InSilicoVA: A Method to Automate Cause of Death Assignment for Verbal Autopsy

Abstract

Verbal autopsies (VA) are widely used to provide cause-specific mortality estimates in developing world settings where vital registration does not function well. VAs assign cause(s) to a death by using information describing the events leading up to the death, provided by care givers. Typically physicians read VA interviews and assign causes using their expert knowledge. Physician coding is often slow, and individual physicians bring bias to the coding process that results in non-comparable cause assignments. These problems significantly limit the utility of physician-coded VAs. A solution to both is to use an algorithmic approach that formalizes the cause-assignment process. This ensures that assigned causes are comparable and requires many fewer person-hours so that cause assignment can be conducted quickly without disrupting the normal work of physicians. Peter Byass' InterVA method is the most widely used algorithmic approach to VA coding and is aligned with the WHO 2012 standard VA questionnaire. The statistical model underpinning InterVA can be improved; uncertainty needs to be quantified, and the link between the population-level CSMFs and the individual-level cause assignments needs to be statistically rigorous. Addressing these theoretical concerns provides an opportunity to create new software using modern languages that can run on multiple platforms and will be widely shared. Building on the overall framework pioneered by InterVA, our work creates a statistical model for automated VA cause assignment.