Validation of SmartVA using conventional autopsy: a study of adult deaths in Brazil

Summary: Background: Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy (VA) is increasingly used to provide population-level cause of death data. VAs are now widely interpreted...

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Autores principales:	John D. Hart, Paulo Afonso de André, Carmen Diva Saldiva de André, Tim Adair, Lucia Pereira Barroso, Sandra Valongueiro, Ana Luiza Bierrenbach, Patrícia Ismael de Carvalho, Maria Bernadete de Cerqueira Antunes, Conceição Maria de Oliveira, Luiz Alberto Amador Pereira, Cátia Martinez Minto, Tânia Maria da Silva Bezerra, Sérgio Parente Costa, Bárbara Araújo de Azevedo, José Ricardo Alves de Lima, Denise Souza de Meira Mota, Ana Maria de Oliveira Ramos, Maria de Fátima Marinho de Souza, Luiz Fernando Ferraz da Silva, Elisabeth Barboza França, Deirdre McLaughlin, Ian D. Riley, Paulo Hilário Nascimento Saldiva
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2022
Materias:	Cause of death Verbal autopsy Autopsy Brazil Validation Vital statistics Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/1b49294547db41c292c76535f267448e
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spelling	oai:doaj.org-article:1b49294547db41c292c76535f267448e2021-12-02T05:04:36ZValidation of SmartVA using conventional autopsy: a study of adult deaths in Brazil2667-193X10.1016/j.lana.2021.100081https://doaj.org/article/1b49294547db41c292c76535f267448e2022-01-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2667193X21000776https://doaj.org/toc/2667-193XSummary: Background: Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy (VA) is increasingly used to provide population-level cause of death data. VAs are now widely interpreted using the automated algorithms SmartVA and InterVA. Here we use conventional autopsy as the gold standard to validate SmartVA methodology. Methods: This study included adult deaths from natural causes in São Paulo and Recife for which conventional autopsy was indicated. VA was conducted with a relative of the deceased using an amended version of the SmartVA instrument to suit the local context. Causes of death from VA were produced using the SmartVA-Analyze program. Physician coded verbal autopsy (PCVA), conducted on the same questionnaires, and Global Burden of Disease Study data were used as additional comparators. Cause of death data were grouped into 10 broad causes for the validation due to the real-world utility of VA lying in identifying broad population cause of death patterns. Findings: The study included 2,060 deaths in São Paulo and 1,079 in Recife. The cause specific mortality fractions (CSMFs) estimated using SmartVA were broadly similar to conventional autopsy for: cardiovascular diseases (46.8% vs 54.0%, respectively), cancers (10.6% vs 11.4%), infections (7.0% vs 10.4%) and chronic respiratory disease (4.1% vs 3.7%), causes accounting for 76.1% of the autopsy dataset. The SmartVA CSMF estimates were lower than autopsy for “Other NCDs” (7.8% vs 14.6%) and higher for diabetes (13.0% vs 6.6%). CSMF accuracy of SmartVA compared to autopsy was 84.5%. CSMF accuracy for PCVA was 93.0%. Interpretation: The results suggest that SmartVA can, with reasonable accuracy, predict the broad cause of death groups important to assess a population's epidemiological transition. VA remains a useful tool for understanding causes of death where medical certification is not possible.John D. HartPaulo Afonso de AndréCarmen Diva Saldiva de AndréTim AdairLucia Pereira BarrosoSandra ValongueiroAna Luiza BierrenbachPatrícia Ismael de CarvalhoMaria Bernadete de Cerqueira AntunesConceição Maria de OliveiraLuiz Alberto Amador PereiraCátia Martinez MintoTânia Maria da Silva BezerraSérgio Parente CostaBárbara Araújo de AzevedoJosé Ricardo Alves de LimaDenise Souza de Meira MotaAna Maria de Oliveira RamosMaria de Fátima Marinho de SouzaLuiz Fernando Ferraz da SilvaElisabeth Barboza FrançaDeirdre McLaughlinIan D. RileyPaulo Hilário Nascimento SaldivaElsevierarticleCause of deathVerbal autopsyAutopsyBrazilValidationVital statisticsPublic aspects of medicineRA1-1270ENThe Lancet Regional Health. Americas, Vol 5, Iss , Pp 100081- (2022)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cause of death Verbal autopsy Autopsy Brazil Validation Vital statistics Public aspects of medicine RA1-1270
