Exposing Misclassified HIV/AIDS Deaths in South Africa/Presentation Du Classement Incorrect Des Deces Lies Au VIH/SIDA En Afrique Du Sud/Difusion De Las Muertes Relacionadas Con El VIH/SIDA Y Clasificadas Erroneamente En Sudafrica
Year: 2011
Type: article
Abstract: Introduction In 2007, South Africa's epidemic of immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS), one of the world's largest, accounted for 17% of the global burden of HIV/AIDS). (1,2) As in other African countries, the epidemic is monitored primarily through antenatal clinic data and data from population surveys. These data are modelled to yield incidence, prevalence and mortality estimates for H IV/ AIDS. (3-5) Yet unlike most other countries with a high burden of HIV/AIDS, South Africa has a national vital registration system that tracks deaths from these causes, although admittedly its coverage is incomplete and its death certification and coding are of questionable quality. For these reasons, the system is not very useful for generating HIV/AIDS statistics. While coverage has steadily improved--it was estimated at 85% in 1996 and 89% in 2000 for adults (6)--data quality is still lacking. Death certificate audits have revealed errors in as many as 45% of all records, a situation that hampers cause of death analysis. (7-10) Moreover, misclassification of HIV/AIDS deaths occurs for reasons beyond these general quality issues. According to the guidelines given in the International Classification of Diseases and Related Health Problems, tenth revision (ICD-10), HIV/ AIDS is the underlying cause of death when an HIV-positive individual dies from a co-morbid condition resulting from the HIV infection (codes B20-B24). (11) In South Africa, issuers of death certificates seldom know or have access to an individual's HIV status, and rural community leaders often omit it when they fill out abbreviated certificates. In addition, many people are unwilling to be tested for HIV for fear of stigma or of losing health insurance benefits. These factors, together with concerns regarding the confidentiality of death certificates, result in an underreporting of deaths from HIV/AIDS. (8,12-14) Despite these issues, South Africa's vital registration system remains a key source of data; it comprises the largest continuous data set for causes of death in southern Africa. Analytic techniques for adjusting for known biases are needed to find a middle ground between uncritically using the raw data and discarding them altogether. Groenewald et al. proposed adjusting a 2000-2001 data sample for misclassification of deaths from HIV/AIDS by comparing the age-specific death rates for selected causes to 1996 rates and attributing deaths to HIV/AIDS when both a noticeable increase in mortality and an age pattern characteristic of HIV/AIDS were present. (12) This method relied on the assumptions that misclassification was negligible in 1996 and that subsequent death rates for indicator causes remained constant at 1996 levels. No further national corrections of vital registration data have appeared in the literature, and the latest report on mortality and causes of death issued by Statistics South Africa did not include corrections for misclassification. (15) We propose an alternative empirical method of quantifying misclassified deaths from HIV/AIDS in South Africa's death registry and provide updated counts of the deaths attributable to H IV/AIDS in 1996-2006. Methods Data Death registration data based on ICD-10 codes were obtained from the mortality database of the World Health Organization (WHO) and aggregated to correspond to 48 mutually exclusive causes of death as listed in Naghavi et al. (16) (Appendix A, available at: http://www.healthmetricsandevaluation.org/sites/default/files/ publication_summary/2011/HIV_IHME_webappendix_0211.pdf). This list is composed of the 47 causes of death of public health importance that comprise most ICD-10 codes and contains a 48th category labelled garbage codes, which includes ill-defined and unspecified causes and modes of death that should never be given as underlying causes (e.g. heart failure). (16-19) The 48 causes are specific enough to provide meaningful distinctions but are also broad enough to not be influenced by minor certification or coding errors. …
Language: Spanish
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2616332796