Abstract
BackgroundDeath registration completeness has never been assessed at the county level in China. Such analyses would provide critical intelligence to monitor the performance of the vital registration system and yield adjustment factors to correct death registration data, thereby increasing their policy utility.MethodsWe estimated the completeness of death registration for 31 provinces and 2844 counties of China in 2018 based on death data from the China Cause of Death Reporting System (CDRS) by using the empirical completeness method. We computed the root mean square difference (RMSD) of county-level completeness compared with provincial-level completeness to study intra-provincial variations. A two-level (province and county) logistic regression model was fitted to explore the association between county-level registration completeness and a set of covariates reflecting socioeconomic status, healthcare quality, and specific strategies and regulations designed to improve registration.ResultsIn 2018, the overall death registration completeness for the CDRS in China was 74.2% (95% uncertainty interval [UI] 66.2–80.4), with very little difference for males and females. Geographical differences in completeness were higher across counties than across provinces. The county-level completeness ranged from 2.4% (95% UI 1.0–5.0%) in Burang County, Tibet, to 100.0% (95% UI 99.9–100.0%) in Guandu District, Yunnan. The coastal provinces of Jiangsu, Guangdong, and Fujian, with higher overall completeness, contained counties with low completeness; conversely, the underdeveloped provinces of Guangxi and Guizhou, with lower overall completeness, included some counties with high completeness. GDP, education, population density, minority population, healthcare access, and registration strategies were important drivers of the geographical differences in registration completeness.ConclusionsThere are marked inequalities in registration completeness at the county level and within provinces in China. The socioeconomic condition, the implementation of specific registration-enhancing initiatives, and the availability and quality of medical care were the primary drivers of the observed geographical variation. A more strategic approach, with more research, is required to identify the main reasons for death under-reporting, especially in the poorer performing counties, to guide remedial action.
Highlights
Death registration completeness has never been assessed at the county level in China
Prior to 2013, the essential data on the causes of death in China were provided by two sample-based mortality surveillance systems, the nationally representative Disease Surveillance Points (DSP) system of the Chinese Center for Disease Control and Prevention (CDC), and the vital registration (VR) system of the Chinese Ministry of Health (MOH) [2]
We investigated intra-provincial variation in completeness of death registration by computing the root mean square difference (RMSD) of county-level completeness compared with provincial-level completeness (Additional file 1: Table S4)
Summary
Death registration completeness has never been assessed at the county level in China Such analyses would provide critical intelligence to monitor the performance of the vital registration system and yield adjustment factors to correct death registration data, thereby increasing their policy utility. Prior to 2013, the essential data on the causes of death in China were provided by two sample-based mortality surveillance systems, the nationally representative Disease Surveillance Points (DSP) system of the Chinese Center for Disease Control and Prevention (CDC), and the vital registration (VR) system of the Chinese Ministry of Health (MOH) [2]. The VR system was built in the 1950s in 13 cities and progressively enlarged to 319 counties/districts in 22 provinces covering about 230 million people in 2012 [3] These two systems overlapped in 42 counties [3]. Differences between the two systems and their development are described in detail elsewhere [3]
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