Mortality information and situation in the americas

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  • NEED LABELS ON THE X AND Y AXES
  • Mortality information and situation in the americas

    1. 1. Mortality Information System Fatima Marinho, MD, MPH, PhD Health and Analysis (HSD/HA) Pan American Health Organization (PAHO/WHO)
    2. 2. Topics• Sources and data base• Quality of death information in The Americas % under-registration, % ill defined, % garbage codes• Distribution major causes of death• Examples of data quality problems• Challenges
    3. 3. Sources• National Offices of Statistics• Mexico, Ecuador, El Salvador, Peru• Civil Registration offices• Costa Rica, Argentina, Chile• Ministry of Health• Republica Dominicana, Brazil, Colombia
    4. 4. Main Variables/Annual data request tothe countries *•Deaths: Individual data on each *Since 2009 this extensive setdeath, with the following specifications: has been requested•Sex•Underlying cause of death Major civil division of•Age (in hours for the first day, in days residence of the decedentfor the first month, in months for the •Certification of the cause (s)first year, and complete years after one of death: physician or nonmedicalyear of age) •Educational attainment of•Other available causes decedent (instruction or education level) •Ethnicity of the decedent •Place of occurrence of the death (hospital, residence, public thoroughfare, etc) •Date of death
    5. 5. Seasonality of Respiratory Deaths
    6. 6. Why evaluate data quality? • Accuracy of the information for policy • Availability of the data doesn’t guarantee quality • The source per se is not a guarantee of quality, for example, hospital statistics • Poor quality of the data  poor decision  lost of opportunity to identify problems and intervention in order to improve the population health
    7. 7. Challenges for using mortality data• Incomplete series of data registries• Poor certification of cause of death• Poor availability and opportunity of the data• Poor use of the data• Poor value of cause of death codification• There is a tendency to codify the cause of death according what is expected to be more frequent• Late registration of death
    8. 8. Total defunciones• En 2007 hubo un total de 5 736 164* defunciones en los 32 países de la Región de las Américas con datos para ese año (53,1% hombres y 46,9% mujeres).• La tasa de mortalidad ajustada por edad para la población total fue 5,8 por 1 000 habitantes (7,1 por 1 000 en hombres y 4,7 por 1 000 en mujeres).*Dato corregido para subregistroLa mortalidad captada fue de 5 085 260USA responde por mitad de las defunciones captadas
    9. 9. Timeliness 1950-2010 Bolivia Haiti Aruba Number of countries in The Region with Netherlands Antilles Martinique mortality data by cause, 1950-2010 Virgin Islands (USA) 50 Guadeloupe French Guiana Honduras Grenada Anguilla 45 CIE-7 CIE-8 Montserrat Jamaica CIE-9 CIE-10 Guyana Cayman Islands 40Turks and Caicos Islands Saint Vincent and Bahamas Brazil 35 British Virgin Islands Peru Nicaragua Saint Lucia 30 Antigua and Barbuda Argentina Suriname Bermuda 25 Belize Cuba Saint Kitts and Nevis Paraguay 20 Dominican Republic Dominica Uruguay Guatemala 15 El Salvador Ecuador Panama Colombia 10 Venezuela Puerto Rico Barbados Costa Rica 5 Trinidad and Tobago Mexico ChileUnited States of America Canada 0 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Percentage of years Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    10. 10. 45/48 Countries andUnder- registration % Territories in thecompleteness Americas have a Vital Statistics System working Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    11. 