目的 了解长沙市死亡数据的漏报程度,评估其完整性,以期为制定卫生政策和卫生保健措施提供科学依据。方法 采取多阶段分层整群随机抽样方法在各区(县/市)抽取3个乡镇/街道,利用多渠道获取和入户调查2018—2020年常住居民死亡名单,与网报系统数据比对,未匹配成功的为漏报。统计分析采用SPSS 21.0软件,率的比较用χ²检验或Fisher确切检验,检验水准α=0.05,利用二元logistic回归进行多因素分析,检验水准α_入=0.05,α_出=0.10。结果 2018—2020年长沙市死亡漏报率为8.18%。多因素结果显示,农村(OR=1.76,95%CI:1.53～2.02)、0～5岁(OR=10.47,95%CI:6.11～17.92)、非监测点(OR=3.01,95%CI:2.61～3.46)、第1季度(OR=1.45,95%CI:1.22～1.71)、医院(OR=24.80,95%CI:14.27～43.12)、家里(OR=45.60,95%CI:26.88～77.37)、来院途中(OR=63.33,95%CI:32.02～125.25)、养老院(OR=35.31,95%CI:14.36～86.78)是居民死亡漏报的危险因素;第3季度(OR=0.78,95%CI:0.65～0.94)、2019年(OR=0.49,95%CI:0.42～0.57)、2020年(OR=0.34,95%CI:0.29～0.40)是居民死亡漏报的保护因素。结论 2018—2020年长沙市死亡漏报情况总体有所好转,但总体漏报率仍较高,特别是非监测点、农村、婴幼儿、来院途中、家里、医院的漏报率偏高。应采取多种针对性措施,减少死亡漏报,提高数据完整性。

Objective To understand the status of under-reporting of data about deaths in Changsha City, and to evaluate its completeness so as to provide a scientific basis for formulation of health policies and health care measures. Methods The multi-stage stratified cluster random sampling method was adopted to select 3 streets/towns from each district (county/city). The death list of permanent residents from 2018 to 2020 was obtained from multiple channels and household investigations, then compared with the data from the network reporting system, and the data failed to match with those from the network reporting system were considered as the under-reporting. SPSS21.0 software was used for statistical analysis. χ² test or Fisher’s exact test was used to compare the rates, with α=0.05. Binary logistic regression was employed for multivariate analysis, with α_in=0.05 and α_out= 0.10. Results The overall under-reporting rate of deaths in Changsha from 2018 to 2020 was 8.18%. Multivariate results showed that rural areas (OR=1.76, 95%CI:1.53-2.02), 0-5 years old (OR=10.47, 95%CI:6.11-17.92), non-monitoring sites (OR=3.01, 95%CI:2.61-3.46), the first quarter (OR=1.45, 95%CI:1.22-1.71), hospitals (OR=24.8, 95%CI:14.27-43.12), homes (OR=45.6, 95%CI:26.88-77.37), on the way to hospital (OR=63.33, 95%CI:32.02-125.25), nursing homes (OR=35.31, 95%CI:14.36-86.78) were risk factors for the under-reporting of deaths in the residents. The third quarter (OR=0.78, 95%CI:0.65-0.94), 2019 (OR=0.49, 95%CI:0.42-0.57) and 2020 (OR=0.34, 95%CI:0.29-0.40) were protective factors for the under-reporting of deaths in the residents. Conclusion The under-reporting of deaths in Changsha City during 2018-2020 was generally improved, but the total under-reporting rate was still high, especially in the non-monitoring sites, rural areas and infants and young children, on the way to hospitals, at home and in hospitals. A variety of measures should be taken so as to reduce the under-reporting of deaths and improve the data integrity.