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Impact of Misclassification on Measures of Cardiovascular Disease Mortality in the Islamic Republic of Iran: A Cross-Sectional Study/ Impact Des Erreurs De Classification Des Deces Sur la Mesure De la Mortalite Cardiovasculaire En Republique Islamique d'Iran: Etude transversale/Estudio Transversal Sobre El Impacto De Los Errores De Clasificacion En la Medicion De la Mortalidad Cardiovascular En la Republica Islamica del Iran

2008; World Health Organization; Volume: 86; Issue: 9 Linguagem: Inglês

1564-0604

Ardeshir Khosravi, Chalapati Rao, Mohsen Naghavi, Richard Taylor, Nahid Jafaria, Alan D. Lopezb,

Autopsy Techniques and Outcomes

Introduction Measures of mortality, such as age-specific death rates, life expectancy, cause-specific death rates and years of life lost, are commonly used to measure the health status of a population and are essential for epidemiological research and priority setting for health development. (1-4) In general, countries can be classified into two broad groups on the basis of availability of data on causes of death.(3) One group comprises countries that typically have complete vital registration with medical certification of the cause of death assigned by attending physicians. The other group includes countries that have death registration systems ranging from incomplete to virtually non-existent, where causes of deaths are often recorded inaccurately at registration, resulting in large proportions of deaths assigned to ill-defined causes. (1,3) In some countries a history obtained from relatives or associates, known as or lay death recording, (5) is available for some segments of the population. In China and India, for example, sample vital registration areas that collect information via the use of verbal autopsy provide useful and representative information on causes of death. (6) Despite international efforts to facilitate and standardize processes for the collection and coding of data on causes of death, the quality of data from many countries remains poor. (1-3) Several factors influence cause of death ascertainment, such as the nature of the disease or circumstances of death, the qualifications and skills of the certifier, and the availability of diagnostic aids and medical evidence. Variations in these factors probably contribute to significant misclassification of cause of death in many countries. (7,8) Studies to assess the accuracy of data on causes of death from routine death registration systems have been implemented in several countries. (4,7) In general, these studies compare causes of death reported on death certificates with diagnoses from clinical records or autopsies. These studies can only be conducted in populations for which detailed clinical records (or autopsies) and data from death registration systems are available and useable, as in the Islamic Republic of Iran. Death registration in the Islamic Republic of Iran was initiated by the National Organization for Civil Registration in 1918, and has evolved over the past few decades into a new comprehensive death registration system operated by the Ministry of Health and Medical Education (MOH&ME). (9-14) Starting in one province (Bushehr) as a pilot study in 1997, the new system was progressively implemented to cover 29 out of 30 Iranian provinces by 2006. (10,15-17) In urban areas, attending physicians complete a medical certificate of cause of death in accordance with the principles of the International Classification of Diseases (ICD). In rural areas, causes of death are determined by physicians from the local rural health centre, based on interviews conducted by health-centre staff. (15) Each month, urban and rural health facilities submit summary information on age, sex and up to three causes for each death to the district health centre, where the data are matched against other sources (e.g. cemetery, hospital or medico-legal records) to improve the level and quality of death registration, and to remove duplication. Next, trained personnel select and code the underlying cause for each death according to ICD rules. These data are then computerized and submitted to the provincial health department, where data are cross-checked with information from the National Organization for Civil Registration to further reconcile missed deaths or duplications. A final dataset is submitted to the MOH&ME where deaths are tabulated according to an abbreviated list of 321 causes based on ICD-10, but adapted to represent the epidemiological profile of the Islamic Republic of Iran. …