Published in PLoS Medicine, April 2010
Novel techniques can make better use of incomplete vital registration systems for population health studies, according to new research. The study, What can we conclude from death registration? Improved methods for evaluating completeness , describes an approach to check the completeness and accuracy of databases that compile information from death certificates. The work was done in collaboration with scientists at the University of Queensland and Harvard University.
Research findings
The study findings describe three death distribution methods (DDMs) that provide the best mortality estimates. However, even these improved methods yielded uncertainty intervals of roughly ±one-quarter of the estimate.
Analytical approach
Researchers systematically evaluated the performance of 234 DDMs in three different validation environments. These methods use the relative proportion of deaths in each age group for recorded deaths and the age distribution of the general population to estimate the number of deaths that have not been officially counted. The World Health Organization uses DDMs to monitor adult mortality in nearly 100 countries. These methods, however, have limitations, including application of methods with little scientific literature to guide their selection, a lack of extensive validation in real population conditions, and the fact that DDMs do not generate uncertainty intervals. Prior to this study, researchers had not previously compared the performance of the various types of DDMs. From this analysis, the researchers identified the three DDMs that yielded the best estimates and demonstrated the application of the optimal variants in eight countries.
Research objective
Policymakers rely on accurate information about mortality patterns to set public health priorities. Most high-income countries generate this information through death registration systems that capture nearly every death in the country. However, in low-resource settings, including most African countries, less than 25% of deaths are officially recorded. IHME is working to improve the analytical methods that can be applied to incomplete death registration data and produce more accurate estimates of death rates.
Recommendations for future work
There continues to be a role for partial vital registration data in measuring adult mortality levels and trends, but such results should only be interpreted alongside all other data sources on adult mortality and the uncertainty of the resulting levels, trends, and age patterns of adult death considered. The researchers recommend that all three DDMs be used to estimate the completeness of a death registration system.
Citation: Murray CJL, Rajaratnam JK, Marcus J, Laakso T, Lopez AD. What can we conclude from death registration? Improved methods for evaluating completeness. PLoS Medicine. 2010 April 13; 7(4):e1000262.