武汉市居民死亡漏报调查及死因监测质量评价

An Evaluation on the Under-reporting and Quality of Death Surveillance System among Wuhan Residents

目的了解武汉市居民死亡个案的漏报情况,评价死因监测系统报告的完整性与准确性。方法采用多阶段分层随机整群抽样方法,从武汉市13个行政区抽取26条街道、乡镇的104个社区居委会、自然村作为抽样点,从武汉市死因监测系统之外的多种渠道收集2007—2008年间抽样点居民死亡数据,与死因监测系统死亡报告数据进行比较,计算漏报率。对抽样点死因监测系统死亡报告卡进行审核,评估死因诊断的可靠性和编码质量。结果抽样点总死亡漏报率为7.90%,其中,中心城区2.11%,远城区为14.69%,城乡之间差异有显著性(χ2=170.913,P<0.001),死因监测系统数据总体完整性较好;死者生前最高诊断单位达到区县级及以上医疗机构占78.70%,未就诊的比例较低(7.10%),死因诊断可靠性较高;全市死因编码不准确率为8.48%,编码错误率为4.12%,编码质量合格。结论武汉市死因监测质量较好,在全人群的范围内能合理反映全市居民的死因模式。

Objective To understand the underreporting situation of death surveillance system among Wuhan residents as well as to evaluate the integrity and accuracy of this system. Methods A multi-stage stratified random cluster sampling survey from 13 administrative divisions was conducted at 104 community committees or natural villages from 26 streets or townships in Wuhan City. The underreporting rate was calculated by compared the mortality data from various means, except Wuhan death surveillance system, in sampling points and from death surveillance system in Wuhan in 2007 and 2008, and the reliability and coding quality of death cause surveillance was assessed by examining the death reporting card from death surveillance system in sampling points. Results The total underreporting rate in sampling points was 7.90% （2.11% in urban and 14.69% in rural） （X2= 170.913, P〈0.001）, the overall integrity of death surveillance system data was good. The highest death diagnosis unit for the decedent reached to county-level medical institutions and above accounted for 78.70%, the rate of undiagnosed decedent was 7.10%, the reliability of death cause diagnosis was high, the rate of citywide coding inaccuracy was 8.48% and the rate of citywide coding errors was 4.12%, the coding quality was eligible. Conclusion The quality of death cause surveillance system in Wuhan was good and could reflect death cause pattern reasonably within the population of whole city.