Strengthening vital statistics in Brazil: investigation of ill-defined causes of death and implicatoins on mortality statistics

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GHME 2013 Conference …

GHME 2013 Conference
Session: Verbal autopsy
Date: June 18 2013
Presenter: Elisabeth Franca
Institution:
Federal University of Minas Gerais, Brazil
PAHO/WHO
Oswaldo Cruz Foundation

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  • 1. Strengthening vital statistics in Brazil: investigation of ill-defined causes of death and implications on mortality statistics GPEAS UniversidadeFederaldeMinasGerais Conference “Global Health Metrics and Evaluation: Data, Debates, Directions” Seattle, June 17-19 2013 Elisabeth França1 , Fátima Marinho2 Lenice H Ishitani1 , Renato Teixeira1 , Celia L Szwarcwald3 1.Federal University of Minas Gerais, Brazil; 2. PAHO/WHO; 3. Oswaldo Cruz Foundation
  • 2. GPEAS/UFMG Introduction (1) Mortality Information System (MIS) in Brazil . Created in 1975 by the Ministry of Heath . Death certificate(DC): international form (ICD) → should be issued by the attending physician (or a coroner under suspicious conditions) . Automatic selection program (SCB) for the underlying cause of death . Cleaning and compilation: Municipal, States and National levels electronic data file transfer . Available on the Internet: www.datasus.gov.br .
  • 3. Quality of causes of death data in the MIS: . North and the Northeast regions: 20%- 30% of IDCD until 2003; . South and Southeast: <10%. Political – administrative division: •5 regions •27 states •5540 municipalities Introduction (2)
  • 4. GPEAS/UFMG Introduction (3) • In 2005, the Brazilian government implemented a project to decrease the ill-defined causes of death (IDCD) from chapter XVIII ICD-10, mainly in states and municipalities in the poorest regions; • In this project, deaths due to IDCD were investigated and reclassified into a defined cause; • A question: Is cause of death distribution among IDCD similar to those of recorded data apart from injuries? • This study aims to compare the distribution of causes of death between the investigated IDCDs and the recorded data.
  • 5. GPEAS/UFMG Investigation of IDCD in Brazil • In the MoH project, for each death certificate with IDCD all attempts were made by health-service professionals to trace existing information about the final disease and cause of death; • Sources of information: hospital records, municipality health departments, autopsies, family health program records, linkage between health information systems (e.g. hospital information system), and verbal autopsy questionnaires (2009-2010); • Underlying cause of death: assigned using the available evidence.
  • 6. Source: CGIAE/DASIS/SVS-MoH Percentage of IDCD 2004 2008 2011 Reduction of deaths due to ill-defined causes, by municipalities 2004, 2008 and 2011 Investigation of IDCD in Brazil –Results (1)
