Validating the diagnostic accuracy of medical certification: a population-level comparison between verbal autopsy and Saudi medical records causes of death of deceased with type 2 diabetes.
Faleh Alyazidi, Deler Shakely, Fawaz R Alyazidi, Max Petzold, Laith Hussain-Alkhateeb
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Abstract
Background: In contexts where certifying causes of death (COD) is inadequate - either in industrialized or non-industrialized countries - verbal autopsy (VA) serves as a practical method for determining probable COD, helping to address gaps in vital data.
Objective: This study aimed to validate the diagnostic accuracy of medical certifications at a population level by comparing COD obtained from medical records against those derived from VA in Saudi Arabia.
Method: Death records from 2018 to 2021 were collected from a type 2 diabetes mellitus register at a major specialist hospital in Makkah. Three hundred and two VA interviews were completed with deceased patients' relatives, and the probable COD was determined using InterVA-5 software. Lin's concordance correlation coefficient was applied to examine similarities of the cause-specific mortality fractions (CSMFs) based on International Classification of Diseases chapters from both verbal autopsy causes of death (VACOD) and the physician review causes of death (PRCOD).
Results: Overall, the findings demonstrated a moderate level of concordance of COD at the population between VACOD and PRCOD. However, the CSMFs for various COD categories derived from both sources showed a broad spectrum of absolute differences, with the largest disparities observed among the most prevalent COD categories.
Conclusion: PRCOD was found to overestimate population-level endocrine/metabolic and respiratory disease COD while underestimating circulatory disease, demonstrating medical certification challenges. Conversely, affirming previous literature on prevalent COD in Saudi Arabia, VA appears to deliver a plausible assessment, further strengthening its potential to integrate within the Saudi health system towards an augmented medical certification process.
期刊介绍：
Global Health Action is an international peer-reviewed Open Access journal affiliated with the Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine at Umeå University, Sweden. The Unit hosts the Umeå International School of Public Health and the Umeå Centre for Global Health Research.
Vision: Our vision is to be a leading journal in the global health field, narrowing health information gaps and contributing to the implementation of policies and actions that lead to improved global health.
Aim: The widening gap between the winners and losers of globalisation presents major public health challenges. To meet these challenges, it is crucial to generate new knowledge and evidence in the field and in settings where the evidence is lacking, as well as to bridge the gaps between existing knowledge and implementation of relevant findings. Thus, the aim of Global Health Action is to contribute to fuelling a more concrete, hands-on approach to addressing global health challenges. Manuscripts suggesting strategies for practical interventions and research implementations where none already exist are specifically welcomed. Further, the journal encourages articles from low- and middle-income countries, while also welcoming articles originated from South-South and South-North collaborations. All articles are expected to address a global agenda and include a strong implementation or policy component.
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