Rao Chalapati, Yang Gonghuan, Hu Jianping, Ma Jiemin, Xia Wan, Lopez Alan D
School of Population Health, University of Queensland Public Health Building, Herston Road, Herston, QLD 4006, Australia.
Int J Epidemiol. 2007 Jun;36(3):642-51. doi: 10.1093/ije/dym003. Epub 2007 Feb 28.
National vital registration systems are the principal source of cause specific mortality statistics, and require periodic validation to guide use of their outputs for health policy and programme purposes, and epidemiological research. We report results from a validation of cause of death statistics from health facilities in urban China.
2917 deaths from health facilities located in six cities in China constituted the study sample. A reference diagnosis of the underlying cause was derived for each death, based on expert review of available medical records, and compared with that filed at registration. Sensitivity, specificity and positive predictive value were computed for specific causes/cause categories according to the International Classification of Diseases (ICD), including analyses based on quality of evidence scores for each cause. Patterns of misclassification by the registration system were studied for individual causes of death.
The registration system had good sensitivity in diagnosing cerebrovascular disease and several site specific cancers (lung, liver, stomach, colorectal, breast and pancreas). Sensitivity was average (50-75%) for some major causes of adult death in China, namely ischaemic heart disease (IHD), chronic obstructive lung disease (COPD), diabetes, and liver and kidney diseases, with compensatory misclassification patterns observed between several of them. Sensitivity was particularly low for hypertensive disease.
Although diagnostic misclassification is not uncommon in urban death registration data, they appear to balance each other at the population level. Compensating misclassification errors suggest that caution is required when drawing conclusions about particular chronic causes of adult death in China. Investment is required to improve the quality of cause attribution for health facility deaths, and to assess the validity of cause attribution for home deaths. Periodic assessments of the quality of cause of death statistics will enhance their usability for health policy and epidemiological research.
国家生命登记系统是特定病因死亡率统计数据的主要来源，需要定期进行验证，以指导将其产出用于卫生政策和规划目的以及流行病学研究。我们报告了对中国城市卫生机构死因统计数据进行验证的结果。
来自中国六个城市卫生机构的2917例死亡构成了研究样本。基于对现有病历的专家审查，为每例死亡得出潜在病因的参考诊断，并与登记时记录的诊断进行比较。根据国际疾病分类（ICD）计算特定病因/病因类别的敏感性、特异性和阳性预测值，包括基于每个病因证据质量得分的分析。研究了登记系统对个别死因的错误分类模式。
登记系统在诊断脑血管疾病和几种特定部位癌症（肺癌、肝癌、胃癌、结直肠癌、乳腺癌和胰腺癌）方面具有良好的敏感性。对于中国成人死亡的一些主要原因，即缺血性心脏病（IHD）、慢性阻塞性肺疾病（COPD）、糖尿病以及肝脏和肾脏疾病，敏感性为中等水平（50 - 75%），其中几种病因之间观察到了补偿性错误分类模式。高血压疾病的敏感性特别低。
尽管在城市死亡登记数据中诊断错误分类并不罕见，但它们在人群层面似乎相互抵消。补偿性错误分类误差表明，在中国对成人死亡的特定慢性病因得出结论时需要谨慎。需要投入资源来提高卫生机构死亡病例病因归因的质量，并评估家庭死亡病例病因归因的有效性。定期评估死因统计数据的质量将提高其在卫生政策和流行病学研究中的可用性。
