Becker Roberto, Silvi John, Ma Fat Doris, L'Hours André, Laurenti Ruy
Pan American Health Organization, Washington, DC, USA.
Bull World Health Organ. 2006 Apr;84(4):297-304. doi: 10.2471/blt.05.028670. Epub 2006 Apr 13.
A standard list for ranking leading causes of death worldwide does not exist. WHO headquarters, regional offices and Member States all use different lists that have varying levels of detail. We sought to derive a standard list to enable countries to identify their leading causes of death and to permit comparison between countries. Our aim is to share the criteria and methodology we used to bring some order to the construction of such a list, to provide a consistent procedure that can be used by others, and to give researchers and data owners an opportunity to utilize the list at national and subnational levels.
Results were primarily data-driven. Data from individual countries representing different regions of the world were extracted from the WHO Mortality Database. Supplementary information from WHO estimates on mortality was used for regions where data were scarce. In addition, a set of criteria was used to group the candidate causes and to determine other causes that should be included on the list.
A ranking list of the leading causes of death that contains broad cause groupings (such as "all cancers", "all heart diseases" or "all accidents") is not effective and does not identify the leading individual causes within these broad groupings; thus it does not allow policy-makers to generate appropriate health advocacy and cost-effective interventions. Similarly, defining candidate causal groups too narrowly or including diseases that have a low frequency does not meet these objectives.
For international comparisons, we recommend that countries use this list; it is based on extensive evidence and the application of public health disease-prevention criteria. It is not driven by political or financial motives. This list may be adapted for national statistical purposes.
全球范围内不存在用于对主要死因进行排名的标准清单。世界卫生组织总部、区域办事处及成员国使用的清单各不相同，详细程度也各异。我们试图得出一份标准清单，以使各国能够确定本国的主要死因，并便于各国之间进行比较。我们的目的是分享用于整理此类清单构建的标准和方法，提供一个可供他人使用的一致程序，并为研究人员和数据所有者提供在国家和次国家层面使用该清单的机会。
结果主要由数据驱动。从世界卫生组织死亡率数据库中提取代表世界不同地区的各个国家的数据。对于数据稀缺的地区，使用世界卫生组织死亡率估计的补充信息。此外，还使用了一套标准对候选死因进行分组，并确定应列入清单的其他死因。
一份包含宽泛死因分组（如“所有癌症”、“所有心脏病”或“所有事故”）的主要死因排名清单并不有效，无法确定这些宽泛分组内的主要个体死因；因此，它无法让政策制定者开展适当的健康宣传和具有成本效益的干预措施。同样，将候选因果组定义得过于狭窄或纳入发病率较低的疾病也无法实现这些目标。
为进行国际比较，我们建议各国使用此清单；它基于广泛的证据以及公共卫生疾病预防标准的应用。它并非受政治或财务动机驱动。这份清单可根据国家统计目的进行调整。
