成都市农村地区死因监测数据质量评价

目的评价成都市农村地区死因监测数据质量。方法使用话语解剖量表,抽样调查652例农村地区院外死亡病例,和常规报告填写的死亡卡片以及通过死因直报系统上报的数据进行比对,判断常规报告卡片填写和上报的准确性。结果各类疾病报告的一致性〉0.4,敏感度和阳性预测值〉75%,错分比例〈25%。结论成都市农村地区死因报告质量较好,通过监测数据获得的死亡模式可靠。     

应用捕获-再捕获方法估计汶上县全死因死亡率和漏报率

目的应用捕获-再捕获方法估计汶上县全死因死亡率,评价死因登记报告系统收集死亡资料的完整性。方法 2009年收集汶上县死因登记报告系统和死因漏报系统的全死因死亡资料。不同来源数据间的匹配使用姓名、年龄、性别、死亡时间、死亡原因和居住地址等变量。应用Chapman and Wittes的无偏估计公式估计目标人群的死亡人数。结果两来源资料中共报告全死因死亡人数为77人,死亡率为7.13‰。死因登记报告系统报告的全死因死亡人数为69人,死亡率为6.39‰。用捕获-再捕获方法估计的全死因死亡人数为79人,死亡率为7.32‰。死因登记报告系统的漏报率为12.6%,两样本合并后,漏报率为2.6%。结论仅使用死因登记报告系统或合并样本资料会低估全死因死亡率,而利用现有的资料,使用捕获-再捕获方法可以校正低估的全死因死亡率。     

根本死因自动编码工具的应用研究

为提高常规死因监测中根本死因编码的准确性，按照WHO的ICD-10根本死因编码规则及国际上同类软件开发设计原理，并参照美国编码策略表，通过计算机语言实现根本死因编码的自动化，研制基于全国死因登记报告信息系统的根本死因自动编码工具，其根本死因编码正确率达到85 %，实现了对死亡个案数据的自动编码，且编码正确率达到国际同类软件水平。     

死亡病例网络直报工作存在问题与对策探讨

目的发现和了解死亡病例网络直报工作中存在的问题,为此项工作的不断完善提供对策性研究。方法对2004年以来"死因登记报告信息系统"中平顶山市报告病例卡片出现的错误进行归纳分类,结合对错误卡片的核查结果和审核订正记录资料分析错误发生的原因。结果在含有错误(或瑕疵)的报告卡片中,死因诊断不明的占10%,因既往史资料收集不全导致报告错误的占15%,诊断明确但死亡报告卡填写错误的占75%;ICD-10死因分类知识培训不到位,临床医生不了解死亡证明书填写规则,管理制度不完善,是影响死因报告工作质量的主要原因。结论对临床医生和疾病控制机构死因报告人员分层次进行培训,健全管理制度,完善考评机制,是降低错误率、提高报告质量的关键环节。     

某国家级死因监测点漏报调查及死因监测质量评价

目的 了解某国家级死因监测点居民死亡漏报情况,评价死因监测信息系统报告的完整性和准确性。 方法 某国家级死因监测点居民死亡信息来源于泸县3个抽样点。采用随机整群抽样的方法,在泸县抽取3个镇(抽样点)共42个村/社,分别从派出所、社事办、妇幼、村(居委会)等渠道收集抽样点2018—2020年全部人口死亡信息,与“人口死因监测信息管理系统”死亡报告数据进行比较,计算漏报率。对“人口死因监测信息管理系统”中抽样点居民死亡报告卡进行审核,评估死因诊断的可靠性和编码质量。 结果 泸县人群总死亡漏报率为9.38%;2018—2020年,漏报率逐渐下降,分别为18.31%、7.53%、2.16%,年度变化百分比为-11.9%,变化趋势差异有统计学意义(t=-5.175,P＜0.001),抽样点死因诊断可靠性和准确性较高,可靠诊断单位占比81.81%,可靠诊断依据占比75.67%,根本死因编码错误率为0.21%。 结论 泸县死因监测数据质量较好,但仍需进一步降低漏报率,提高死因监测数据的完整性和诊断的可靠性。     