  • 7. GPEAS/UFMG Investigation of IDCD in Brazil –Results (2) Proportions of ill-defined causes of death according to States. Northeast region, Brazil, 1996-2010. Ano SE AL CE Bahia Maranhão PE PI Paraíba RN 1996 32.1 41.2 30.9 28.6 40.1 27.1 34.1 50.4 29.9 1997 33.0 38.2 28.9 27.8 39.6 24.7 32.3 51.9 29.7 1998 32.0 34.8 24.0 28.2 40.0 24.7 32.7 52.9 29.5 1999 31.7 34.4 21.9 29.9 40.7 24.6 31.4 53.5 29.5 2000 29.7 29.1 20.2 29.7 36.1 22.8 30.7 46.5 27.6 2001 26.4 28.0 21.5 26.7 39.5 21.0 29.6 45.1 28.0 2002 23.5 28.2 25.5 25.4 40.3 19.0 25.9 40.5 27.0 2003 23.8 27.2 26.1 25.7 37.4 17.7 26.2 34.9 24.9 2004 10.6 25.2 24.8 24.8 36.6 16.2 24.3 29.7 20.0 2005 9.6 13.5 19.1 25.3 16.6 10.0 22.1 15.6 8.5 2006 8.2 10.4 6.2 14.9 10.3 5.9 6.5 11.2 5.0 2007 7.2 7.0 5.1 14.1 8.1 5.3 4.3 8.2 3.6 2008 6.6 6.7 5.0 14.5 7.5 5.2 3.0 7.6 3.4 2009 7.6 8.0 5.4 14.5 6.5 5.5 3.4 8.2 3.8 2010 6.2 8.9 5.5 15.6 6.6 5.5 4.8 8.3 3.1 Source: MIS/MoH
  • 8. GPEAS/UFMG Investigation of IDCD in Brazil –Results (3) Recorded deaths n n % n % n % 2006 1,031,691 95,280 9.2 24,947 26.2 15,212 61.0 2007 1,047,824 96,078 9.2 24,649 25.7 15,997 64.9 2008 1,077,007 95,166 8.8 26,151 27.5 17,089 65.3 2009 1,103,088 94,836 8.6 26,822 28.3 17,150 63.9 2010 1,136,947 97,314 8.6 29,487 30.3 19,304 65.5 Total 5,396,557 478,674 8.9 132,056 27.6 84,751 64.2 Ill-defined causes of death (IDCD) according to investigation and reclassification. Brazil, 2006 - 2010 *Among investigated deaths Year Investigated IDCD Reclassified IDCD*IDCD
  • 9. GPEAS/UFMG 9
  • 10. GPEAS/UFMG 10 Distribution of causes of death among reclassified ill-defined conditions byregions. Brazil, 2010. n % n % n % n % n % n % Infectious diseases 44 3.8 295 3.4 228 3.5 31 1.9 78 5.4 676 3.5 Neoplasms 135 11.7 1,061 12.4 392 6.0 128 8.0 76 5.3 1,792 9.3 Endocrine diseases 132 11.4 1,032 12.0 615 9.4 140 8.7 55 3.8 1,974 10.2 Mental and behavioural disorders 61 5.3 486 5.7 509 7.8 131 8.1 45 3.1 1,232 6.4 Diseases of the circulatory system 487 42.1 3,750 43.8 2,666 40.8 680 42.2 599 41.8 8,182 42.4 Diseases of the respiratory system 89 7.7 640 7.5 442 6.8 123 7.6 232 16.2 1,526 7.9 Diseases of the digestive system 52 4.5 291 3.4 229 3.5 88 5.5 168 11.7 828 4.3 Diseases of the genitourinary system 9 0.8 78 0.9 73 1.1 17 1.1 17 1.2 194 1.0 Maternal conditions 3 0.3 23 0.3 41 0.6 7 0.4 2 0.1 76 0.4 Perinatal conditions 18 1.6 24 0.3 35 0.5 18 1.1 10 0.7 105 0.5 Congenital malformations 6 0.5 23 0.3 28 0.4 9 0.6 6 0.4 72 0.4 External causes 78 6.7 547 6.4 926 14.2 154 9.6 91 6.4 1,796 9.3 Total 1,156 100.0 8,567 100.0 6,538 100.0 1,610 100.0 1,433 100.0 19,304 100.0 BrazilCause-of-death North Northeast Southeast South Centre-West
  • 11. GPEAS/UFMG 11
  • 12. GPEAS/UFMG Investigation of ill-defined causes of death in Brazil – Results in 2010 Cause-of-death (n) (%) n % Infectious diseases 676 3.5 48,488 4.7 0.7 Neoplasms 1,792 9.3 176,402 17.0 0.5 Diseases of the blood and immune system 92 0.5 6,290 0.6 0.8 Endocrine diseases 1,974 10.2 67,863 6.5 1.6 Mental and behavioural disorders 1,232 6.4 11,374 1.1 5.8 Diseases of the nervous system 613 3.2 24,468 2.4 1.3 Chapter 7 8 0 28 0 15.4 Chapter 8 4 0 122 0 1.8 Diseases of the circulatory system 