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. 2010 May 18:8:11.
doi: 10.1186/1478-7954-8-11.

Verifying causes of death in Thailand: rationale and methods for empirical investigation

Chalapati Rao  1 , Yawarat Porapakkham, Junya Pattaraarchachai, Warangkana Polprasert, Narumol Swampunyalert, Alan D Lopez
Affiliations

Verifying causes of death in Thailand: rationale and methods for empirical investigation

Chalapati Rao et al. Popul Health Metr. .

Abstract

Background: Cause-specific mortality statistics by age and sex are primary evidence for epidemiological research and health policy. Annual mortality statistics from vital registration systems in Thailand are of limited utility because about 40% of deaths are registered with unknown or nonspecific causes. This paper reports the rationale, methods, and broad results from a comprehensive study to verify registered causes in Thailand.

Methods: A nationally representative sample of 11,984 deaths was selected using a multistage stratified cluster sampling approach, distributed across 28 districts located in nine provinces of Thailand. Registered causes were verified through medical record review for deaths in hospitals and standard verbal autopsy procedures for deaths outside hospitals, the results of which were used to measure validity and reliability of registration data. Study findings were used to develop descriptive estimates of cause-specific mortality by age and sex in Thailand.

Results: Causes of death were verified for a total of 9,644 deaths in the study sample, comprised of 3,316 deaths in hospitals and 6,328 deaths outside hospitals. Field studies yielded specific diagnoses in almost all deaths in the sample originally assigned an ill-defined cause of death at registration. Study findings suggest that the leading causes of death in Thailand among males are stroke (9.4%); transport accidents (8.1%); HIV/AIDS (7.9%); ischemic heart diseases (6.4%); and chronic obstructive lung diseases (5.7%). Among females, the leading causes are stroke (11.3%); diabetes (8%); ischemic heart disease (7.5%); HIV/AIDS (5.7%); and renal diseases (4%).

Conclusions: Empirical investigation of registered causes of death in the study sample yielded adequate information to enable estimation of cause-specific mortality patterns in Thailand. These findings will inform burden of disease estimation and economic evaluation of health policy choices in the country. The development and implementation of research methods in this study will contribute to improvements in the quality of annual mortality statistics in Thailand. Similar research is recommended for other countries where the quality of mortality statistics is poor.

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Figures

Figure 1
Figure 1
Distribution of study provinces in Thailand.
Figure 2
Figure 2
Data processing and quality control measures for selection and coding of underlying causes of death in the study sample. Incorrect = Change in ICD code at 3 or 4 character level, but no change at Mortality Tabulation List 1 level of aggregation. Disagreement = Change in ICD code resulting in change at Mortality Tabulation List 1 level of aggregation.
Figure 3
Figure 3
Analytical plan for estimating cause-specific mortality in Thailand, 2005.
Figure 4
Figure 4
Proportionate mortality (in %) for selected leading causes of death based on study findings, for females, Thailand, 2005.
Figure 5
Figure 5
Proportionate mortality (in %) for selected leading causes of death based on study findings, for males, Thailand, 2005.
See this image and copyright information in PMC

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