Under-reporting of mortalities in areas of Anhui province covered by national disease surveillance system,2013-2014

Objective To examine the under-reporting of death cases in national disease surveillance points (DSPs) of Anhui province from 2013 to 2014 and to evaluate the completeness of the death surveillance system.Methods Using multi-stage cluster random sampling,we carried out a field survey in all DSPs of Anhui province to collect under-reported death cases during 2013-2014.Three townships or communities with crude death rate similar to the average level of a county or a district were selected randomly.Then three villages or neighborhood committees were selected randomly from each of the township or community.All the death cases in the survey areas were collected from all information sources beyond the disease surveillance system and checked with those registered in the disease surveillance system by an automatic computer checking and a thorough manual verification to identify the under-reported of death cases.Results The overall under-reporting rate for all the 23 DSPs was 8.26%,ranging from 1.43% to 25.60%.There was a significant between age group difference in the under-reporting rate (χ²=69.05,P<0.001),with the under-reporting rates of 26.61%,11.45%,6.23%,and 8.13% for the age groups of 0-14,15-44,45-64 and ≥ 65 years,respectively.The under-reporting rate in the urban areas (10.25%) was significantly higher than that in the rural areas (5.66%) (χ²=59.99,P<0.001).Conclusion The mortality data of DSPs in Anhui province was good in integrity;however,there were significant regional and between age group differences in mortality under-reporting rate among the DSPs,suggesting that surveys on mortality under-reporting need to be conducted to adjust the national disease surveillance-based mortality rate and the death registration of the DSPs should be improved.