11. % ill-defined causes of deathSubregion circa 2009Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    12. 12. % ill-definedcauses of deathby countrycirca 2009Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    13. 13. % ill-defined causes of death Selected countries, 2000-2009 25.0 20.0 Cuba Estados Unidos de América México 15.0 Colombia Chile Nicaragua Panamá 10.0 Brasil Paraguay El Salvador 5.0 0.0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    14. 14. % ill-defined causes of death Americas 2005-2009 2005 2006 2007 2008 2009 % % % % % Other ill-defined and unspecified causes of 40.4 41.6 42.5 45.3 46.5 mortality (R99) Unattended death (R98) 26.5 20.7 17.9 21.8 20.3 Senility (R54) 9.3 10.7 10.3 9.6 8.5 Other symptoms and signs involving the 8.2 7.1 7.1 6.9 7.6 circulatory and respiratory systems (R09) Other sudden death, cause unknown 2.7 2.6 3.3 3.8 4.2 (R96) Remainder 11.2 15.3 16.9 12.6 12.3 Number of deaths 196919 175695 179553 143577 137622Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    15. 15. % ill-defined causes of death Brazil 2005-2009 2005 2006 2007 2008 2009 % % % % % Other ill-defined and unspecified causes of 35.9 41.6 42.0 44.1 43.8 mortality (R99) Unattended death (R98) 46.1 38.2 35.1 34.9 33.1 Other symptoms and signs involving the 9.4 8.7 8.8 7.5 8.9 circulatory and respiratory systems (R09) Senility (R54) 2.6 4.1 4.3 4.3 4.7 Other general symptoms and signs 1.7 3.3 3.7 3.3 3.3 (R68) Remainder 2.2 3.3 3.5 3.5 3.6 Number of deaths 104455 85543 80244 79784 78994Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    16. 16. % ill-defined causes of death Cuba 2005-2009 2005 2006 2007 2008 2009 % % % % % Other ill-defined and unspecified causes of 45.8 54.0 49.8 44.2 40.6 mortality (R99) Senility (R54) 18.2 17.6 19.3 24.1 23.1 Other sudden death, cause unknown 19.2 15.2 14.2 13.5 16.8 (R96) Unattended death (R98) 3.6 0.9 4.5 3.7 4.4 Other general symptoms and signs 4.6 4.7 3.9 3.5 3.0 (R68) Remainder 6.4 4.7 4.7 5.9 8.1 Number of deaths 637 635 643 764 794Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    17. 17. % ill-defined causes of death Peru 2003-2007 2005 2006 2007 2008 2009 % % % % % Other ill-defined and unspecified causes of 27.6 44.6 77.8 78.1 74.6 mortality (R99) Senility (R54) 18.3 8.9 0.0 0.0 0.0 Other symptoms and signs involving the 11.4 19.5 0.0 0.0 0.0 circulatory and respiratory systems (R09) Shock, not elsewhere classified (R57) 10.8 5.1 0.0 0.0 1.6 Unattended death (R98) 4.4 7.9 0.0 8.3 11.6 Remainder 27.5 14.0 22.2 13.7 12.2 Number of deaths 2149 1814 18 630 189Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    18. 18. % under-registration and % ill-defined causesof death Americas, 2007-2009 Nicaragua Jamaica Cayman Islands Americas Source: Health situation in the Americas – Basic Indicators 2011
    19. 19. Causes of death?In the Second Annual Report of the Registrar General of Great Britain in 1840, WilliamFarr presented the statistics of causes of death (CoD), defined as:“diseases, which terminate in the extinction of existence,” but Farr highlighted theconcern that “…the attention of the observer was less attracted to this class offacts, and overlooking the proximate cause, that is, the internal morbidprocess…”In that report, he also criticized the use of vague categories like“sudden death,”“natural death,” “visitation of God,” and “old age,”but he admitted that in some cases, no particular cause of death could be identifiedAll these criticisms remain relevant today
