Abstract
BackgroundValid 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.MethodsA 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.ResultsAge-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.ConclusionsVariations 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.
Highlights
Valid and comparable cause of death (COD) statistics are crucial for health policy analyses
Part I includes a chain of events leading directly to death, with the immediate COD stated on the first line and the underlying cause of death (UCD) on the last [4]
Quantitative analysis To assess the comparability of UCD statistics across the two cities, we obtained anonymized mortality data from Hong Kong’s Department of Health (Hong Kong: for the period 2005–2008) and the Shanghai Center for Disease Control and Prevention (SCDC) (Shanghai: for the period 2005–2007)
Summary
Valid and comparable cause of death (COD) statistics are crucial for health policy analyses. Valid and comparable cause of death (COD) statistics are essential to identify emerging public health challenges, to inform and assist in priority setting and health services planning, and to evaluate health policies and interventions [1, 2]. To ensure the uniformity and quality of mortality data for valid comparisons across regions, the World Health Organization (WHO) has advocated a standardized COD diagnosis form for death certification [3]. Part I includes a chain of events leading directly to death, with the immediate COD (the final disease, injury, or complication directly causing death) stated on the first line and the underlying cause of death (UCD) on the last [4]. COD data are usually compiled and disseminated in the form of yearly statistics on the basis of UCD under the Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD-10), a medical classification list by WHO [5]
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