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Mortality registration and surveillance in China: History, current situation and challenges

Quality of the system and assessment
Background: Mortality statistics are key inputs for evidence based health policy at national level.
Little is known of the empirical basis for mortality statistics in China, which accounts for roughly
one-fifth of the world's population. An adequate description of the evolution of mortality
registration in China and its current situation is important to evaluate the usability of the statistics
derived from it for international epidemiology and health policy.

Current situation: The Chinese vital registration system currently covers 41 urban and 85 rural
centres, accounting for roughly 8 % of the national population. Quality of registration is better in
urban than in rural areas, and eastern than in western regions, resulting in significant biases in the
overall statistics. The Ministry of Health introduced the Disease Surveillance Point System in 1980,
to generate cause specific mortality statistics from a nationally representative sample of sites.
Currently, the sample consists of 145 urban and rural sites, covering populations from 30,000 –
70,000, and a total of about 1 % of the national population. Causes of death are derived through a
mix of medical certification and 'verbal autopsy' procedures, applied according to standard
guidelines in all sites. Periodic evaluations for completeness of registration are conducted, with
subsequent corrections for under reporting of deaths.

: Results from the DSP have been used to inform health policy at national, regional and
global levels. There remains a need to critically validate the information on causes of death, and a
detailed validation exercise on these aspects is currently underway. In general, such sample based
mortality registration systems hold much promise as models for rapidly improving knowledge
about levels and causes of mortality in other low-income populations.

The paper was published in 2005 on Population Health Metrics (open access).

Authors: Gonghuan Yuan, Jianping Hu, Ke Quin Rao, Jeimin Ma, Chalapati Rao and Alan D Lopez



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