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International Journal of Epidemiology, Vol 26, 1090-1096, Copyright © 1997 by International Epidemiological Association
M Anker
BACKGROUND: Verbal autopsy (VA) studies are important for measuring
cause-specific mortality in areas where medical certification of cause of
death is uncommon. This paper explores the effects of misclassification
errors on the results of verbal autopsy studies, and recommends ways to
take misclassification errors into account in the interpretation of
results. METHODS: Mathematical formulae are derived for determining the
size and direction of the error in cause-specific mortality estimates based
on VA studies caused by misclassification. The levels of sensitivity and
specificity found in currently available validation studies for childhood
VA are examined. RESULTS: There can be substantial errors in the estimates
of the cause-specific mortality fraction derived from VA studies. The
cause-specific mortality fraction itself has an important influence on the
size of the error for given levels of sensitivity and specificity, and when
the cause-specific mortality fraction is small, the size of the error
depends more on specificity than on sensitivity. CONCLUSION: Despite its
drawbacks VA seems to be the most promising way of establishing cause of
death when most deaths take place at home without medical attention.
However, more validation studies on standardized instruments are required
in order to collect information about sensitivity and specificity and
subsequently improve the design of the instrument. At the same time,
analysts need to take misclassification errors into consideration in ways
outlined in this paper.
ARTICLES
The effect of misclassification error on reported cause-specific mortality fractions from verbal autopsy
Division of Emerging and other Communicable Diseases Surveillance and Control (EMC), World Health Organization, Geneva, Switzerland.
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