中国人群自杀死亡报告准确性评估

Evaluation on the accuracy of reported suicides in the Chinese popula tion

目的 评估中国现有死因报告系统中自杀死亡报告的准确性 ,计算更准确的自杀率。方法 选择中国现有死因报告系统之一的全国疾病监测点系统的 2 3个监测点 ,收集 1995年 8月至2 0 0 0年 8月死因为“伤害”或“精神病”的死亡案例 ,从中抽取 193 2例欲进行入户死因核查 ,最终 1653例进入分析。将死亡医学证明书上记录的原始上报死因与详细入户调查后判断的死因进行比较 ,然后用此结果调整自杀率。结果 原始上报死因为自杀的 857例中有 16例 ( 1.87% )通过调查后判断为其他伤害死亡 ;上报为其他伤害死亡的 72 1例中有 3 9例 ( 5.41% )判断为自杀 ;上报为伤害死亡原因不明的 3 5例中有 17例 ( 4 8.57% )判断为自杀 ;上报为精神疾病的 40例中有 6例 ( 15.0 0 % )判断为自杀。经错报漏报调整后 ,将粗自杀率从 13 .65 10万调整到了 2 2 .99 10万 ( 95%CI :2 1.78 10万～2 4.2 5 10万 )。结论 经准确性评估后 ,中国的实际自杀率高于公布的报告数据 。

Objective To evaluate the accuracy of re po rts of suicide in the national death registry systems and to estimate a more acc urate suicide rate. Methods Twenty-three sites from the Disease Surveillance Points Network-one of the national death registry systems-were selected and 1 932 of the deaths that occurred at these sites from August 1995 through Au gust 2000 in which the official cause was classified as “accidental” or “ment al illness” were selected for detailed household surveys focusing on reassessi ng the cause of death. Valid interviews were completed in 1 653 of these ca ses. T he original cause of death recorded on the death certificate was compared with t he finding of the detailed household survey and the result was used to adjust th e suicide rate. Results After detailed investigation,16 of the 857 ( 1 . 87 %) deaths reported on the death certificate as suicide were considered accid ental deaths, 39 of the 721( 5.41 %) accidental deaths were considered suicide , 17 of the 35( 48.57 %) cases reported as undetermined accidents were conside red suicide, and 6 of the 40( 15.00 %) cases in which mental illness was the r ecorded cause of death were considered suicide. After adjustments for errors in the reported cause of death and for missing deaths, the reported crude suicide rate of 13.65/ 100 000 in China was adjusted to 22.99/ 100 000 (9 5% CI: 21.78/100 000- 24.25 /100 000). Conclusion After adjustments the actual suicide rate for China was higher than the reported rate indicating that suicide was an increa singly important public health problem for China.