死因診斷與死因統計品質

Quality of Cause-of-Death Statements and Statistics

本文包括四部份：首先說明死亡原因（譬如肺癌、糖尿病、腦出血等）與死亡機轉（譬如出血性休克、呼吸衰竭、敗血症或心律不整等）的差異；接著指出理想死因診斷應該具備明確性特徵（譬如消化道出血沒有明確出血部位，腦瘤沒有明確指出是惡性或良性），第三部分點出死亡證明書死因診斷欄填在甲乙丙丁行的死因診斷間應具備合理因果關係（譬如將高血壓填在糖尿病下一行是錯誤填寫），第四部分以實際數據呈現台灣不同死因統計品質指標二十年來的改變情況，發現總體台灣死因統計品質有明顯改進，但是對於惡性腫瘤與循環系統疾病之不明確死因診斷還是偏高，需要進一步努力改善。

This paper consists four parts. In the first part, we contrasted the differences between cause of death (COD), such as lung cancer, diabetes mellitus, or intracerebral hemorrhage etc., and mechanism of death, such as hemorrhagic shock, sepsis, or arrhythmia etc. In the second part, we suggested that an idea COD statement should be as specific as possible. For example, peptic bleeding without specifying location or brain tumor without indicating whether the tumor was malignant or benign were examples of unspecified COD diagnosis. In third part, we pointed out that COD diagnoses reported in line A, B, C, and D should have proper causal sequence. For example, it is an incorrect statement if hypertension is reported on the line below diabetes. In the fourth part, we demonstrated the changes in indicators of quality of COD statistics in Taiwan from 1992 to 2012. Most of the indicators decreased drastically during the past two decades. However, the percentage of reporting unspecified cancer and cardiovascular-related COD statements were still high compared with other countries. Efforts are needed to improve the quality of COD statements and statistics in Taiwan.