Cause-specific mortality patterns among hospital deaths in Thailand: Validating routine death certification

Pattaraarchachai, Junya, Rao, Chalapati, Polprasert, Warangkana, Porapakkham, Yawarat, Pao-in, Wansa, Singwerathum, Noppcha and Lopez, Alan D. (2010) Cause-specific mortality patterns among hospital deaths in Thailand: Validating routine death certification. Population Health Metrics, 8 12: 1-12. doi:10.1186/1478-7954-8-12

Author Pattaraarchachai, Junya
Rao, Chalapati
Polprasert, Warangkana
Porapakkham, Yawarat
Pao-in, Wansa
Singwerathum, Noppcha
Lopez, Alan D.
Title Cause-specific mortality patterns among hospital deaths in Thailand: Validating routine death certification
Journal name Population Health Metrics   Check publisher's open access policy
ISSN 1478-7954
Publication date 2010-01-01
Sub-type Article (original research)
DOI 10.1186/1478-7954-8-12
Open Access Status DOI
Volume 8
Issue 12
Start page 1
End page 12
Total pages 12
Place of publication London, England, U.K.
Publisher BioMed Central
Language eng
Formatted abstract
Background: In Thailand, 35% of all deaths occur in hospitals, and the cause of death is medically certified by attending physicians. About 15% of hospital deaths are registered with nonspecific diagnoses, despite the potential for greater accuracy using information available from medical records. Further, issues arising from transcription of diagnoses from Thai to English at registration create uncertainty about the accuracy of registration data even for specified causes of death. This paper reports findings from a study to measure validity of registered diagnoses in a sample of deaths that occurred in hospitals in Thailand during 2005.

Methods: A sample of 4,644 hospital deaths was selected, and for each case, medical records were reviewed. A process of medical record abstraction, expert physician review, and independent adjudication for the selection and coding of underlying causes of death was used to derive reference diagnoses. Validation characteristics were computed for leading causes of hospital deaths from registration data, and misclassification patterns were identified for registration diagnoses. Study findings were used to estimate cause-specific mortality patterns for hospital deaths in Thailand.

Results: Adequate medical records were available for 3,316 deaths in the study sample. Losses to follow up were nondifferential by age, sex, and cause. Medical records review identified specific underlying causes for the majority of deaths that were originally assigned ill-defined causes as well as for those originally assigned to residual categories for specific cause groups. In comparison with registration data for the sample, we found an increase in the relative proportion of deaths in hospitals due to stroke, ischemic heart disease, transport accidents, HIV/AIDS, diabetes, liver diseases, and chronic obstructive pulmonary disease.

Conclusions: Registration data on causes for deaths occurring in hospitals require periodic validation prior to their use for epidemiological research or public health policy. Procedures for death certification and coding of underlying causes of death need to be streamlined to improve reliability of registration data. Estimates of cause-specific mortality from this research will inform burden of disease estimation and guide interventions to reduce avoidable mortality in hospitals in Thailand.
Keyword AIDS
death rate
human immunodeficiency virus infections
ischaemic heart disease
lung diseases
myocardial ischemia
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published: 18 May 2010

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Public Health Publications
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Citation counts: TR Web of Science Citation Count  Cited 29 times in Thomson Reuters Web of Science Article | Citations
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Created: Thu, 10 Feb 2011, 00:48:22 EST by Geraldine Fitzgerald on behalf of School of Public Health