2010～2012年北京市延庆县死亡漏报调查

目的了解北京市延庆县居民死因登记工作的漏报情况及主要原因。方法采用多阶段按比例整群抽样的方法,确定分层原则,采用分层随机抽样方法抽取7个镇乡/街道共36个行政村/居委会作为调查点,以2010~2012年延庆县人口抽样死因回顾性调查数据作为实际死亡数据,将常规报告数据与之进行匹配,未匹配上的记录为漏报数据。计算漏报率并分析其在人群中的分布。结果 2010~2012年延庆县调查点实际死亡人数为456人,漏报人数为42人,总漏报率为9.21%;不同乡镇比较,珍珠泉乡漏报率最高,为22.08%,旧县镇无漏报;不同地区分类比较,非火化区漏报率最高;因脑血管病死亡漏报率最高为10.22%;2012年度漏报率最高为12.66%。结论延庆县居民死亡漏报现象仍较为严重,应进一步采取相应的措施,提高死因报告的质量。     

2007-2010年安福县医疗机构死因监测结果分析

目的了解安福县医疗机构死亡病例的死因构成,为制定疾病预防控制措施提供科学依据。方法资料来源于安福县2007-2010年通过死因登记报告信息系统报告的所有死亡病例个案,使用根本死因编码进行死因构成及顺位分析。结果 2007-2010年安福县死因登记报告信息系统共报告死亡病例692例,排在前10位的死因分别为循环系统疾病(25.14%)、损伤和中毒外部原因(22.83%)、肿瘤(18.06%)、呼吸系统疾病(8.96%)、起源于围生期的某些情况(5.50%)、消化系统疾病(4.77%)、传染病(3.90%)、先天畸形、变性和染色体异常(3.03%)、泌尿生殖系统疾病(2.6 0%)、内分泌及营养和代谢的其他疾病(2.31%)。各年龄组的死因构成不同。0岁组的主要死因为围生期疾病(51.35%),1~39岁组的主要死因为损伤和中毒外部原因(54.78%),≥40岁组的主要死因为慢性非传染性疾病(73.36%)。结论安福县医疗机构死亡病例的死因主要为慢性非传染性疾病、损伤和中毒外部原因及起源于围生期的某些情况。各年龄组的死因构成有很大差别,应采取针对性干预措施。     

濉溪县2013年居民死亡原因分析

目的了解濉溪县居民的死因特点,为制定疾病防治策略提供科学依据。方法通过死因监测信息报告系统,对濉溪县2013年死亡居民资料进行统计分析。结果 2013年濉溪县共网络报告死亡5 557人,总死亡率为517.66/10万,标化死亡率505.02/10万,男女死亡率分别为591.22/10万、435.38/10万。慢性非传染性疾病死亡占86.40%。心脏病、脑血管病、恶性肿瘤、伤害、呼吸系统疾病前5位死因占94.76%。男女居民前5位死因相同,但顺位有所不同。不同年龄人群的主要死因不同。潜在寿命损失(PYLL)前5位分别为伤害、恶性肿瘤、心脏病、脑血管病、传染病和寄生虫病,标化平均潜在寿命损失(S·AYLL)分别为32.25年、16.78年、12.31年、10.49年、20.91年。结论慢性非传染性疾病是当前濉溪县的疾病控制重点,应针对不同年龄人群采取相应的防控措施。     

同安县1987—1995年老年人常见死因的动态分析

随着经济的发展和人民生活水平的提高，人均期望寿命逐渐延长，随之而来的是日益突出的老年人的预防保健问题。本文参照同安县1987～1995年老年人的死亡资料对该县老年人常见死因的死亡情况、发病趋势、分布特征进行分析，为预防老年人常见病提供科学依据。一、材料与方法1987～1989年的资料来自全死因回顾调查，1990年起采用县、乡、村三级死因登记报告资料，人口资料由县统计局提供。死因资料按国际疾病分类法ICD—9编码，在386微机上用EPiinfo软件运行，用常规统计学方法计算死亡率、占死因的百分比、死因位次，用1964年全国标准人口计…     

