应用捕获-再捕获法评估云南省疾病监测点居民死亡水平

目的 应用捕获-再捕获方法(CMR)评价居民死因登记报告质量,校正常规监测居民死亡率和婴儿死亡率.方法 采用多阶段随机整群抽样方法,对抽取的37 538户居民逐户调查人口死亡情况,再与同期监测系统所报告的死亡资料进行核对,计算漏报率以及总体死亡率95%可信区间(CI).结果 云南省国家疾病监测点居民死亡漏报率和婴儿死亡漏报率分别为19.86%和44.74%;校正报告死亡率和校正报告婴儿死亡率分别为7.04‰和32.29%.;估计总体死亡率和总体婴儿死亡率95%CI分别为6.89%.～7.18%和23.02‰～41.57%.结论 使用捕获一再捕获方法可以校正低估的全死因死亡率和婴儿死亡率,适时开展漏报调查,是有效弥补常规监测不足的方法之一.     

捕获-再捕获方法在估计居民全死因死亡漏报率中的应用

目的应用捕获-再捕获方法(CMR)评价合肥市居民死因登记报告的质量,校正常规监测居民死亡率。方法采用分层随机抽样法,对抽取的51,504人调查人口死亡情况,再与同期监测系统所报告的死亡资料进行核对,计算漏报率以及总体死亡率的95%可信区间(CI)。结果 2007～2009年3年的报告死亡率分别为2.89%、3.34%、3.86%,校正报告死亡率分别为4.17%、4.76%和4.75%。结论使用捕获-再捕获方法可以校正死亡率,适时开展漏报调查可有效弥补常规监测的不足。     

应用捕获-再捕获方法评价死因登记报告信息完整性

目的应用捕获-再捕获方法估计汶上县全死因死亡率和漏报率,并评价死因登记报告系统收集死亡信息的完整性。方法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采用标准匹配。应用Chapman和Wittes的无偏估计公式估计目标人群的死亡人数。结果在抽样地区,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%。结论死因登记报告信息存在明显的漏报,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。     

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。     

用捕获-再捕获方法估计林州市传染病死亡人数

目的应用捕获-再捕获方法估计林州市2004—2005年的传染病死亡人数，以评价死因登记处中传染病死亡数据的完整性。方法收集林州市死因登记处、民政和公安三来源2004—2005年的传染病死亡登记资料。用居住地址、姓名、性别、身份证编码、死亡时间、死亡原因等变量对不同来源数据进行匹配。利用三来源的对数线性泊松模型估计林州市2004—2005年真实的传染病死亡人数。结果在2004—2005年共报告传染病死亡人数为361人；用捕获-再捕获方法估计传染病死亡人数为375人（95％CI：367～393），以此估计值作分母，登记处的漏报率为6．7％，公安、民政和登记处资料合并后的漏报率为3．7％。结论运用捕获-再捕获法对传染病死亡登记进行估计，可以校正因漏报而造成的数值误差，获得较准确的传染病死亡人数。     

应用捕获-再捕获方法估计儿童出生率

为了解常规的儿童出生月报系统出生率的可信性 ,以及对该系统报告质量作出科学的评价 ,从而为发现、分析、解决该系统运行过程中存在的问题提供科学的依据 ,运用捕获 -再捕获方法估算 1999年全县儿童出生率。结果表明 :1999年全县常规的儿童出生月报系统报告的出生数为 8197人 ,出生率为 7 99‰ ,运用捕获 -再捕获方法估算 1999年全县儿童出生数为 890 2人 ,95 %的可信区间为 8398～ 940 6人 ,儿童出生率的 95 %可信区间为 8 19‰～ 9 7‰ ,说明常规的儿童月报系统中存在严重漏报情况 ,建议采取措施解决这一问题 ,以提高常规的儿童出生月报系统工作的运行质量     

