Cause-specific mortality patterns among hospital deaths in Thailand: validating routine death certification

Area of Science:

• Public Health
• Epidemiology
• Medical Record Analysis

Background:

• 35% of Thai deaths occur in hospitals, with 15% having nonspecific diagnoses.
• Transcription errors from Thai to English further reduce accuracy of registered causes of death.
• Study assesses the validity of registered diagnoses for hospital deaths in Thailand.

Purpose of the Study:

• To measure the validity of registered diagnoses for hospital deaths in Thailand.
• To identify misclassification patterns in registered causes of death.
• To estimate accurate cause-specific mortality patterns for hospital deaths.

Main Methods:

• Reviewed medical records for a sample of 4,644 hospital deaths.
• Used expert physician review and independent adjudication to determine reference diagnoses.
• Computed validation characteristics and identified misclassification patterns.

Main Results:

• Specific underlying causes were identified for most deaths initially assigned ill-defined or residual causes.
• Compared to registration data, an increased proportion of deaths were attributed to stroke, ischemic heart disease, transport accidents, HIV/AIDS, diabetes, liver diseases, and COPD.
• Adequate medical records were available for 3,316 deaths.

Conclusions:

• Registered causes of death in Thai hospitals require validation for epidemiological research and policy.
• Streamlining death certification and coding procedures is essential to improve data reliability.
• Accurate mortality estimates will guide interventions to reduce avoidable hospital deaths in Thailand.