张家港市2011年居民死亡资料分析

目的分析张家港市2011年居民死亡资料,为相关部门制定卫生工作决策和评价疾病预防控制工作的防治效果提供基础信息和科学依据。方法利用DeathReg 2005《死亡医学登记系统》进行分析,计算居民的粗死亡率、分性别死亡率、婴儿死亡率、新生儿死亡率、平均期望寿命、死因构成和死因顺位等统计指标。利用SPSS 13.0软件计算不同性别间死亡率差异有无统计学意。结果 2011年张家港市居民粗死亡率为693.78/10万,标化死亡率为311.69/10万,男性死亡水平高于女性;婴儿死亡率为3.68‰,新生儿死亡率为2.39‰;平均期望寿命为81.34岁;前10位死因依次为恶性肿瘤、脑血管病、损伤和中毒、呼吸系统疾病、心脏病、内分泌营养代谢疾病、其他疾病、精神障碍疾病、消化系统疾病、神经系统疾病,共占全部死因的95.85%,其中男性前3位死因是恶性肿瘤、脑血管病和呼吸系统疾病,女性前3位死因是脑血管病、恶性肿瘤和损伤和中毒。结论恶性肿瘤、脑血管病和损伤和中毒已经成为影响居民健康的重要公共卫生问题,应将以上因素的预防控制措施作为今后工作的重点,从而提高居民的生活质量。     

死因推断在儿童生命登记系统中的应用

儿童死亡原因的登记与报告是信息统计工作中的重要组成部分。世界上各国进行生命登记的方法大致可分为全人群生命登记系统和监测点生命登记系统,此外还有医疗机构信息统计、人口普查和入户调查等。其中死亡原因的统计不仅要靠临床诊断,还应辅以回顾性死因推断的方法。该方法在全世界得到了广泛应用,但我国在儿童死亡原因调查和统计方面还缺乏全国性的标准和规范,今后应不断规范我国儿童死亡原因登记工作。     

Validation of verbal autopsy procedures for adult deaths in China

BACKGROUND: Vital registration of causes of death in China is incomplete with poor coverage of medical certification. Information on the leading causes of mortality will continue to rely on verbal autopsy (VA) methods. A new international VA form is being considered for data collection in China, but it first needs to be validated to determine its operating characteristics. METHODS: Detailed medical records and clinical evidence for 3290 deaths (mostly adults) among residents of six cities representative of the urban Chinese population were reviewed by a panel of physicians and coded by experts to establish a reference underlying cause of death. Independently, families of the deceased were interviewed using a structured symptomatic questionnaire and a separate death certificate was prepared for each matching case (2102). Validity of the VA procedure was assessed using standard measurement criteria of sensitivity, specificity, and positive predictive value. RESULTS: VA methods perform reasonably well in identifying deaths from several leading causes of adult deaths including stroke, several major cancer sites (lung, liver, stomach, oesophagus, and colorectal), and transport accidents. Sensitivity was less satisfactory in detecting deaths from several causes of major public health concern in China including ischaemic heart disease, chronic obstructive pulmonary disease, diabetes, and tuberculosis, and was particularly poor in diagnosing deaths from viral hepatitis, hypertension, and kidney diseases. CONCLUSIONS: VA is an imprecise tool for detecting leading causes of death among adults. However, much of the misclassification generally occurs within broad cause groups (e.g. CVD, respiratory diseases, and liver diseases). Moreover, compensating patterns of misclassification would appear to suggest that, in urban China at least, the method yields population-level cause-specific estimates that are reasonably reliable. These results suggest the possible utility of these methods in rural China, to back up the low coverage of medical certification of cause of death owing to poor access to health facilities there.     

Validation of cause-of-death statistics in urban China

BACKGROUND: National vital registration systems are the principal source of cause specific mortality statistics, and require periodic validation to guide use of their outputs for health policy and programme purposes, and epidemiological research. We report results from a validation of cause of death statistics from health facilities in urban China. METHODS: 2917 deaths from health facilities located in six cities in China constituted the study sample. A reference diagnosis of the underlying cause was derived for each death, based on expert review of available medical records, and compared with that filed at registration. Sensitivity, specificity and positive predictive value were computed for specific causes/cause categories according to the International Classification of Diseases (ICD), including analyses based on quality of evidence scores for each cause. Patterns of misclassification by the registration system were studied for individual causes of death. RESULTS: The registration system had good sensitivity in diagnosing cerebrovascular disease and several site specific cancers (lung, liver, stomach, colorectal, breast and pancreas). Sensitivity was average (50-75%) for some major causes of adult death in China, namely ischaemic heart disease (IHD), chronic obstructive lung disease (COPD), diabetes, and liver and kidney diseases, with compensatory misclassification patterns observed between several of them. Sensitivity was particularly low for hypertensive disease. CONCLUSIONS: Although diagnostic misclassification is not uncommon in urban death registration data, they appear to balance each other at the population level. Compensating misclassification errors suggest that caution is required when drawing conclusions about particular chronic causes of adult death in China. Investment is required to improve the quality of cause attribution for health facility deaths, and to assess the validity of cause attribution for home deaths. Periodic assessments of the quality of cause of death statistics will enhance their usability for health policy and epidemiological research.     

