title: A composite metric for assessing data on mortality and causes of death: the vital statistics performance index.
abstract: BACKGROUND
  Timely and reliable data on causes of death are fundamental for informed decision-making in the health sector as well as public health research. An in-depth understanding of the quality of data from vital statistics (VS) is therefore indispensable for health policymakers and researchers. We propose a summary index to objectively measure the performance of VS systems in generating reliable mortality data and apply it to the comprehensive cause of death database assembled for the Global Burden of Disease (GBD) 2013 Study.
  
  
  METHODS
  We created a Vital Statistics Performance Index, a composite of six dimensions of VS strength, each assessed by a separate empirical indicator. The six dimensions include: quality of cause of death reporting, quality of age and sex reporting, internal consistency, completeness of death reporting, level of cause-specific detail, and data availability/timeliness. A simulation procedure was developed to combine indicators into a single index. This index was computed for all country-years of VS in the GBD 2013 cause of death database, yielding annual estimates of overall VS system performance for 148 countries or territories.
  
  
  RESULTS
  The six dimensions impacted the accuracy of data to varying extents. VS performance declines more steeply with declining simulated completeness than for any other indicator. The amount of detail in the cause list reported has a concave relationship with overall data accuracy, but is an important driver of observed VS performance. Indicators of cause of death data quality and age/sex reporting have more linear relationships with simulated VS performance, but poor cause of death reporting influences observed VS performance more strongly. VS performance is steadily improving at an average rate of 2.10% per year among the 148 countries that have available data, but only 19.0% of global deaths post-2000 occurred in countries with well-performing VS systems.
  
  
  CONCLUSIONS
  Objective and comparable information about the performance of VS systems and the utility of the data that they report will help to focus efforts to strengthen VS systems. Countries and the global health community alike need better intelligence about the accuracy of VS that are widely and often uncritically used in population health research and monitoring.
authors: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA.
authors: David E
authors: DE
authors: Phillips
authors: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA ; National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Cerrada Los Pinos y Caminera, Cuernavaca, MOR 62100, México.
authors: Rafael
authors: R
authors: Lozano
authors: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA.
authors: Mohsen
authors: M
authors: Naghavi
authors: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA.
authors: Charles
authors: C
authors: Atkinson
authors: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA.
authors: Diego
authors: D
authors: Gonzalez-Medina
authors: LM Consulting, Independent Consultant, 4/78 Cairns St., Brisbane, QLD 4169, Australia.
authors: Lene
authors: L
authors: Mikkelsen
authors: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave. Suite 600, Seattle, WA 98121, USA.
authors: Christopher Jl
authors: CJ
authors: Murray
authors: School of Population and Global Health, University of Melbourne, 207 Bouverie St., Level 5, Melbourne, VIC 3010, Australia.
authors: Alan D
authors: AD
authors: Lopez
keywords: Causes of death; Civil registration; Data quality; Health information systems; Mortality; Vital registration; Vital statistics