTS
  VA showed both good validity (sensitivity, specificity, PPV, and NPV all above 0.81) and reliability (kappa>0.75) in determining the general cause of death independent of sex and place of residence. The overall multi-rater agreement across four reviews was 0.84 (95%CI: 0.78-0.89). The results for identifying specific cancer deaths were also promising, especially for upper GI cancers (kappa = 0.95). The multi-rater agreement in cancer subgroup was 0.93 (95%CI: 0.85-0.99).
  
  
  CONCLUSIONS
  VA seems to have good reliability and validity for determining the cause of death in a large-scale adult follow up study in a predominantly rural area of a middle-income country.
authors.affiliation: Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences Tehran, Iran.
authors.forename: Hooman
authors.initials: H
authors.lastname: Khademi
authors.forename: Arash
authors.initials: A
authors.lastname: Etemadi
authors.forename: Farin
authors.initials: F
authors.lastname: Kamangar
authors.forename: Mehdi
authors.initials: M
authors.lastname: Nouraie
authors.forename: Ramin
authors.initials: R
authors.lastname: Shakeri
authors.forename: Behrooz
authors.initials: B
authors.lastname: Abaie
authors.forename: Akram
authors.initials: A
authors.lastname: Pourshams
authors.forename: Mohammad
authors.initials: M
authors.lastname: Bagheri
authors.forename: Afshin
authors.initials: A
authors.lastname: Hooshyar
authors.forename: Farhad
authors.initials: F
authors.lastname: Islami
authors.forename: Christian C
authors.initials: CC
authors.lastname: Abnet
authors.forename: Paul
authors.initials: P
authors.lastname: Pharoah
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Sanford M
authors.initials: SM
authors.lastname: Dawsey
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
mesh_terms: D000368:Aged; D001344:Autopsy / Q000379:methods*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires