Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia: testing existing methods and development and validation of a novel weighted score
Objectives Verbal autopsy (VA) is a useful tool to ascertain cause of death where no other mechanisms exist. We aimed to assess the utility of VA data to ascertain deaths due to uncontrolled hyperglycaemia and to develop a weighted score (WS) to specifically identify cases. Cases were identified by...
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BMJ Publishing Group
2019-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/10/e026331.full |
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| author | Justine I Davies David Beran Miles D Witham Alisha N Wade Amelia Crampin Sarah Blackstock Graham D Ogle |
| author_facet | Justine I Davies David Beran Miles D Witham Alisha N Wade Amelia Crampin Sarah Blackstock Graham D Ogle |
| author_sort | Justine I Davies |
| collection | DOAJ |
| description | Objectives Verbal autopsy (VA) is a useful tool to ascertain cause of death where no other mechanisms exist. We aimed to assess the utility of VA data to ascertain deaths due to uncontrolled hyperglycaemia and to develop a weighted score (WS) to specifically identify cases. Cases were identified by a study or site physician with training in diabetes. These diagnoses were also compared with diagnoses produced by a standard computer algorithm (InterVA-4).Setting This study was done using VA data from the Health and Demographic Survey sites in Agincourt in rural South Africa. Validation of the WS was done using VA data from Karonga in Malawi.Participants All deaths from ages 1 to 49 years between 1992 and 2015 and between 2002 and 2016 from Agincourt and Karonga, respectively. There were 8699 relevant deaths in Agincourt and 1663 in Karonga.Results Of the Agincourt deaths, there were 77 study physician classified cases and 58 computer algorithm classified cases. Agreement between study physician classified cases and computer algorithm classified cases was poor (Cohen’s kappa 0.14). Our WS produced a receiver operator curve with area under the curve of 0.952 (95% CI 0.920 to 0.985). However, positive predictive value (PPV) was below 50% when the WS was applied to the development set and the score was dominated by the necessity for a premortem diagnosis of diabetes. Independent validation showed the WS performed reasonably against site physician classified cases with sensitivity of 86%, specificity of 99%, PPV of 60% and negative predictive value of 99%.Conclusion Our results suggest that widely used VA methodologies may be missing deaths due to uncontrolled hyperglycaemia. Our WS may offer improved ability to detect deaths due to uncontrolled hyperglycaemia in large populations studies where no other means exist. |
| format | Article |
| id | doaj-art-4a7b02bddfe74245b7a5f9a0cbb5bf6a |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-4a7b02bddfe74245b7a5f9a0cbb5bf6a2025-08-20T02:50:30ZengBMJ Publishing GroupBMJ Open2044-60552019-10-0191010.1136/bmjopen-2018-026331Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia: testing existing methods and development and validation of a novel weighted scoreJustine I Davies0David Beran1Miles D Witham2Alisha N Wade3Amelia Crampin4Sarah Blackstock5Graham D Ogle6Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South AfricaDivision of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, SwitzerlandNIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UKMRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South AfricaMalawi Epidemiology and Intervention Research Unit, Lilongwe, MalawiUniversity College London Hospital NHS Trust, London, UK8 Life for a Child Program, Diabetes NSW, Glebe, New South Wales, AustraliaObjectives Verbal autopsy (VA) is a useful tool to ascertain cause of death where no other mechanisms exist. We aimed to assess the utility of VA data to ascertain deaths due to uncontrolled hyperglycaemia and to develop a weighted score (WS) to specifically identify cases. Cases were identified by a study or site physician with training in diabetes. These diagnoses were also compared with diagnoses produced by a standard computer algorithm (InterVA-4).Setting This study was done using VA data from the Health and Demographic Survey sites in Agincourt in rural South Africa. Validation of the WS was done using VA data from Karonga in Malawi.Participants All deaths from ages 1 to 49 years between 1992 and 2015 and between 2002 and 2016 from Agincourt and Karonga, respectively. There were 8699 relevant deaths in Agincourt and 1663 in Karonga.Results Of the Agincourt deaths, there were 77 study physician classified cases and 58 computer algorithm classified cases. Agreement between study physician classified cases and computer algorithm classified cases was poor (Cohen’s kappa 0.14). Our WS produced a receiver operator curve with area under the curve of 0.952 (95% CI 0.920 to 0.985). However, positive predictive value (PPV) was below 50% when the WS was applied to the development set and the score was dominated by the necessity for a premortem diagnosis of diabetes. Independent validation showed the WS performed reasonably against site physician classified cases with sensitivity of 86%, specificity of 99%, PPV of 60% and negative predictive value of 99%.Conclusion Our results suggest that widely used VA methodologies may be missing deaths due to uncontrolled hyperglycaemia. Our WS may offer improved ability to detect deaths due to uncontrolled hyperglycaemia in large populations studies where no other means exist.https://bmjopen.bmj.com/content/9/10/e026331.full |
| spellingShingle | Justine I Davies David Beran Miles D Witham Alisha N Wade Amelia Crampin Sarah Blackstock Graham D Ogle Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia: testing existing methods and development and validation of a novel weighted score BMJ Open |
| title | Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia: testing existing methods and development and validation of a novel weighted score |
| title_full | Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia: testing existing methods and development and validation of a novel weighted score |
| title_fullStr | Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia: testing existing methods and development and validation of a novel weighted score |
| title_full_unstemmed | Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia: testing existing methods and development and validation of a novel weighted score |
| title_short | Ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia: testing existing methods and development and validation of a novel weighted score |
| title_sort | ability of verbal autopsy data to detect deaths due to uncontrolled hyperglycaemia testing existing methods and development and validation of a novel weighted score |
| url | https://bmjopen.bmj.com/content/9/10/e026331.full |
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