捕获-再捕获方法在济南市死因漏报调查中的应用

目的 了解济南市死亡个案的漏报情况,为制定卫生策略提供依据。方法 用捕获一再捕获方法(Capture - Mark - Recapture,CMR),采用分层整群随机抽样的方法,全市各县区根据2015年度各乡镇（街道）死因监测数据质量水平,随机抽取4个乡镇（街道）,每个抽中的乡镇（街道）的所有家庭均为调查家庭,调查对象包括调查家庭的所有成员。从当地公安、民政和村(居委会)搜集人口死亡情况,再与死因登记系统已报告的死亡资料进行比对,计算漏报率。结果 2015年济南市死因监测漏报率为9.21%。其中,农村死亡漏报率较城区高2.23%（95%CI:1.17%～3.29%）。0～4岁组较其他年龄组高18.99%（95%CI:9.58%～28.40%）。男性死亡率较女性高0.90%（95%CI:-5.28%～7.08%）,无统计学意义。根据死亡漏报率,调整后的2015年济南市居民粗死亡率为731.45/10万,调整后的人均期望寿命是78.33岁。结论 济南市死因监测系统死亡漏报情况不容忽视,应规范死因报告管理,逐步提高死因监测数据质量。同时,使用捕获一再捕获方法可以校正低估的粗死亡率和人均期望寿命,适时开展漏报调查,是有效弥补常规监测不足的方法之一。     

应用捕获-再捕获方法估计林州市全死因死亡率和漏报率

[目的]应用捕获-再捕获方法估计林州市2004～2005年全死因死亡率,评价全死因登记处收集死亡资料的完整性. [方法]收集林州市死因登记处、民政和公安3部门2004～2005年的全死园死亡登记资料.不同来源数据间的匹配使用姓名、年龄、性别、死亡时闻、死亡原因和居住地址等变量.使用对数线性泊松模型估计3样本中都没有出现的死亡人数. [结果]2004～2005年期间3来源资料中共报告全死因死亡人数为13007人,死亡率为6.42‰.其中,登记处报告的全死因死亡人数为12261人,死亡率为6.06‰.用捕获-再捕获方法估计的全死因死亡人数为13402人,死亡率为6.62‰.登记处的漏报率为8.5%,合并样本的漏报率为2,3%. [结论]仅仅使用登记处或合并样本资料会低估全死因死亡率,而利用公安、村访谈、登记处等部门现有的资料,使用捕获-再捕获方法可以校正低估的全死因死亡率.     

搞好疾病监测点人口信息反馈为人口普查服务

奉化市是全国疾病监测点。1990年点内102868人,占全市总人口的22.09％,代表我省农村二类地区的类型。监测点根据全国统一疾病监测方案,全面系统地收集人口资料,在一定程度上校正了我市1990年第四次人口普查中婴儿死亡率偏低的缺陷,对保证我市人口普查质量,起了积极作用。 1990年监测点内出生1593人,出生率为15.42‰;死亡626例,死亡率为6.09‰,其中婴儿死亡35例,婴儿死亡率为21.97‰(男19.65‰,女24.97‰);平均期望寿命男性69.21岁,女性75.27岁,出生漏报率为13.2‰,死亡漏报率为33.9‰,未发现婴儿死亡漏报。监测点死亡漏报率低于1982年全国第三次人口普查的36‰和1986年全国农村疾病监测点的43‰,可认为我市疾病监测点的出生和死亡数据比较可靠。1990年恰逢全国第四次人口普     

应用捕获-再捕获法估计5岁以下儿童死亡漏报率及死亡率

目的探索用捕获-再捕获方法(CRM)估计5岁以下儿童死亡漏报率和死亡率,评价卫生部门收集5岁以下儿童死亡资料的准确程度.方法利用内蒙古喀喇沁旗卫生和计生两部门1997～2000年的5岁以下儿童死亡登记资料通过核对、入户核查,用CRM估计儿童死亡率.结果用CRM估计研究地区1997～2000年5岁以下儿童死亡数为399人,卫生部门的漏报率为24.8%,并且存在死亡儿童年龄越低死亡漏报率越高的现象;卫生部门1997～2000年报表登记的5岁以下儿童平均死亡率为22.97‰,估计5岁以下儿童死亡率为30.55‰,高于将两部门资料合并得到的儿童死亡率28.56‰.结论可以利用卫生和计生部门现有的信息依靠CRM校正因漏报而造成的数值误差,获得较准确的儿童死亡率.但在使用时必须注意其使用的前提条件,不能盲目地套用公式.     

