Validation of cause-of-death statistics in urban China
Validation of cause-of-death statistics in urban China
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DOI：
10.1093/ije/dym003
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发表时间：
2007-06-01
影响因子：
7.7
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
Rao, Chalapati;Yang, Gonghuan;Lopez, Alan D.
背景 国家人口动态登记系统是特定原因死亡率统计数据的主要来源，需要定期验证以指导其输出用于卫生政策和计划目的以及流行病学研究。我们报告了中国城市卫生机构死因统计数据的验证结果。方法 中国六个城市卫生机构的 2917 例死亡构成了研究样本。根据专家对现有医疗记录的审查，并与登记时提交的数据进行比较，得出每例死亡的根本原因的参考诊断。根据国际疾病分类（ICD）计算特定原因/原因类别的敏感性、特异性和阳性预测值，包括基于每个原因的证据质量评分的分析。研究了登记系统对个体死因的错误分类模式。结果登记系统在诊断脑血管疾病和几种特定部位癌症（肺癌、肝癌、胃癌、结直肠癌、乳腺癌和胰腺癌）方面具有良好的敏感性。对于中国成人死亡的一些主要原因，即缺血性心脏病（IHD）、慢性阻塞性肺病（COPD）、糖尿病以及肝肾疾病，敏感性处于平均水平（50-75%），并且在其中一些疾病之间观察到补偿性错误分类模式。对于高血压疾病的敏感性特别低。结论 尽管诊断错误分类在城市死亡登记数据中并不罕见，但它们似乎在人口水平上相互平衡。补偿错误分类错误表明，在对中国成人死亡的特定慢性原因得出结论时需要谨慎。需要投资来提高医疗机构死亡原因归因的质量，并评估家庭死亡原因归因的有效性。定期评估死因统计数据的质量将增强其对卫生政策和流行病学研究的可用性。
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.