Zhao Jiaying, Tu Edward Jow-Ching, Law Chi-Kin
The Institute for Asian Demographic Research, School of Sociology and Political Science, Shanghai University, Shanghai, China.
School of Demography, The Australian National University, Canberra, Australia.
Popul Health Metr. 2017 Sep 29;15(1):37. doi: 10.1186/s12963-017-0155-z.
Valid and comparable cause of death (COD) statistics are crucial for health policy analyses. Variations in COD assignment across geographical areas are well-documented while socio-institutional factors may affect the process of COD and underlying cause of death (UCD) determination. This study examines the comparability of UCD statistics in Hong Kong and Shanghai, having two political systems within one country, and assesses how socio-institutional factors influence UCD comparability.
A mixed method was used. Quantitative analyses involved anonymized official mortality records. Mortality rates were analyzed by location of death. To analyze the odds ratio of being assigned to a particular UCD, logistic regressions were performed. Qualitative analyses involved literature reviews and semi-structural interviews with key stakeholders in death registration practices. Thematic analysis was used.
Age-standardized death rates from certain immediate conditions (e.g., septicemia, pneumonia, and renal failure) were higher in Hong Kong. Variations in UCD determination may be attributed to preference of location of death, procedures of registering deaths outside hospital, perceptions on the causal chain of COD, implications of the selected UCD for doctors' professional performance, and governance and processes of data quality review.
Variations in socio-institutional factors were related to the process of certifying and registering COD in Hong Kong and Shanghai. To improve regional data comparability, health authorities should develop standard procedures for registering deaths outside hospital, provide guidelines and regular training for doctors, develop a unified automated coding system, consolidate a standard procedure for data review and validity checks, and disseminate information concerning both UCD and multiple causes of death.
有效且具可比性的死因统计对于卫生政策分析至关重要。地理区域间死因分配的差异已有充分记录，而社会制度因素可能会影响死因及根本死因确定的过程。本研究考察了香港和上海（在一个国家内实行两种政治制度）根本死因统计的可比性，并评估社会制度因素如何影响根本死因的可比性。
采用了混合方法。定量分析涉及匿名的官方死亡率记录。按死亡地点分析死亡率。为分析被分配到特定根本死因的比值比，进行了逻辑回归分析。定性分析涉及文献综述以及对死亡登记实践中的关键利益相关者进行半结构化访谈。采用了主题分析法。
香港某些直接死因（如败血症、肺炎和肾衰竭）的年龄标准化死亡率较高。根本死因确定的差异可能归因于死亡地点偏好、医院外死亡登记程序、对死因因果链的认知、所选根本死因对医生专业表现的影响以及数据质量审查的治理和流程。
社会制度因素的差异与香港和上海死因认证及登记过程相关。为提高区域数据可比性，卫生当局应制定医院外死亡登记的标准程序，为医生提供指南和定期培训，开发统一的自动编码系统，巩固数据审查和有效性检查的标准程序，并传播有关根本死因和多种死因的信息。