Estimating mortality and causes of death in Turkey: methods, results and policy implications

BACKGROUND: Cause-specific mortality statistics are primary evidence for health policy formulation, programme evaluation, and epidemiological research. In Turkey, a partially functioning vital registration system in urban areas yields fragmentary evidence on levels and causes of mortality. This article discusses the application of innovative methods to develop national mortality estimates in Turkey, and their implications for national health development policies. METHODS: Child mortality levels from the Demography and Health Survey (DHS) were applied to model life tables to estimate age-specific death rates. Reported causes of death from urban areas were adjusted using re-distribution algorithms from the Global Burden of Disease (GBD) Study. Rural cause structure was estimated from epidemiological models. Local epidemiological data was used to adjust model-based estimates. RESULTS: Life expectancy at birth in 2000 was estimated to be 67.7 years (males) and 71.9 years (females), about 8-10 years lower than in Western Europe. Leading causes of death include major vascular diseases (ischaemic heart disease, stroke) causing 35-38% of deaths, chronic obstructive lung disease and lung cancer in men, but also perinatal causes, lower respiratory infections and diarrhoeal diseases. Injuries cause about 6-8% of deaths, although this may be an underestimate. CONCLUSIONS: Mortality estimates are uncertain in Turkey, given the poor quality of death registration systems. Application of burden of disease methods suggests that there has been progress along the epidemiological transition. Key health development strategies for Turkey include improved access to communicable disease control technologies, and urgent attention to the development of a reliable, nationally representative health information system.     

Urban-Rural Disparities in Injury Mortality in China, 2006

Context: Urban-rural disparity is an important issue for injury control in China. Details of the urban-rural disparities in fatal injuries have not been analyzed.
Purpose: To target key injury causes that most contribute to the urban-rural disparity, we decomposed total urban-rural differences in 2006 injury mortality by gender, age, and cause.
Methods: Mortality data came from the Chinese Vital Registration data, covering a sample of about 10% of the total population. The chi-square test was used to test the significance of urban-rural disparities.
Findings: For all ages combined, the injury death rate for males was 60.1/100,000 in rural areas compared with 40.9 in urban areas; for females, the respective rates were 31.5 and 23.6/100,000. The greatest disparity was at age <1 year for both sexes, where the rate from unintentional suffocation in rural areas was more than twice the urban rate. The higher mortality from drowning among males of all ages and among females ages 1-24 and 35+ contributed substantially to the age-specific urban-rural disparities. For both sexes, transportation incidents and suicide were the most important contributors to higher rates among rural residents ages 15+.
Conclusions: Unintentional suffocation, drowning, transportation incidents, and suicide not only are the major causes of injury death, but also play a key role in explaining the urban-rural disparities in fatal injuries. Further research is needed to identify factors leading to higher rural death rates and to explore economical and feasible interventions for reducing injuries and narrowing the urban-rural gap in injury mortality.     

Impact of Policy Initiatives on Civil Registration System in Haryana

Background:

Despite the existence of Registration of Birth and Death Act (1969), Civil Registration System (CRS) in India registered only 68.3% of the births and 63.2% of the deaths. Hence, National Population Policy (2000) emphasized the need to improve registration of vital events. In 2005, Haryana initiated policy changes to enhance registration of vital events. We evaluated the impact of these policy changes on CRS in 2009.

Materials and Methods:

Records and reports of CRS were reviewed. On the basis of the birth and deaths reported by the Sample Registration System, the proportion of births and deaths registered by CRS were estimated using the projected population from 2001 Census.

Results:

Before 2005, Police Stations were the registration centers in rural Haryana. On 1^st January 2005, the birth and death registration was made the responsibility of Primary Health Centers (PHCs). Medical Officers at PHCs were designated as Registrar and Pharmacists as Sub-Registrar of Births and Deaths. Auxiliary Nurse Midwife and Anganwadi Workers facilitated the registration. Till 2004, the registration of births was stagnant at the level of 70% for several years, which increased to 95% by 2009. Similarly registration of death events increased from 73.5% to 92.1%.

Conclusion:

Haryana state is still to achieve complete registration of births and deaths, but certainly shift of registration from police to health department has strengthened the CRS.     

