M. Anker, THE EFFECT OF MISCLASSIFICATION ERROR ON REPORTED CAUSE-SPECIFIC MORTALITY FRACTIONS FROM VERBAL AUTOPSY, International journal of epidemiology, 26(5), 1997, pp. 1090-1096
Background. Verbal autopsy (VA) studies are important for measuring ca
use-specific mortality in areas where medical certification of cause o
f death is uncommon. This paper explores the effects of misclassificat
ion errors on the results of Verbal autopsy studies, and recommends wa
ys to take misclassification errors into account in the interpretation
of results. Methods. Mathematical formulae are derived for determinin
g the size and direction of the error in cause-specific mortality esti
mates based on VA studies caused by misclassification. The levels of s
ensitivity and specificity found in currently available validation stu
dies for childhood VA are examined, Results. There can be substantial
errors in the estimates of the cause-specific mortality fraction deriv
ed from VA studies. The cause-specific mortality fraction itself has a
n important influence on the size of the error forgiven levels of sens
itivity and specificity, and when the cause-specific mortality fractio
n is small, the size of the error depends more on specificity than on
sensitivity. Conclusion. Despite its drawbacks VA seems to be the most
promising way of establishing cause of death when most deaths take pl
ace at home without medical attention. However, more validation studie
s an standardized instruments are required in order to collect informa
tion about sensitivity and specificity and subsequently improve the de
sign of the instrument. At the same time, analysts need to take miscla
ssification errors into consideration in ways outlined in this paper.