spellingShingle	Cause of death Verbal autopsy Autopsy Brazil Validation Vital statistics Public aspects of medicine RA1-1270 John D. Hart Paulo Afonso de André Carmen Diva Saldiva de André Tim Adair Lucia Pereira Barroso Sandra Valongueiro Ana Luiza Bierrenbach Patrícia Ismael de Carvalho Maria Bernadete de Cerqueira Antunes Conceição Maria de Oliveira Luiz Alberto Amador Pereira Cátia Martinez Minto Tânia Maria da Silva Bezerra Sérgio Parente Costa Bárbara Araújo de Azevedo José Ricardo Alves de Lima Denise Souza de Meira Mota Ana Maria de Oliveira Ramos Maria de Fátima Marinho de Souza Luiz Fernando Ferraz da Silva Elisabeth Barboza França Deirdre McLaughlin Ian D. Riley Paulo Hilário Nascimento Saldiva Validation of SmartVA using conventional autopsy: a study of adult deaths in Brazil
description	Summary: Background: Accurate cause of death data are essential to guide health policy. However, mortality surveillance is limited in many low-income countries. In such settings, verbal autopsy (VA) is increasingly used to provide population-level cause of death data. VAs are now widely interpreted using the automated algorithms SmartVA and InterVA. Here we use conventional autopsy as the gold standard to validate SmartVA methodology. Methods: This study included adult deaths from natural causes in São Paulo and Recife for which conventional autopsy was indicated. VA was conducted with a relative of the deceased using an amended version of the SmartVA instrument to suit the local context. Causes of death from VA were produced using the SmartVA-Analyze program. Physician coded verbal autopsy (PCVA), conducted on the same questionnaires, and Global Burden of Disease Study data were used as additional comparators. Cause of death data were grouped into 10 broad causes for the validation due to the real-world utility of VA lying in identifying broad population cause of death patterns. Findings: The study included 2,060 deaths in São Paulo and 1,079 in Recife. The cause specific mortality fractions (CSMFs) estimated using SmartVA were broadly similar to conventional autopsy for: cardiovascular diseases (46.8% vs 54.0%, respectively), cancers (10.6% vs 11.4%), infections (7.0% vs 10.4%) and chronic respiratory disease (4.1% vs 3.7%), causes accounting for 76.1% of the autopsy dataset. The SmartVA CSMF estimates were lower than autopsy for “Other NCDs” (7.8% vs 14.6%) and higher for diabetes (13.0% vs 6.6%). CSMF accuracy of SmartVA compared to autopsy was 84.5%. CSMF accuracy for PCVA was 93.0%. Interpretation: The results suggest that SmartVA can, with reasonable accuracy, predict the broad cause of death groups important to assess a population's epidemiological transition. VA remains a useful tool for understanding causes of death where medical certification is not possible.
format	article
author	John D. Hart Paulo Afonso de André Carmen Diva Saldiva de André Tim Adair Lucia Pereira Barroso Sandra Valongueiro Ana Luiza Bierrenbach Patrícia Ismael de Carvalho Maria Bernadete de Cerqueira Antunes Conceição Maria de Oliveira Luiz Alberto Amador Pereira Cátia Martinez Minto Tânia Maria da Silva Bezerra Sérgio Parente Costa Bárbara Araújo de Azevedo José Ricardo Alves de Lima Denise Souza de Meira Mota Ana Maria de Oliveira Ramos Maria de Fátima Marinho de Souza Luiz Fernando Ferraz da Silva Elisabeth Barboza França Deirdre McLaughlin Ian D. Riley Paulo Hilário Nascimento Saldiva
author_facet	John D. Hart Paulo Afonso de André Carmen Diva Saldiva de André Tim Adair Lucia Pereira Barroso Sandra Valongueiro Ana Luiza Bierrenbach Patrícia Ismael de Carvalho Maria Bernadete de Cerqueira Antunes Conceição Maria de Oliveira Luiz Alberto Amador Pereira Cátia Martinez Minto Tânia Maria da Silva Bezerra Sérgio Parente Costa Bárbara Araújo de Azevedo José Ricardo Alves de Lima Denise Souza de Meira Mota Ana Maria de Oliveira Ramos Maria de Fátima Marinho de Souza Luiz Fernando Ferraz da Silva Elisabeth Barboza França Deirdre McLaughlin Ian D. Riley Paulo Hilário Nascimento Saldiva
author_sort	John D. Hart
title	Validation of SmartVA using conventional autopsy: a study of adult deaths in Brazil
title_short	Validation of SmartVA using conventional autopsy: a study of adult deaths in Brazil
title_full	Validation of SmartVA using conventional autopsy: a study of adult deaths in Brazil
title_fullStr	Validation of SmartVA using conventional autopsy: a study of adult deaths in Brazil
title_full_unstemmed	Validation of SmartVA using conventional autopsy: a study of adult deaths in Brazil
title_sort	validation of smartva using conventional autopsy: a study of adult deaths in brazil
publisher	Elsevier
publishDate	2022
url	https://doaj.org/article/1b49294547db41c292c76535f267448e
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Validation of SmartVA using conventional autopsy: a study of adult deaths in Brazil

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