2008-2012年中国肿瘤登记地区脑及神经系统肿瘤发病与死亡分析

目的 描述中国肿瘤登记地区2008-2012年脑及神经系统肿瘤发病与死亡水平。方法 对全国135个肿瘤登记处的数据进行汇总,计算脑及神经系统肿瘤的发病率与死亡率。结果 2008-2012年全国肿瘤登记地区脑及神经系统肿瘤发病率为6.21/10万,中国人口标化率（以下简称中标率）为3.93/10万,世界人口标化率（以下简称世标率）为3.87/10万,占全部恶性肿瘤发病的2.19%,位居全部恶性肿瘤发病的第11位。男性发病率为9.45/10万（中标率为6.31/10万）,女性发病率2.88/10万（中标率1.72/10万）。城市和农村地区,脑及神经系统肿瘤发病率分别为7.59/10万和4.07/10万（发病中标率分别为4.60/10万和2.78/10万）。2008-2012年,全国肿瘤登记地区脑及神经系统肿瘤死亡率为2.48/10万（中标率和世标率都为1.40/10万）,在各种恶性肿瘤死亡原因中排列第12位。男性的死亡率为3.71/10万,女性为1.21/10万。城市和农村地区脑及神经系统肿瘤死亡率分别为2.91/10万和1.81/10万（中标死亡率分别为1.53/10万和1.16/10万）。结论 脑及神经系统肿瘤是危害中国居民主要恶性肿瘤之一,城市发病率高于农村,男性高于女性。应加强脑及神经系统肿瘤的预防与控制工作。     

山东省诸城市2010年居民恶性肿瘤死亡情况分析

目的对诸城市2010年居民恶性肿瘤死亡情况进行分析,为制定恶性肿瘤的防治措旅提供科学依据。方法应用死亡率、标化死亡率、构成比等对死因登记报告信息系统中诸城市2010年恶性肿瘤死亡资料进行分析。结果2010年诸城市居民恶性肿瘤死亡率178．60／10万,标化死亡率105．81／10万,居全死因首位,占全死因的23．19％;男性高于女性,性别比值为1．92;前3位恶性肿瘤死因依次为肺癌、肝癌和胃癌,占恶性肿瘤死亡总数的70．68％。结论恶性肿瘤已成为诸城市居民的主要致死疾病之一,肺癌、肝癌、胃癌是造成居民死亡的主要恶性肿瘤,是今后我市恶性肿瘤防控工作的重点。     

Myanmar mortality registration: an assessment for system improvement

Background

The vital registration system in Myanmar has a long history and geographical coverage is currently high. However, a recent assessment of vital registration systems of 148 countries showed poor performance of the death registration system in Myanmar, suggesting the need for improvement. This study assessed the quality of mortality data generated from the vital registration system with regard to mortality levels and patterns, quality of cause of death data, and completeness of death registration in order to identify areas for improvement.

Methods

The study used registered deaths in 2013 from the vital registration system, data from the 2014 Myanmar Population and Housing Census, and mortality indicators and COD information for the country estimated by international organizations. The study applied the guidelines recommended by AbouZahr et al. 2010 to assess mortality levels and patterns and quality of cause of death data. The completeness of death registration was assessed by a simple calculation based on the estimated number of deaths.

Results

Findings suggested that the completeness of death registration was critically low (less than 60%). The under-registration was more severe in rural areas, in states and regions with difficult transportation and poor accessibility to health centers and for infant and child deaths. The quality of cause of death information was poor, with possible over-reporting of non-communicable disease codes and a high proportion of ill-defined causes of death (22.3% of total deaths).

Conclusion

The results indicated that the vital registration system in Myanmar does not produce reliable mortality statistics. In response to monitoring mortalities as mandated by the Sustainable Development Goals, a significant and sustained government commitment and investment in strengthening the vital registration system in Myanmar is recommended.

     

昆山市慢性病流行现状与防治对策

目的 分析昆山市慢性病的流行现状与疾病负担，探讨其防治对策。方法 对昆山市1999年慢性病基线调查资料与生命统计资料进行常规统计分析，对慢性病死亡情况进行PYLL及DALY分析。结果 1999年城乡高血压患病率分别高达28．93％和22．40％，是首要的公共卫生问题；慢性病死亡构成占全死因的71．79％；1～70岁人群慢性病死亡造成19329个PYLL损失，占全死因PYLL的78．09％；推测慢性病死亡和伤残造成的DALY损失为6．6万个健康生命年。结论 慢性病造成了较为沉重的疾病负担，积极开展社区综合防治是有效途径。