Ganapathy Shubash Shander, Yi Yi Khoo, Omar Mohd Azahadi, Anuar Mohamad Fuad Mohamad, Jeevananthan Chandrika, Rao Chalapati
Institut Kesihatan Umum (Institute of Public Health), Ministry of Health Malaysia, Jalan Bangsar, 50590, Kuala Lumpur, Malaysia.
Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia.
BMC Public Health. 2017 Aug 11;17(1):653. doi: 10.1186/s12889-017-4668-y.
Mortality statistics by age, sex and cause are the foundation of basic health data required for health status assessment, epidemiological research and formation of health policy. Close to half the deaths in Malaysia occur outside a health facility, are not attended by medical personnel, and are given a lay opinion as to the cause of death, leading to poor quality of data from vital registration. Verbal autopsy (VA) is a very useful tool in diagnosing broad causes of deaths for events that occur outside health facilities. This article reports the development of the VA methods and our principal finding from a validation study.
A cross sectional study on nationally representative sample deaths that occurred in Malaysia during 2013 was used. A VA questionnaire suitable for local use was developed. Trained field interviewers visited the family members of the deceased at their homes and conducted face to face interviews with the next of kin. Completed questionnaires were reviewed by trained physicians who assigned multiple and underlying causes. Reference diagnoses for validation were obtained from review of medical records (MR) available for a sample of the overall study deaths.
Corresponding MR diagnosis with matched sample of the VA diagnosis were available in 2172 cases for the validation study. Sensitivity scores were good (>75%) for transport accidents and certain cancers. Moderate sensitivity (50% - 75%) was obtained for ischaemic heart disease (64%) and cerebrovascular disease (72%). The validation sample for deaths due to major causes such as ischaemic heart disease, pneumonia, breast cancer and transport accidents show low cause-specific mortality fraction (CSMF) changes. The scores obtained for the top 10 leading site-specific cancers ranged from average to good.
We can conclude that VA is suitable for implementation for deaths outside the health facilities in Malaysia. This would reduce ill-defined mortality causes in vital registration data, and yield more accurate national mortality statistics.
按年龄、性别和死因划分的死亡率统计数据是健康状况评估、流行病学研究以及卫生政策制定所需基础健康数据的基石。在马来西亚，近半数死亡发生在医疗机构之外，未得到医务人员诊治，死因由非专业人员判定，这导致生命登记数据质量不佳。对于发生在医疗机构之外的死亡事件，死因推断（VA）是诊断广泛死因的一项非常有用的工具。本文报告了死因推断方法的发展情况以及我们在一项验证研究中的主要发现。
采用了一项对2013年马来西亚具有全国代表性的样本死亡病例进行的横断面研究。开发了一份适用于当地的死因推断问卷。经过培训的现场访员前往死者家属家中，与近亲进行面对面访谈。完成的问卷由经过培训的医生进行审查，他们会确定多种死因和根本死因。通过查阅总体研究死亡样本的病历（MR）来获取用于验证的参考诊断。
在2172例病例中可获得与死因推断诊断相匹配样本的相应病历诊断，用于验证研究。交通事故和某些癌症的灵敏度得分良好（>75%）。缺血性心脏病（64%）和脑血管疾病（72%）的灵敏度中等（50% - 75%）。缺血性心脏病、肺炎、乳腺癌和交通事故等主要死因的验证样本显示特定病因死亡率比例（CSMF）变化较低。前10位主要部位特异性癌症的得分从一般到良好不等。
我们可以得出结论，死因推断适用于马来西亚医疗机构之外的死亡情况。这将减少生命登记数据中死因不明的情况，并得出更准确的国家死亡率统计数据。
