对海洛因相关死亡的分类和报告问题的分析。

An analysis of issues in the classification and reporting of heroin-related deaths.

机构信息

Department of Forensic Medicine, Monash University, Melbourne, Australia.

Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Australia.

出版信息

Addiction. 2019 Mar;114(3):504-512. doi: 10.1111/add.14486. Epub 2018 Dec 3.

DOI:10.1111/add.14486

PMID:30397976

Abstract

AIMS

To investigate the extent of variability in the reporting of heroin-related deaths in Victoria, Australia. Additionally, to identify opportunities to improve the accuracy and consistency of heroin-related death reporting by examining variability in the attribution, death certification, classification and coding of heroin-related death cases.

METHODS

Heroin-related deaths in Victoria, Australia during a 2-year period (2012-13) were identified using the National Coronial Information System (NCIS) and used as the 'gold standard' measure in this study. Heroin-related death data from the Australian Institute of Health and Welfare (AIHW) and Australian Bureau of Statistics (ABS) were then compared. Differences in the number of deaths reported as well as the classification and coding assigned to the identified heroin-related death cases were investigated by cross-referencing these data sets and examining the assigned ICD-10 codes.

RESULTS

A total of 243 heroin-related deaths were identified through the NCIS compared with 165 heroin-related deaths reported by the AIHW and assigned the heroin-specific ICD-10 code of T40.1. Forty per cent of all the missed heroin-related death cases resulted from either the attribution of the death to morphine toxicity or with non-specific drug toxicity certification; 30% occurred where the cases had been attributed to heroin but there were irregularities in death certification. Additional missed heroin-related death cases occurred as a result of late initial registration of these deaths to the Registry of Births, Deaths and Marriages, and where these cases were then not assessed by the ABS for classification and coding purposes.

CONCLUSIONS

In Victoria, Australia, in 2012 and 2013, the overall number of heroin-related deaths was under-reported by 32% compared with the number of deaths currently identified by the Australian Bureau of Statistics and reported by the Australian Institute of Health and Welfare.

摘要

目的

调查澳大利亚维多利亚州报告海洛因相关死亡的程度存在差异的情况。此外，通过检查海洛因相关死亡案例归因、死亡证明、分类和编码的可变性，确定改善海洛因相关死亡报告准确性和一致性的机会。

方法

使用国家验尸信息系统（NCIS）确定澳大利亚维多利亚州在两年期间（2012-13 年）的海洛因相关死亡病例，并将其用作本研究的“黄金标准”衡量标准。然后，将澳大利亚卫生与福利研究所（AIHW）和澳大利亚统计局（ABS）的海洛因相关死亡数据进行比较。通过交叉参考这些数据集并检查分配的 ICD-10 代码，调查报告的死亡人数以及分配给已确定的海洛因相关死亡案例的分类和编码的差异。

结果

通过 NCIS 确定了 243 例海洛因相关死亡病例，而 AIHW 报告并分配海洛因特定 ICD-10 编码 T40.1 的海洛因相关死亡病例为 165 例。所有错过的海洛因相关死亡病例中有 40%是由于将死亡归因于吗啡毒性或非特异性药物毒性证明所致；30%是由于将病例归因于海洛因，但死亡证明存在不规则情况。其他错过的海洛因相关死亡病例是由于这些死亡病例后来向出生、死亡和婚姻登记处的登记延迟，并且 ABS 未对这些病例进行分类和编码目的的评估所致。