海南省2018—2020年死亡监测漏报调查

Under-reporting of mortality surveillance in Hainan,2018-2020

目的了解海南省死因监测总体漏报情况,为评估死亡登记报告数据的完整性和健康海南规划提供科学依据。方法采用多阶段整群抽样方法,从全省各市县所有乡镇/街道按照粗死亡率水平从高到低进行排序,分成高、中、低3层(每层乡镇/街道数量基本相同),每层随机抽取1个乡镇/街道,共计3个乡镇/街道作为调查地区,地区内所有家庭均为调查家庭,收集2018—2020年期间所有常住人口的死亡信息,并与同期常规监测数据比对,计算漏报率,组间率的比较采用χ^(2)检验。结果2018—2020年死亡病例有12583例,合计死亡率621.48/10万,漏报4809例,合计漏报率为38.22%。2018—2020年死亡漏报率分别为39.75%、39.99%和34.77%(χ^(2)=30.404,P<0.01)。东中西部地区漏报率分别为30.33%、30.10%和60.15%(χ^(2)=931.901,P<0.01)。各年龄组漏报率差异有统计学意义(χ^(2)=14.834,P<0.05)。4809例漏报个案中,死于家中高达93.49%,中部死于医院的构成比约为东、西部的10倍。结论海南省一半以上的市县死因监测数据的完整性有所提高,5岁以下婴幼儿死因漏报现象仍严重,仍需定期开展漏报调查加强死亡信息的报告和管理工作。

Objective To understand the overall under-reporting of cause of death monitoring in Hainan Province,and to provide a scientific basis for evaluating the data from death registration report and health planning in Hainan.Methods Multi-stage cluster random sampling was used,all towns/streets in cities and counties of the province were ranked from highest to lowest in terms of crude death rate,divided into high,medium and low levels(the number of each level was basically the same),and one was randomly selected from each level.A total of three towns/streets were used as survey areas,and all households in the area were survey households.Death information of resident population during 2018-2020 was collected and compared with routine surveillance data for the same period.The under-reporting rate was calculated,and comparison between groups was performed by chi-square.Results A total of 12583 death cases were investigated from 2018 to 2020,and the average mortality was 621.48/105.4809 cases were missed with the total underreporting rate of 38.22%.The under-reporting rate from 2018 to 2020 were 39.75%,39.99%and 34.77%(χ^(2)=30.404,P<0.01)respectively.The under-reporting rate in eastern and central and western areas were 30.33%,30.10%and 60.15%(χ^(2)=931.901,P<0.01)respectively.The negative rate were different in different years old group(χ^(2)=14.834,P<0.05).Of the 4809 under-reported cases,as many as 93.49%died at home,and the composition of deaths in hospitals was about10 times higher in the center than in the east and west,and the proportion of those who died in hospital in central areas was about 10 times higher than in eastern and central areas.Conclusions More than half of the cities and counties in Hainan Province have improved the completeness of cause of death surveillance data.The under-reporting rate in age group<5 years are still high,and regular under-reporting investigations are still needed to strengthen the reporting and management of death information.