Evaluating the quality of evidence for diagnosing ischemic heart disease from verbal autopsy in Indonesia

Table 1 Data variables used for analysis of quality of evidence from verbal autopsy questionnaires

Data category	Data variables
General information of deceased	Age / sex
	Place of death (health facilities/home)
	Relationship with respondent
	Recall period of interview
Structured questions	Previous medical history (heart disease, stroke, hypertension, diabetes, etc.)
	Signs and symptoms of terminal illness
	Risk factors
	Use of health services
	Cause of death provided by health staff
Open sections	Respondent’s free-flowing narrative of the course of illness and terminal events
	Information from available health records
	Physician reviewer’s case summary

Table 2 Distribution of each category of strength of evidence

Category	Criteria	Cases	Proportion
Strong	(1) Surgery for coronary heart disease (1%); (2) Terminal chest pain and two of: (A) Sudden death; (B) History of heart disease; (C) Medical diagnosis of heart disease3; (D) Terminal shortness of breath.	213	53%
Medium	(1) Terminal chest pain alone; (2) Sudden death AND either: (A) History of heart disease OR; (B) Medical diagnosis of heart disease; (3) Only medical diagnosis of heart disease.	87	22%
Weak	(1) Only history of heart disease; (2) Only symptomatic evidence (without chest pain): (A) Sudden death; (B) Hypertension; (C) Shortness of breath.	98	24.5%
Nil	No evidence for the cause of death.	2	0.5%
TOTAL		400	100

Medical diagnosis of heart disease³: (A) informed by health facility staff where treatment accessed during illness; or (B) recorded by local health centre physician with prior knowledge of medical condition of deceased.

Table 3 Sample description by socio-demographic factors and health background

Variable		Female		Male		Total		Chi-square	P value
		n	%	n	%	n	%	χ2	P
Age
	< 30	2	1.2	3	1.3	5	1.3	-	-
	30-49	27	16.3	30	12.9	57	14.3	-	1.000
	50-69	70	42.2	123	52.8	193	48.4	-	1.000
	70+	67	40.4	77	33.0	144	36.1	-	1.000
	All ages	166	41.6	233	58.4	399	100
Place of death
	Health facilities1	46	28.0	80	34.3	126	31.6	-	-
	Home2	118	72.0	153	65.7	271	67.9	1.8	0.185
Medical history
	Hypertension	74	44.6	87	37.3	161	40.4	-	-
	Heart disease	73	44.0	133	57.9	206	51.6	4.2	0.041a
	Diabetes	20	12.0	30	12.1	50	12.5	-	0.516
Risk factors
	Smoking	4	66.7	172	93.0	176	44.1	-	-
	Alcohol	2	33.3	13	7.0	15	3.8	-	0.072
Recall period in days
	Mean	110		123				-	-
	Median	102		114				0	0.998

¹Health facilities¹: Includes deaths occurring in hospital, other health facilities and walk-in clinic; Home²: Includes deaths occurring at home and in transit;

^aP value < 0.05.

Table 4 Associations between strength of evidence and Verbal Autopsy interview characteristics

Variable	Category	Evidence				Chi-square	P value
		Acceptable		Weak		χ2	P
		n	%	n	%
Sex of deceased
	Male	189	81.5	43	18.5	-	-
	Female	110	66.7	55	33.3	11.4	< .001a
Age of deceased
	30-69	191	76.4	59	23.6	-	-
	70+	106	74.1	37	25.9	0.3	0.627
Place of death
	Hospital	111	87.4	16	12.6	-	-
	Home	188	69.9	81	30.1	14.3	< 0.001a
Relationship between respondent and deceased
	Spouse/sibling	109	86.5	17	13.5	-	-
	Parent/offspring	126	69.6	55	30.4	11.8	< 0.001a
Respondent living with the deceased
	Yes	223	76.4	69	23.6	-	-
	No	69	70.4	29	29.6	0.2	0.281
Recall period
	> 90 d	172	80.0	43	20.0	-	-
	≤ 90 d	122	70.1	52	29.9	4.4	0.036a

^aP value < 0.05.

Table 5 Deaths in health facilities and outside health facilities by gender

Deaths in health facilities		Acceptable evidence		Weak evidence		Chi-square
		n	%	n	%	χ2	P value
	Male	72	90.0	8	10.0	-	-
	Female	38	82.6	8	17.4	-	0.271
Deaths outside health facilities
	Male	117	77.0	35	23.0	-	-
	Female	71	60.7	46	39.3	-	0.005a

^aP value < 0.05.