    20. 20. Underlying cause of death (ICD)a) the disease or injury which initiated the train of morbid events leading directly to death orc) b) the circumstances of the accident or violence which produced the fatal injury” The most effective public health objective is to prevent the precipitating from operating From the stand point of prevention of death is necessary to break the chain of events or to effect a cure at some point Even with a physician-completed death certificate, assignment of the underlying cause of death can be problematic
    21. 21. many deaths assigned to causes thatcannot or should not be consideredunderlying causes of death“often called garbage codes (GCs)”In 1996, Murray and Lopez introduced theterm “garbage coding” for the practiceof assigning deaths to causes that arenot useful for public health analysis ofcause-of-deathdata as part of the assessment of the GlobalBurden of Disease (GBD)
    22. 22. Typology of Garbage CodesFour categories were identified:3.Causes that cannot or should not be considered as underlying causes of death(Type 1) chapter 18 of ICD-10 or R codes essential primary hypertension and atherosclerosis. causes that are described as the long-term sequelae of disease, such as paraplegia and tetraplegia2. Intermediate causes of death (Type 2): heart failure, septicemia, peritonitis, osteomyelitis, or pulmonary embolism.3. Immediate causes of death (Type 3): final steps in a disease pathway leading to death. disseminated intravascular coagulation or defibrination syndrome . Cardiac arrest and respiratory failure4. Unspecified causes (Type 4): injuries are coded to unspecified factors or intentSource: Algorithms for enhancing public health utility of nationalcauses of death data IHME
    23. 23. This typology has been developedtaking into consideration thefollowing: •the likelihood that a condition can be an underlying cause of death •the need for codes that provide a location for unspecified or ambiguous causes of death •the need for codes that represent causes that are not underlying but intermediate or final events in the chain leading to deathSource: Algorithms for enhancing public health utility of nationalcauses of death data IHME
    24. 24. Garbage CodesSubregion and country ARG VGB circa 2009 GTM VCT MSR SLV GRD LCA ABW BRB ATG CYM URY DOM PRI ECU AIA GUY PAN PRY BHS TCA NIC BLZ BRA KNA USA VEN BMU MEX JAM TTO SUR CHL COL CRI CUB VIR 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% Source: PAHO/WHO. Mortality Information System; Washington DC:2011Source: PAHO/WHO. Mortality Information System; Washington DC:2011 Source: Algorithms for enhancing public health utility of national causes of death data IHME
    25. 25. • Intermediate causes Causes %are the most important gc(60%) Heart failure (I50) 19.0 Other sepsis (A41) 9.6 12% 23% 6% Essential (primary) hypertension 6.7 (I10) Chronic kidney disease (N18) 6.0 Malignant neoplasm, without 5.7 specification of site (C80) Exposure to unspecified factor 3.7 59% (X59) Type 1 Causes that cannot or should not be considered as ucd Unspecified kidney failure (N19) 3.5 Type 3 Immediate Pneumonitis due to solids and 3.1 Type 2 Intermediate liquids (J69) Type 4 Unspecified causes Other diseases of digestive 2.9 system (K92) Cardiac arrest (I46) 2.7 Remainder 39.3Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    26. 26. Type 1 Causes that cannot % Type 2 Intermediate causes %or should not be consideredas ucd Heart failure (I50) 31.9Essential (primary) 57.7hypertension (I10) Other sepsis (A41) 16.1Atherosclerosis (I70) 15.9 Chronic kidney disease (N18) 10.1Cerebral palsy (G80) 5.3 Unspecified kidney failure 5.8Hyperplasia of prostate (N40) 2.8 (N19)Remainder 18.3 Remainder 36.1Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    27. 27. Type 3 Immediate causes % Type 4 Unspecified causes % of death Respiratory failure, not 50.1 Malignant neoplasm, without 24.9 elsewhere classified (J96) specification of site (C80) Cardiac arrest (I46) 45.1 Exposure to unspecified factor 16.2 (X59) Complications and ill-defined 12.8 Disseminated intravascular 2.8 descriptions of heart disease coagulation [defibrination (I51) syndrome] (D65) Unspecified event, undetermined 6.9 intent (Y34) Remainder 1.9 Remainder 39.3Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    28. 28. Cause of death andEpidemiologic transition in the Region
