Evaluation of the quality of cause of death statistics in rural China using verbal autopsies
Evaluation of the quality of cause of death statistics in rural China using verbal autopsies
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DOI：
10.1136/jech.2005.043927
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发表时间：
2007-06-01
影响因子：
6.3
通讯作者：
Lopez, Alan D.
中科院分区：
文献类型：
--
作者：
Wang, Lijun;Yang, Gonghuan;Lopez, Alan D.
背景：中国农村的死亡登记制度正处于发展阶段。疾病监测点 (DSP) 系统提供唯一具有全国代表性的死因信息。在这个系统中，没有确定死亡原因的标准程序或工具；因此，现有统计数据在使用前需要仔细评估。目的：评估 DSP 数据的可靠性。方法：通过分层抽样选择 14 个 DSP 站点，登记了 2002 年 6 月至 11 月期间登记的 2482 例死亡。使用明确的口头尸检（VA）程序来得出死亡的根本原因。 kappa 计算 VA 和注册诊断之间的一致性度量。 VA 诊断用作计算敏感性和阳性预测值的参考。最后，研究了两个数据源之间特定原因不一致的模式。结果：kappa 评分表明慢性阻塞性肺病 (COPD) 和缺血性心脏病 (IHD) 的一致性中等。结果还表明，登记数据中慢性阻塞性肺病 (COPD) 被低估了。在两个数据源之间发现了显着程度的交叉归因。总体而言，VA 成功地将原因不明的死亡人数限制在 < 10%。结论：与登记数据中的外行报告诊断相比，VA 方法中基于结构化症状问卷的诊断似乎合理且可靠。对登记数据中 COPD、IHD 和结核病死因归因的担忧表明，在将其用于研究和健康计划目的时应谨慎行事。本研究中测试的 VA 方法为在常规注册系统中实施提供了希望。
Background: Death registration systems in rural China are in a developmental stage. The Disease Surveillance Points (DSP) system provides the only nationally representative information on causes of death. In this system, there are no standard procedures or instruments for ascertaining causes of death; hence available statistics require careful evaluation before use.Aim: To assess the reliability of data from the DSP.Methods: 14 DSP sites were selected through stratified sampling, enrolling 2482 deaths registered during June-November 2002. Defined verbal autopsy (VA) procedures were used to derive underlying causes of death. kappa Measures of agreement between VA and registered diagnoses were computed. VA diagnoses were used as references to compute sensitivity and positive predictive values. Finally, patterns of cause-specific discordance between the two data sources were studied.Results: kappa Scores indicate only moderate agreement for chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD). The results also suggest that COPD is undercounted in registration data. A significant degree of cross attribution of cause was found between the two data sources. Overall, the VA was successful in limiting deaths with ill-defined causes to < 10%.Conclusions: Diagnoses based on structured symptom questionnaires in the VA approach seem plausible and reliable as compared with lay-reported diagnoses in registration data. Concerns with attribution of cause of death due to COPD, IHD and tuberculosis in registration data suggest caution in their use for research and health programme purposes. The VA methods tested in this study offer promise for implementation in the routine registration system.