Correcting for Verbal Autopsy Misclassification Bias in Cause-Specific Mortality Estimates

Am J Trop Med Hyg. 2023 Apr 10;108(5_Suppl):66-77. doi: 10.4269/ajtmh.22-0318. Print 2023 May 2.

Abstract

Verbal autopsies (VAs) are extensively used to determine cause of death (COD) in many low- and middle-income countries. However, COD determination from VA can be inaccurate. Computer coded verbal autopsy (CCVA) algorithms used for this task are imperfect and misclassify COD for a large proportion of deaths. If not accounted for, this misclassification leads to biased estimates of cause-specific mortality fractions (CSMFs), a critical piece in health-policy making. Recent work has demonstrated that the knowledge of the CCVA misclassification rates can be used to calibrate raw VA-based CSMF estimates to account for the misclassification bias. In this manuscript, we review the current practices and issues with raw COD predictions from CCVA algorithms and provide a complete primer on how to use the VA calibration approach with the calibratedVA software to correct for verbal autopsy misclassification bias in cause-specific mortality estimates. We use calibratedVA to obtain CSMFs for child (1-59 months) and neonatal deaths using VA data from the Countrywide Mortality Surveillance for Action project in Mozambique.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms*
  • Autopsy
  • Cause of Death
  • Child
  • Humans
  • Infant, Newborn
  • Mortality
  • Mozambique
  • Software*