8,182 42.4 317,674 30.6 1.4 Diseases of the respiratory system 1,526 7.9 119,334 11.5 0.7 Diseases of the digestive system 828 4.3 57,239 5.5 0.8 Chapter 12 54 0.3 3,282 0.3 0.9 Chapter 13 80 0.4 4,396 0.4 1.0 Diseases of the genitourinary system 194 1.0 24,613 2.4 0.4 Maternal conditions 76 0.4 1,422 0.1 2.9 Perinatal conditions 105 0.5 23,723 2.3 0.2 Congenital malformations 72 0.4 9,869 1.0 0.4 Chapter 19 0 0 20 0 0 External causes 1,796 9.3 141,360 13.6 0.7 Total 19,304 100.0 1,037,967 100.0 1.0 *IDCD: ill-defined causes of death **All causes apart from IDCD (n=97,314) and unclassified deaths (n=1,666) ***%IDCD / %defined causes Ratio*** Distribution of causes of death among ill-defined causes and recorded data. Brazil, 2010. IDCD investigated and reclassified* Defined causes (DC) among recorded data**
  • 13. GPEAS/UFMG Investigation of ill-defined causes of death in Brazil –Results in 2010 Age Ratio n % n % < 01 316 1.6 38,103 3.7 0.4 01-04 126 0.7 6,341 0.6 1.1 05-09 70 0.4 3,833 0.4 1.0 10-14 92 0.5 5,284 0.5 0.9 15-19 240 1.2 17,899 1.7 0.7 20-24 320 1.7 26,431 2.5 0.7 25-29 410 2.1 27,002 2.6 0.8 30-34 504 2.6 27,562 2.7 1.0 35-39 623 3.2 29,250 2.8 1.1 40-44 844 4.4 36,702 3.5 1.2 45-49 1,085 5.6 47,871 4.6 1.2 50-54 1,132 5.9 59,595 5.7 1.0 55-59 1,237 6.4 70,070 6.8 0.9 60-64 1,462 7.6 78,437 7.6 1.0 65-69 1,475 7.6 87,602 8.4 0.9 70-74 1,769 9.2 103,357 10 0.9 75-79 1,904 9.9 109,025 10.5 0.9 80-84 1,968 10.2 108,696 10.5 1.0 85 + 3,661 19.0 151,738 14.6 1.3 Total*** 19,304 100.0 1,037,967 100.0 1.0 * Ill-defined causes **Defined causes (DC) ***Missing age included (n=65 for IDCD and n=3,169 for recorded data) IDCD Recorded data (%) Comparing age distribution among reclassified IDCD* and recorded data (DC)**. Brazil, 2010.
  • 14. GPEAS/UFMG Investigation of ill-defined causes of death in Brazil –Results in 2010 Garbage codes Recorded data (DC) Reclassified IDCD Ill-defined circulatory codes/all circulatory diseases 6.0 7.1 Ill-defined cancercodes/all cancer 5.6 7.7 Ill-defined injury codes/all injuries 14.8 16.3 Ill-defined digestive codes/all digestive diseases 17.5 11.8 Ill-defined respiratory codes/all respiratory diseases 7.7 8.7 *Codes ICD-10 I47.2,I49.0,I46,I50,I51.4,I51.5,I51.6,I51.9,I70.9 (Cardiovascular disease) *Codes ICD-10 C76, C80, C97 (Cancer) *Codes ICD-10 Y10-Y34 and Y87.2 ( Injury) *Codes ICD-10 K92, K76.9, K92.0-K92.2 (Digestive) *Codes ICD-10 J96.9, J98 ( Respiratory) Percentage of garbage codes* among recorded data (DC) and reclassified IDCD. Brazil, 2010.
  • 15. GPEAS/UFMG Investigation of ill-defined causes of death in Brazil Conclusion The distribution of the cause of death after investigation of IDCD was different from those in the observed (DC) data; There are regional differences; In order to minimize bias, these differences must be taken into consideration when redistributing ill-defined causes; The investigation of IDCD may provide the basis for a methodology to be used in the correction of the data and also leads to an improvement in the quality of the mortality data.