Monumental measurement of mortality

The world's largest prospective study on mortality, in which a staff of a thousand are monitoring 14 million people in 2.4 million representative households, is currently underway in India. As described in the open access journal PLoS Medicine, the study will ascertain the causes of one million deaths expected to occur among these people in the period between 1998 and 2014. Three quarters of the 9.5 million annual deaths in India occur in the home, and most of them do not have a certified cause. Reliable mortality measurements for the Indian population are urgently needed, particularly in light of the rising adult mortality from HIV/AIDS and non-communicable diseases like heart disease and cancer. The routine collection of mortality data, covering variations in age, sex, socioeconomic status and region, is critical to the success of public health programs.

To tackle the daunting task, over a dozen prominent Indian and global institutions - led by Prabhat Jha of St. Michael's Hospital and the University of Toronto - have formed a novel partnership with the Indian government. India's Sample Registration System (SRS) works by sending two independent surveyors to monitor selected households in rural and urban areas across India. To better document the causes of death within the SRS framework, the study has trained 800 full-time government staff to use a simple and validated method called verbal autopsy.

Family or close associates of the deceased discuss the details of his or her death in structured one-on-one interviews. To ensure the robustness of the method, a random 10% of the fieldwork is repeated by an independent audit team. About 300,000 deaths from 1998-2003 are expected to be recorded in the first phase of the study, and 700,000 from the second phase between 2004 and 2014. Around 850,000 of these will be coded by two independent physicians, with a third arbitrating in the case of disagreement, to record causes of death. The study to date has already demonstrated that causes of death can be measured reliably in young and middle age, when most avoidable deaths occur.

The results of this large-scale effort will improve the understanding of various health risk factors such as tobacco and alcohol use, indoor air pollution, fertility preferences for male children, immunization, and migration. But Jha and colleagues have even bigger ambitions: they are testing the feasibility of collecting physical measurements, such as blood pressure and obesity, and blood samples from adults in the survey to measure other risk factors. The study could substantially improve our understanding of genetic and environmental factors that influence an individual's risk for a variety of conditions, including infectious diseases common to developing countries and chronic diseases common worldwide.

Citation: Jha P, Gajalakshmi V, Gupta PC, Kumar R, Mony P, et al. (2006) Prospective study of 1 million deaths in India: Rationale, design, and validation results. PLoS Med 3(2): e18.

CONTACTS: Dr. Prabhat Jha
University of Toronto
Centre for Global Health Research, St Michael's Hospital
70 Richmond Street
Toronto, ON Canada M5C1N8
+1 416.864.6042
+1 416.864.5256
prabhat.jha@utoronto.ca

Sharon Bala
Media Relations
St. Michael's Hospital
Tel: + 1 416.864.5047
or page via Locating +1 416-864-5431

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