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Publications by Author: Kenji Shibuya

2010
Deaths From Heart Failure: Using Coarsened Exact Matching to Correct Cause of Death Statistics
Gretchen Stevens, Gary King, and Kenji Shibuya. 2010. “Deaths From Heart Failure: Using Coarsened Exact Matching to Correct Cause of Death Statistics.” Population Health Metrics, 8, 6.Abstract

Background: Incomplete information on death certificates makes recorded cause of death data less useful for public health monitoring and planning. Certifying physicians sometimes list only the mode of death (and in particular, list heart failure) without indicating the underlying disease(s) that gave rise to the death. This can prevent valid epidemiologic comparisons across countries and over time. Methods and Results: We propose that coarsened exact matching be used to infer the underlying causes of death where only the mode of death is known; we focus on the case of heart failure in U.S., Mexican and Brazilian death records. Redistribution algorithms derived using this method assign the largest proportion of heart failure deaths to ischemic heart disease in all three countries (53%, 26% and 22%), with larger proportions assigned to hypertensive heart disease and diabetes in Mexico and Brazil (16% and 23% vs. 7% for hypertensive heart disease and 13% and 9% vs. 6% for diabetes). Reassigning these heart failure deaths increases US ischemic heart disease mortality rates by 6%.Conclusions: The frequency with which physicians list heart failure in the causal chain for various underlying causes of death allows for inference about how physicians use heart failure on the death certificate in different settings. This easy-to-use method has the potential to reduce bias and increase comparability in cause-of-death data, thereby improving the public health utility of death records. Key Words: vital statistics, heart failure, population health, mortality, epidemiology

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Designing Verbal Autopsy Studies
Gary King, Ying Lu, and Kenji Shibuya. 2010. “Designing Verbal Autopsy Studies.” Population Health Metrics, 8, 19.Abstract
Background: Verbal autopsy analyses are widely used for estimating cause-specific mortality rates (CSMR) in the vast majority of the world without high quality medical death registration. Verbal autopsies -- survey interviews with the caretakers of imminent decedents -- stand in for medical examinations or physical autopsies, which are infeasible or culturally prohibited. Methods and Findings: We introduce methods, simulations, and interpretations that can improve the design of automated, data-derived estimates of CSMRs, building on a new approach by King and Lu (2008). Our results generate advice for choosing symptom questions and sample sizes that is easier to satisfy than existing practices. For example, most prior effort has been devoted to searching for symptoms with high sensitivity and specificity, which has rarely if ever succeeded with multiple causes of death. In contrast, our approach makes this search irrelevant because it can produce unbiased estimates even with symptoms that have very low sensitivity and specificity. In addition, the new method is optimized for survey questions caretakers can easily answer rather than questions physicians would ask themselves. We also offer an automated method of weeding out biased symptom questions and advice on how to choose the number of causes of death, symptom questions to ask, and observations to collect, among others. Conclusions: With the advice offered here, researchers should be able to design verbal autopsy surveys and conduct analyses with greatly reduced statistical biases and research costs.
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