Analysis of causes of death using verbal autopsies and vital registration in Hidalgo, Mexico

INTRODUCTION: Verbal autopsy (VA) is a useful tool for evaluating causes of death, especially in places with limited or no vital registration systems. The Population Health Metrics Research Consortium (PHMRC) developed a validated questionnaire and a set of automated methods to determine the cause of death from a VA. However, the application of these methods needs to be tested in a community environment. OBJECTIVE: To estimate cause-specific mortality fractions (CSMFs) using VAs and compare them against those obtained in the vital statistics of the state of Hidalgo, Mexico. METHODS: A random sample of deaths occurred in 2009 was selected from vital statistics in the state of Hidalgo. The full PHMRC validated VA instrument was applied to the relatives of the deceased, and the cause of death was determined using Tariff's automated method. The causes of death were grouped into 34 causes for adults, 21 for children and 6 for newborns. Results were compared with cause of death on death certificates for all deaths. RESULTS: A total of 1,198 VAs were analyzed. The Tariff method was not able to assign a cause of death in only 9% of adults, 2% of children and 7% of neonatal deaths. The CSMFs obtained from the Tariff method were similar in some cases to those of vital statistics (e.g. cirrhosis), but different in others (e.g. sepsis). CONCLUSION: The application of VAs in a community sample, analyzed with the Tariff method, allowed assigning a cause of death to most of the cases, with results similar to those of vital statistics for most conditions. This tool can be useful to strengthen the quality of vital statistics.