三峡库区蓄水前后（1997-2009年）以生物媒介传播疾病为重点的人群健康状况监测与评价

目的 评价1997-2009年三峡库区人群健康状况以及蓄水对健康的影响.方法 在三峡库区选择9个县(区)的17个乡镇(街道)设立疾病和生物媒介监测点,1997-2009年连续系统收集人口出生死亡、传染病、生物媒介等监测数据.采用时间和空间分析以及蓄水前后比较,分析疾病流行状况及其影响因素,评价库区人群健康状况.结果 三峡库区监测点2003年蓄水后7年室内平均鼠密度(2.22％)比蓄水前6年平均鼠密度(4.38％)下降49.32％;蓄水后室外平均鼠密度(2.76％)比蓄水前平均鼠密度(4.43％)下降37.70％.蓄水后人房年均蚊密度[35.09只/(间·人工小时)]较蓄水前[54.24只/(间·人工小时)]下降35.31％.蓄水后畜圈年均蚊密度[125.75只/(间·人工小时)]比蓄水前[179.46只/(间·人工小时)]下降29.93％.2003年蓄水后,流行性乙型脑炎(乙脑)、疟疾、钩端螺旋体(钩体)病和流行性出血热(出血热)发病率分别较蓄水前下降22.88％、84.85％、95.03％和81.82％.在蓄水后,钩体病、疟疾和出血热各年发病率均处于较低水平(＜0.4/10万),乙脑历年发病率＜2/10万,下降幅度略低于重庆市和宜昌市.各年粗死亡率低于重庆市和湖北省的平均水平,标化死亡率为3.77％ ～ 5.12％,低于全国平均水平.平均婴儿死亡率为11.83‰,低于全国平均水平.结论 2003年三峡水库蓄水后未诱发疟疾、乙脑、钩体病、出血热等生物媒介传播疾病的明显升高,尚未发现水库蓄水对人群死亡率造成影响,库区人群总体健康状况较好.     

三峡库区医疗机构传染病漏报调查

目的了解三峡库区医疗卫生机构传染病漏报情况。方法随机抽取监测点内15家不同级别的医疗机构,调查2005年1-3季度法定传染病漏报情况和报告及时性。结果共查出乙、丙类传染病488例,漏报76例,漏报率15.57%,其中县级医院漏报率6.77%,乡镇卫生院35.33%,市级医院无漏报;丙类传染病漏报率35.92%（36/102）,乙类传染病漏报率10.36%（40/386）;报告及时率为75.00%。结论县、乡级基层医疗机构传染病报告漏报率较高,需加大传染病报告工作的监督管理力度。     

Estimation of Preterm Birth Rate, Associated Factors and Maternal Morbidity From a Demographic and Health Survey in Brazil

To determine the prevalence of preterm birth from self-reports by Brazilian women, to assess complications, interventions and outcomes, to identify factors associated with preterm birth, and to improve the preterm birth rates estimates. This is a secondary analysis of data from a Demographic Health Survey. It interviewed a sample of 4,743 Brazilian women who had 6,113 live births from 2001 to 2007. Estimates of preterm birth rates were obtained per region and per year according to self-reported gestational age. The prevalence rate and 95 % confidence interval (CI) for preterm was determined according to the characteristics of mothers and offspring. Odds ratios and 95 % CI were estimated for complications such as severe maternal morbidity. The preterm birth rate was 9.9 %, with regional variations. Preterm birth was more likely to be associated with neonatal death, low birth weight, and longer hospital stay. Maternal factors associated with preterm birth were: white ethnicity, living in an urban area, history of hypertension or heart disease, twin gestation, non-elective Cesarean section, medical insurance for delivery, low number of antenatal visits, and severe morbidity. A self-report survey has indicated that the preterm birth rate in Brazil is higher than official data suggest, with an increasing trend in more developed areas, and is associated with poor neonatal and maternal outcomes.     

