Tøllefsen Ingvild Maria, Thiblin Ingemar, Helweg-Larsen Karin, Hem Erlend, Kastrup Marianne, Nyberg Ullakarin, Rogde Sidsel, Zahl Per-Henrik, Østevold Gunvor, Ekeberg Øivind
Department of Acute Medicine, Oslo University Hospital Ullevaal, Box 4950, Nydalen, N-0424, Oslo, Norway.
Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1072, Blindern, N-0316, Oslo, Norway.
BMC Public Health. 2016 May 27;16:449. doi: 10.1186/s12889-016-3135-5.
National mortality statistics should be comparable between countries that use the World Health Organization's International Classification of Diseases. Distinguishing between manners of death, especially suicides and accidents, is a challenge. Knowledge about accidents is important in prevention of both accidents and suicides. The aim of the present study was to assess the reliability of classifying deaths as accidents and undetermined manner of deaths in the three Scandinavian countries and to compare cross-national differences.
The cause of death registers in Norway, Sweden and Denmark provided data from 2008 for samples of 600 deaths from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of deaths and 200 as natural deaths. The information given to the eight experts was identical to the information used by the Cause of Death Register. This included death certificates, and if available external post-mortem examinations, forensic autopsy reports and police reports.
In total, 69 % (Sweden and Norway) and 78 % (Denmark) of deaths registered in the official mortality statistics as accidents were confirmed by the experts. In the majority of the cases where disagreement was seen, the experts reclassified accidents to undetermined manner of death, in 26, 25 and 19 % of cases, respectively. Few cases were reclassified as suicides or natural deaths. Among the extracted accidents, the experts agreed least with the official mortality statistics concerning drowning and poisoning accidents. They also reported most uncertainty in these categories of accidents. In a second re-evaluation, where more information was made available, the Norwegian psychiatrist and forensic pathologist increased their agreement with the official mortality statistics from 76 to 87 %, and from 85 to 88 %, respectively, regarding the Norwegian and Swedish datasets. Among the extracted undetermined deaths in the Swedish dataset, the two experts reclassified 22 and 51 %, respectively, to accidents.
There was moderate agreement in reclassification of accidents between the official mortality statistics and the experts. In the majority of cases where there was disagreement, accidents were reclassified as undetermined manner of death, and only a small proportion as suicides.
使用世界卫生组织《国际疾病分类》的国家之间，其全国死亡率统计数据应具有可比性。区分死亡方式，尤其是自杀和意外事故，是一项挑战。了解意外事故对于预防意外事故和自杀都很重要。本研究的目的是评估在三个斯堪的纳维亚国家将死亡分类为意外事故和死因不明的可靠性，并比较跨国差异。
挪威、瑞典和丹麦的死亡原因登记处提供了2008年的数据，每个国家抽取600例死亡样本，其中200例登记为自杀，200例登记为意外事故或死因不明，200例登记为自然死亡。提供给八位专家的信息与死亡原因登记处使用的信息相同。这包括死亡证明，以及如有外部尸检、法医尸检报告和警方报告。
在官方死亡率统计中登记为意外事故的死亡病例中，专家确认的比例在瑞典和挪威为69%，在丹麦为78%。在大多数存在分歧的病例中，专家将意外事故重新分类为死因不明，分别占病例的26%、25%和19%。很少有病例被重新分类为自杀或自然死亡。在提取的意外事故中，专家对官方死亡率统计中溺水和中毒事故的认同度最低。他们还报告了这些事故类别中存在的最大不确定性。在第二次重新评估中，提供了更多信息，挪威的精神科医生和法医病理学家分别将他们对挪威和瑞典数据集与官方死亡率统计的认同度从76%提高到87%，从85%提高到88%。在瑞典数据集中提取的死因不明的死亡病例中，两位专家分别将22%和51%重新分类为意外事故。
官方死亡率统计与专家在意外事故重新分类方面存在中等程度的一致性。在大多数存在分歧的病例中，意外事故被重新分类为死因不明，只有一小部分被重新分类为自杀。
