Investigation of underreporting of death monitoring in Xi’an city, 2018-2020 / 西安交通大学学报(医学版)

ABSTRACT

【Objective】 To evaluate the underreporting of death cases and related factors in disease surveillance system of Xi’an. 【Methods】 Multi-stage cluster random sampling was used, and 733 villages (neighborhood committees) were selected from 44 townships or streets in Xi’an. All the death cases of the residents in the sampled areas from 2018 to 2020 were collected through a variety of channels and checked with those registered in the Disease Surveillance System. Then the missing cases were investigated and verified. The underreporting rate was calculated, the Excel software was applied for statistical processing and Chi square analysis, and the related factors of underreporting were analyzed by using Logistic regression method. 【Results】 A total of 37650 death cases were investigated from 2018 to 2020; the average mortality was 650.59/105, and 2 901 cases were underreported. From 2018 to 2020, the underreporting rate was 9.89%, 6.95%, and 6.24%, respectively (χ2=133.525, P<0.001), with the average underreporting rate of 7.71%. The underreporting rate in the 44 sampled areas ranged from 0.90% to 42.07%. Multivariate Logistic regression analysis showed that compared with that in rural areas (9.87%), the underreporting rate was lower in urban areas (5.91%, OR=0.567, 95% CI0.525-0.613), and higher in children under 5 years old (31.20%, OR=5.494, 95% CI3.732-8.090) and people aged 15-44 years old (11.85%, OR=1.541, 95% CI1.284-1.846) compared to people over 65 years old (7.44%), and higher in 2018 (9.89%, OR=1.702, 95% CI1.551-1.869) and 2019 (6.95%, OR=1.148, 95% CI1.038-1.271) compared to the year 2020 (6.24%). There were 2901 cases reported missing, and the proportion of those who died at home was the highest (81.39%). Underreporting of death more easily occurred in heart diseases (36.80%) and cerebrovascular diseases (27.08%) than others. 【Conclusion】 The reporting completeness of disease surveillance system increased in Xi’an. The overall underreporting rate of death causes decreased with year from 2018 to 2020. The underreporting rates in age group under 5 years old and in rural population were still high. Therefore, the reporting and management of death information should still be strengthened to minimize the underreporting rate.