2008—2009年三峡库区监测点人群健康状况动态分析

目的了解三峡库区疾病监测点人群健康状况动态变化,为进一步评价三峡水库蓄水后对库区人群健康的影响积累本底资料,为及时制定卫生防病措施提供科学依据。方法在重庆市和湖北宜昌市选择5个县区设置疾病监测点,按照统一监测方案,收集出生和死亡、传染病、地方病和生物媒介等资料,对人群健康相关指标进行描述性分析。结果 2008—2009年三峡库区监测点人群年粗死亡率为583/10万,略高于2004—2007年年均值;婴儿死亡率为883/10万,低于2004—2007年年均值;死因顺位前五位为循环系统疾病、肿瘤、呼吸系统疾病、损伤中毒和消化系统疾病,与2004—2007年死因顺位相同;法定报告传染病年均发病率为658.22/10万,低于2004—2007年平均值;地方性甲状腺肿大率为9.11%;重庆奉节县的地氟病阳性率达33.89%;室内鼠密度平均为2.66%,户外鼠密度平均为2.86%,鼠密度均分别高于2004—2007年平均值。人房成蚊总密度平均为31.11只(/间.人工小时),低于2004—2007年平均值,畜圈成蚊总密度平均为131.64只(/间.人工小时),高于2004—2007年平均值,但二者均低于1997—2007年平均值。结论尚未发现三峡库区生态环境的变化对人群健康造成明显影响,但应持续开展疾病监测和危险因素监测。     

Annual incidence rate of infectious diseases estimated from sentinel surveillance data in Japan

BACKGROUND: The estimation of incidence rates of infectious diseases based on the sentinel surveillance data is rather rare. We attempted to estimate these in 2000 in Japan by the surveillance data, and to evaluate their biases. METHODS: We used the incidences of influenza-like illness and 12 pediatric diseases in each of the sentinel medical institutions in Japan based on surveillance data in 2000. The incidence in all medical institutions was estimated under the assumption that the sentinel medical institutions were randomly selected. The possible bias of this estimate was evaluated in comparison with the hypothetical true incidence obtained as the total incidence in all medical institutions estimated by a regression model using the numbers of all disease outpatients per day from the National Survey of Medical Care Institutions of Japan. RESULTS: The estimated annual incidence rate was 75.6 (95% confidence interval: 72.3-78.7) per 1,000 population in influenza-like illness, and ranged from 1.1 (95% confidence interval: 1.0-1.2) to 285.2 (95% confidence interval: 270.2-300.3) per 1,000 population aged 0-19 years among 12 pediatric diseases. The ratio of the estimated incidence to the hypothetical true one was 1.06-1.26 among influenza-like illness and the 12 pediatric diseases. CONCLUSIONS: The incidence rates of influenza-like illness and pediatric diseases in 2000 in Japan were estimated from sentinel surveillance data. The rates obtained provide some useful but not always accurate information. Thus, further research is necessary.     

Economic evaluation of delivering Haemophilus influenzae type b vaccine in routine immunization services in Kenya

OBJECTIVE: Haemophilus influenzae type b (Hib) vaccine was introduced into routine immunization services in Kenya in 2001. We aimed to estimate the cost-effectiveness of Hib vaccine delivery. METHODS: A model was developed to follow the Kenyan 2004 birth cohort until death, with and without Hib vaccine. Incidence of invasive Hib disease was estimated at Kilifi District Hospital and in the surrounding demographic surveillance system in coastal Kenya. National Hib disease incidence was estimated by adjusting incidence observed by passive hospital surveillance using assumptions about access to care. Case fatality rates were also assumed dependent on access to care. A price of US$ 3.65 per dose of pentavalent diphtheria-tetanus-pertussis-hep B-Hib vaccine was used. Multivariate Monte Carlo simulations were performed in order to assess the impact on the cost-effectiveness ratios of uncertainty in parameter values. FINDINGS: The introduction of Hib vaccine reduced the estimated incidence of Hib meningitis per 100,000 children aged < 5 years from 71 to 8; of Hib non-meningitic invasive disease from 61 to 7; and of non-bacteraemic Hib pneumonia from 296 to 34. The costs per discounted disability adjusted life year (DALY) and per discounted death averted were US$ 38 (95% confidence interval, CI: 26-63) and US$ 1197 (95% CI: 814-2021) respectively. Most of the uncertainty in the results was due to uncertain access to care parameters. The break-even pentavalent vaccine price--where incremental Hib vaccination costs equal treatment costs averted from Hib disease--was US$ 1.82 per dose. CONCLUSION: Hib vaccine is a highly cost-effective intervention in Kenya. It would be cost-saving if the vaccine price was below half of its present level.     

