Dying to make a care policy: Community perception of causes of deaths using standardized verbal autopsy method: Saudi type 2 diabetes mellitus register data

Abstract

Diabetes mellitus (DM) is a serious global health issue which significantly impacts public health and socioeconomic development. Exploring how the community perceives the causes of deaths and their associated risk factors is crucial for public health. This study combines verbal autopsy (VA) with the Type 2 Diabetes Mellitus (T2DM) register to explore community perceptions of causes of death and associated influential factors in the western region of Saudi Arabia. 302 VA interviews were conducted with relatives or caregivers of deceased who died between 2017 and 2021 based on T2DM medical register from Alnoor Specialist Hospital in Makkah city, Saudi Arabia. Cause-specific mortality fractions (CSMFs) obtained from the VA using the InterVA-5 model were utilized to assess community perception. We used a multivariable logistic regression model to determine factors influencing community perceptions of causes of death. Lin's CCC with 95% CI was used to analyze the concordance for the CSMFs from verbal autopsy causes of death (VACoD) as a presumed reference standard and family-reported causes of death (FRCoD). The outcomes of this study demonstrate a generally broad spectrum of community perceived mortalities, with some critical misconceptions based on the type of death and the deceased's background and characteristics, with an overall CCC of 0.60 (95% CI: 0.20-1.00; p=003). The study findings demonstrate that community perception is weak if the deceased was male compared to female (aOR: 0.52; 95% CI: 0.26 –1.03) and if the deceased was >=80 years compared to 34–59 years (aOR: 0.48; 95% CI: 0.16-1.38), but it significantly improves among married compared to single (aOR: 2.13; 95% CI: 1.02 –4.42). The Saudi community perception of causes of death with reported type 2 diabetes was relatively plausible but varied substantially based on the type of death, sex, age >=80 years, and other vital events like marital status. Higher or lower community perception is attributed to how people may perceive risk factors associated with the causes of death, which can guide public health planning and interventional programs. The study findings further emphasize the need to employ robust and standardized VA methods within the routine medical services for a systemized assessment of families' reported causes of death.