Tuberculosis mortality: quantifying agreement in clinical cause of death assessments

Abstract

Objectives: Mortality is a key statistic for public health globally, and mortality reduction is a key target of ‘End TB’ strategy. However, cause of death in relation to tuberculosis (TB) may be controversial, and we aimed to evaluate classification in Australia. Methods: We surveyed Australian clinicians and public health officers, presenting a variety of scenarios. Respondents were asked to classify each scenario with regards to whether TB was considered causative, contributory or not related to death. Results: Fifty-nine individuals completed the survey. Respondents were experienced TB clinicians and public health officers (median 14 years of TB care experience), with a majority having recently been involved in death certification/classification. In most scenarios, there was substantial variation, particularly where death was related to TB medications, or if an alternative contributing process was recognised, such as cardiovascular complications. Variation in classification was not evidently associated with classification experience. Conclusion: We found significant variation in cause of death classification among experienced TB clinicians and public health officers, using representative TB death scenarios. Implications for public health: Consensus and transparency with regards to classification would assist in more uniform cause of death classification across jurisdictions and allow for better tracking of this critical performance measure.