Basic Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Oct 26, 2019; 11(10): 244-255
Published online Oct 26, 2019. doi: 10.4330/wjc.v11.i10.244
Evaluating the quality of evidence for diagnosing ischemic heart disease from verbal autopsy in Indonesia
Wenrong Zhang, Yuslely Usman, Retno Widyastuti Iriawan, Merry Lusiana, Sha Sha, Matthew Kelly, Chalapati Rao
Wenrong Zhang, Sha Sha, Matthew Kelly, Chalapati Rao, Department of Global Heath, Research School of Population Health, Australian National University, Canberra, ACT 2602, Australia
Yuslely Usman, Retno Widyastuti Iriawan, Merry Lusiana, National Agency for Health Research and Development, Ministry of Health, Jakarta 10110, Indonesia
Author contributions: Zhang W collected the data, carried out data analysis and drafted the paper; Sha S collaborated on the study design and development of analysis methods; Kelly M and Rao C conceived the design of the study and contributed to drafting the paper; Usman Y, Iriawan RW and Lusiana M provided access to the data, and guided and assisted with data collection; All authors contributed to final editing of the paper.
Supported by the Department of Foreign Affairs and Trade, Australian Government, under the Government Partnership for Development program, No. 70856.
Institutional review board statement: This research was approved by the Australian National University Human Ethics Review board with protocol number 2018/493. It was also approved by the Indonesian National Agency for Health Research and Development ethics review board.
Institutional animal care and use committee statement: All procedures involving animals were reviewed and approved by the Institutional Animal Care and Use Committee of Australian National University.
Conflict-of-interest statement: The authors declare no conflicts of interest.
ARRIVE guidelines statement: The authors have read the ARRIVE guidelines, and the manuscript was prepared and revised according to the ARRIVE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Wenrong Zhang, Doctor, Department of Global Heath, Research School of Population Health, Australian National University, 62 Mills Road, Canberra, ACT 2602, Australia. wenrong.zhang@anu.edu.au
Telephone: +61-2-61250714
Received: June 4, 2019
Peer-review started: June 6, 2019
First decision: July 30, 2019
Revised: August 29, 2015
Accepted: September 13, 2019
Article in press: September 13, 2019
Published online: October 26, 2019
Abstract
BACKGROUND

Mortality and cause of death data are fundamental to health policy development. Civil Registration and Vital Statistics systems are the ideal data source, but the system is still under development in Indonesia. A national Sample Registration System (SRS) has provided nationally representative mortality data from 128 sub-districts since 2014. Verbal autopsy (VA) is used in the SRS to obtain causes of death. The quality of VA data must be evaluated as part of the SRS data quality assessment.

AIM

To assess the strength of evidence used in the assignment of Ischaemic Heart Disease (IHD) as causes of death from VA.

METHODS

The sample frame for this study is the 4,070 deaths that had IHD assigned as the underlying cause in the SRS 2016 database. From these, 400 cases were randomly selected. A data extraction form and data entry template were designed to collect relevant data about IHD from VA questionnaires. A standardised categorisation was designed to assess the strength of evidence used to infer IHD as a cause of death. A pilot test of 50 cases was carried out. IBM SPSS software was used in this study.

RESULTS

Strong evidence of IHD as a cause of death was assigned based on surgery for coronary heart disease, chest pain and two out of: sudden death, history of heart disease, medical diagnosis of heart disease, or terminal shortness of breath. More than half (53%) of the questionnaires contained strong evidence. For deaths outside health facilities, VA questionnaires for male deaths contained acceptable evidence in significantly higher proportions as compared to those for female deaths. (P < 0.001). Nearly half of all IHD deaths were concentrated in the 50-69 year age group (48.40%), and a further 36.10% were aged 70 years or more. Nearly two-thirds of the deceased were male (58.40%). Smoking behaviour was found in 44.11% of IHD deaths, but this figure was 73.82% among males.

CONCLUSION

More than half of the VA questionnaires from the study sample were found to contain strong evidence to infer IHD as the cause of death. Results from medical records such as electrocardiograms, coronary angiographies, and load tests could have improved the strength of evidence and contributed to IHD cause of death diagnosis.

Keywords: Verbal autopsy, Data quality evaluation, Mortality, Cause of death

Core tip: In many countries in Southeast Asia, systems for recording mortality and causes of death are under development. In such settings, due to large proportions of deaths happening outside of health facilities, verbal autopsy interviews with families of the deceased are often used to ascertain the cause of death. However, there is a need to evaluate the quality of cause of death estimation from the verbal autopsy. This study specifically addresses the assignment of ischemic heart disease as a cause of death, concluding that a significant proportion of deaths were assigned this cause using strong evidence.