Circumstances of Mortality Categories (COMCAT) in International Context: A Scoping Review of Applications and Outcomes

Background: Up to 60% of deaths worldwide go unrecorded. Verbal autopsy (VA) was introduced to capture deaths occurring outside health systems and assign medical causes. Conventionally, VA doesn’t capture social and health systems circumstances shaping how, where and why a death occurred. Thus, the Circumstances of Mortality Categories (COMCAT) tool made of eight categories was developed to close this gap by assigning a probable circumstantial category to each VA-investigated death. Objectives: To map literature applying COMCAT; describe settings and populations included; synthesise reported outcomes; and identify implications for further methodological development. Design: Joanna Briggs Institute Scoping review methodology and PRISMA-ScR guidelines. Methods: Ovid MEDLINE, Embase and CAB Abstracts were searched between June and August 2026, supplemented by citation chasing and grey-literature. Data extraction was across three domains: study characteristics; COMCAT application; and Outcomes &Implications. Results: Ten studies met the inclusion criteria spanning 14 countries and a total of 18,630 deaths. Descriptive comparisons revealed Emergencies and Recognition dominated alongside infections in younger populations; and Inevitability in older and chronically-diseased populations. COMCAT’s reliability (InterVA-5 against physician review) was reported in only one study (κ = 0.04) of 16 deaths in India. The refined eight-category model, including Referral, has not been re-applied since its proof of concept. Conclusions: COMCAT generates plausible, policy relevant circumstantial mortality data. While crucial to healthcare planning, further methodological development is required to address key concerns including absence of a gold standard; heterogeneity across different care pathways; and input and model availability for its latest refinement.