Whiting David R, Setel Philip W, Chandramohan Daniel, Wolfson Lara J, Hemed Yusuf, Lopez Alan D
MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, NC, USA.
Bull World Health Organ. 2006 Dec;84(12):940-8. doi: 10.2471/blt.05.028910.
To compare mortality burden estimates based on direct measurement of levels and causes in communities with indirect estimates based on combining health facility cause-specific mortality structures with community measurement of mortality levels.
Data from sentinel vital registration (SVR) with verbal autopsy (VA) were used to determine the cause-specific mortality burden at the community level in two areas of the United Republic of Tanzania. Proportional cause-specific mortality structures from health facilities were applied to counts of deaths obtained by SVR to produce modelled estimates. The burden was expressed in years of life lost.
A total of 2884 deaths were recorded from health facilities and 2167 recorded from SVR/VAs. In the perinatal and neonatal age group cause-specific mortality rates were dominated by perinatal conditions and stillbirths in both the community and the facility data. The modelled estimates for chronic causes were very similar to those from SVR/VA. Acute febrile illnesses were coded more specifically in the facility data than in the VA. Injuries were more prevalent in the SVR/VA data than in that from the facilities.
In this setting, improved International classification of diseases and health related problems, tenth revision (ICD-10) coding practices and applying facility-based cause structures to counts of deaths from communities, derived from SVR, appears to produce reasonable estimates of the cause-specific mortality burden in those aged 5 years and older determined directly from VA. For the perinatal and neonatal age group, VA appears to be required. Use of this approach in a nationally representative sample of facilities may produce reliable national estimates of the cause-specific mortality burden for leading causes of death in adults.
比较基于社区层面死因和死亡水平直接测量得出的死亡负担估计值，与通过结合医疗机构特定病因死亡率结构及社区层面死亡水平测量得出的间接估计值。
利用哨点生命登记（SVR）结合口头尸检（VA）的数据，确定坦桑尼亚联合共和国两个地区社区层面的特定病因死亡负担。将医疗机构特定病因的比例死亡率结构应用于SVR获得的死亡计数，以得出模型估计值。死亡负担以生命损失年数表示。
医疗机构记录了2884例死亡，SVR/VA记录了2167例死亡。在围产期和新生儿年龄组中，社区和医疗机构数据的特定病因死亡率均以围产期疾病和死产为主。慢性病的模型估计值与SVR/VA得出的估计值非常相似。急性发热性疾病在医疗机构数据中的编码比在VA中更具体。伤害在SVR/VA数据中比在医疗机构数据中更普遍。
在这种情况下，改进国际疾病和健康相关问题统计分类第十次修订本（ICD-10）的编码做法，并将基于医疗机构的病因结构应用于SVR得出的社区死亡计数，似乎能合理估计直接通过VA确定的5岁及以上人群的特定病因死亡负担。对于围产期和新生儿年龄组，似乎需要VA。在全国代表性的医疗机构样本中采用这种方法，可能会得出关于成年人主要死因的特定病因死亡负担的可靠全国估计值。