1996年出生缺陷监测质量检查结果分析

对新疆、广西、陕西、江西、四川５省（自治区）进行了“三网合一”后的出生缺陷监测报表质量进行了检查。结果显示，存在的主要问题为：行政与业务部门的协调及业务部门之间协调不够；原始记录不完整；概念不清或有关标准掌握不准确；死胎、死产及新生儿７天内死亡存在漏报；先天畸形存在漏报；先天畸形诊断水平有待提高。针对上述问题，笔者建议：加强行政领导，稳定监测人员队伍；完善各环节，提高报表质量；提高先天畸形的诊断水平；掌握质量抽查方法，减少漏报、错报。     

三峡库区蓄水后湖北省宜昌段人群健康状况及影响因素分析

目的初步评价三峡水库蓄水后对库区人群健康的影响。方法连续收集三峡库区监测点卫生资源变化情况,出生和死亡资料及传染病的发病资料,对所收集的资料进行综合分析。结果三峡库区蓄水后,库区监测点年均人口出生率为5.91‰,死亡率为6.37‰,人口自然增长率为-0.46‰;婴儿死亡率呈下降趋势,期望寿命为80.6岁;人均卫生资源变化不大;居民死亡原因以循环系统疾病(38.57%)和肿瘤(16.28%)为主;传染病发病率呈逐年增高趋势,居前5位的传染病为肺结核、病毒性肝炎、痢疾、淋病和麻疹。结论三峡水库蓄水后2004—2008年湖北宜昌段人群健康状况及影响因素未发生明显变化。     

Fetal death certificates as a source of surveillance data for stillbirths with birth defects

OBJECTIVE: We assessed fetal death certificates (FDCs) as a source of surveillance for stillbirths with birth defects by linkage with data from the Metropolitan Atlanta Congenital Defects Program (MACDP), a population-based birth defects surveillance system. METHODS: Stillbirths with defects in MACDP were identified from 1994 through 2002 and linked to FDCs. Sensitivity of FDCs for capturing stillbirths with defects was estimated, and predictors for a case being reported were assessed. Concordance for selected variables from each data source was evaluated. RESILTS: Two hundred twenty-four of 257 stillbirths with birth defects in MACDP were linked to an FDC (linkage rate = 87.2%; 95% confidence interval [CI] 82.4, 91.0). Stillbirths of non-Hispanic black and Hispanic/other mothers were more likely to be issued an FDC (odds ratio [OR] = 5.6 [95% CI 1.9, 17.0] and 14.0 [95% CI 1.7, 114.0], respectively). Cases undergoing autopsy were more likely to be issued an FDC (OR = 3.2; 95% CI 1.1, 8.7). Performance of an amniocentesis was poorly recorded on FDCs. The sensitivity and positive predictive value of FDCs for selected classes of defects ranged from 10% to 70% and 25% to 93%, respectively. CONCLUSIONS: Compared to FDCs, MACDP's active case identification improves the ascertainment of stillbirths with birth defects and the quality of certain recorded data.     

Incidence and Mortality of Dementia-Related Missing and Their Associated Factors: An Ecological Study in Japan

BackgroundDementia-related missing and subsequent deaths are becoming serious problems with increases in people with dementia. However, there are no sufficient studies investigating the incidence rate, the mortality rate, and their risk factors.MethodsAn ecological study aggregated at the Japanese prefectural level was conducted. Dementia-related missing persons cases and deaths in 2018 were extracted from the statistics of the National Police Agency in Japan. We extracted variables about older adults’ characteristics, care, and safety as candidate variables considered to be relevant to dementia-related missing persons cases and deaths. Associations of the candidate variables with the incidence and mortality rates were analyzed using the generalized linear model (family: quasi-poisson, link: log) adjusted for confounding factors (proportion of older adults and gross prefectural product).ResultsThe incidence rate and mortality rate per 100,000 person-year was 21.72 and 0.652 in Japan, respectively. One facility increase in the number of nursing care facilities for older adults per 100,000 persons aged 65-years-old or more was associated with a 7.9% (95% confidence interval [CI], 3.3–12.4%) decrease in the incidence rate. One increase in the number of public health nurses per 100,000 persons was associated with a 3.2% (95% CI, 1.6–4.9%) decrease in the incidence rate. A ten percent increase in the proportion of people who live in an urban area was associated with a 20.3% (95% CI, 8.7–33.2%) increase in the incidence rate and a 12.9% (95% CI, 5.6–19.8%) decrease in the mortality rate.ConclusionsIdentified associated factors may be useful for managing or predicting dementia-related missing persons cases and associated deaths.Key words: dementia-related missing incident, death after dementia-related missing, dementia, ecological study