An integrated national mortality surveillance system for death registration and mortality surveillance, China

Abstract

In China, sample-based mortality surveillance systems, such as the Chinese Center for Disease Control and Prevention’s disease surveillance points system and the Ministry of Health’s vital registration system, have been used for decades to provide nationally representative data on health status for health-care decision-making and performance evaluation. However, neither system provided representative mortality and cause-of-death data at the provincial level to inform regional health service needs and policy priorities. Moreover, the systems overlapped to a considerable extent, thereby entailing a duplication of effort. In 2013, the Chinese Government combined these two systems into an integrated national mortality surveillance system to provide a provincially representative picture of total and cause-specific mortality and to accelerate the development of a comprehensive vital registration and mortality surveillance system for the whole country. This new system increased the surveillance population from 6 to 24% of the Chinese population. The number of surveillance points, each of which covered a district or county, increased from 161 to 605. To ensure representativeness at the provincial level, the 605 surveillance points were selected to cover China’s 31 provinces using an iterative method involving multistage stratification that took into account the sociodemographic characteristics of the population. This paper describes the development and operation of the new national mortality surveillance system, which is expected to yield representative provincial estimates of mortality in China for the first time.

A social change perspective on injury prevention in China

“…As of 2012, vital registration data existed for only 8% of the Chinese population and Disease Surveillance Point (DSP) data for 6% 18. Since 2013 an integrated system based on vital registration and DSP covers 24% of the national population, though estimates from this system have not become publicly available 19. Methods for estimates vary from simple scale-up of the vital registration data, to complex adjustments to vital registration and DSP estimates to improve representativeness 16 18…”

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“…In 1987, the system covered 99 million people in more than 100 cities and counties, approximately 10% of the total Chinese population22. By 2012, the system included a total of 138 rural counties and 181 urban districts from 22 provinces of China and the population covered by the system had increased to 17% of the total population23. However, the MOH-VR data before 2013 are generally not representative of China’s mortality conditions because the system purposively sampled counties and cities with relatively good reporting mechanisms, primarily distributed in eastern and central China2324.…”

“…By 2012, the system included a total of 138 rural counties and 181 urban districts from 22 provinces of China and the population covered by the system had increased to 17% of the total population23. However, the MOH-VR data before 2013 are generally not representative of China’s mortality conditions because the system purposively sampled counties and cities with relatively good reporting mechanisms, primarily distributed in eastern and central China2324. To ensure the sample representativeness, in 2013 the MOH extensively modified MOH-VR and established the Integrated National Mortality Surveillance System (INMSS), which retained about one third MOH-VR’s original surveillance sites and included over 500 new representative sites23.…”

“…However, the MOH-VR data before 2013 are generally not representative of China’s mortality conditions because the system purposively sampled counties and cities with relatively good reporting mechanisms, primarily distributed in eastern and central China2324. To ensure the sample representativeness, in 2013 the MOH extensively modified MOH-VR and established the Integrated National Mortality Surveillance System (INMSS), which retained about one third MOH-VR’s original surveillance sites and included over 500 new representative sites23. By 2014, the INMSS had included 605 surveillance sites from all 31 provinces covering 323.8 million people, roughly 24% of the total population23.…”

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“…5,15,16 In the 2013 survey, an integrated national mortality surveillance system was used to provide a nationally and provincially representative survey of the country. 17 This new system increased the number of surveillance points from 161 to 605 to cover major geographic areas of all 31 provinces, autonomous regions, and municipalities in mainland China, and enlarged the surveillance population covered from 6% to 24% of the Chinese population. The first level of sampling was stratified by 31 provinces.…”