    29. 29. Transición Epidemiológica en EU Estados Unidos100.00%90.00%80.00%70.00%60.00%50.00%40.00%30.00%20.00%10.00% 0.00% 50 52 54 58 60 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 00 02 04 56 62 19 19 19 19 19 19 19 19 19 19 19 19 20 20 19 19 19 19 19 19 19 19 19 19 19 19 19 20 Group I Communicable Group II Non communicable Group III Injuries Ill defined Fuente: Sistema de inforamción de Mortaldiad HA/HSD/OPS
    30. 30. Transición Epidemiológica en Brasil100 90 80 70 60 50 40 30 20 10 0 1930 1940 1950 1960 1970 1980 1990 2000 2009 Group I Communicable Group II No Communicable Group III Injuries Group IV Ill Defined Fuente: Sistema de inforamción de Mortaldiad HA/HSD/OPS
    31. 31. Transición Epidemiológica en México México100.00%90.00%80.00%70.00%60.00%50.00%40.00%30.00%20.00%10.00% 0.00% 59 67 83 85 91 99 07 55 57 61 63 65 69 71 73 75 77 79 81 87 89 93 95 97 01 03 05 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 20 20 19 19 19 19 20 20 Group I Communicable Group II Non communicable Group III Injuries Ill defined Fuente: Sistema de inforamción de Mortaldiad HA/HSD/OPS
    32. 32. Transición Epidemiológica en Guatemala Guatemala100.00%90.00%80.00%70.00%60.00%50.00%40.00%30.00%20.00%10.00% 0.00% 63 65 69 71 75 81 86 88 92 94 96 98 00 02 06 67 77 79 90 04 19 19 19 19 19 19 19 19 20 20 19 19 19 19 19 19 19 19 20 20 Group I Communicable Group II Non communicable Group III Injuries Ill defined Fuente: Sistema de inforamción de Mortaldiad HA/HSD/OPS
    33. 33. The three leading causes of death in the Americas Rango 1 2 3 Países Año Argentina 2009 Enfermedades isquémicas Enfermedades Influenza y neumonía del corazón cerebrovasculares Belice 2008 Enfermedades isquémicas Eventos de intención no Diabetes mellitus del corazón determinada Brasil 2009 Enfermedades Enfermedades isquémicas cerebrovasculares del corazón Influenza y neumonía Canadá 2007 Neoplasia maligna de la Enfermedades tráquea, de los bronquios Demencia y enfermedad isquémicas del corazón y del pulmón de Alzheimer Chile 2008 Enfermedades Enfermedades isquémicas Cirrosis y otras cerebrovasculares del corazón enfermedades del hígado Colombia 2008 Enfermedades Enfermedades isquémicas del corazón Agresiones/homicidios cerebrovasculares Costa Rica 2009 Enfermedades Enfermedades Enfermedades isquémicas del corazón cerebrovasculares hipertensivas Cuba Neoplasia maligna de la Enfermedades Enfermedades tráquea, de los bronquios 2009 isquémicas del corazón cerebrovasculares y del pulmón Ecuador 2009 Enfermedades Diabetes mellitus cerebrovasculares Influenza y neumonía El Salvador 2008 Enfermedades del sistema Enfermedades isquémicas Agresiones/homicidios urinario del corazón Estados 2007 Neoplasia maligna de la Unidos de Enfermedades tráquea, de los bronquios Demencia y enfermedad América isquémicas del corazón y del pulmón de Alzheimer Guatemala 2008 Ciertas afecciones originadas en el período Influenza y neumonía Agresiones/homicidios perinatal Enfermedades Enfermedades Américas 2007 isquémicas del corazón cerebrovasculares Diabetes mellitus Source: Mortality Information System - PAHO
    34. 34. The three leading cause of death in the Americas Rango 1 2 3 Países Año Guyana 2006 Enfermedades Enfermedades isquémicas del corazón cerebrovasculares Diabetes mellitus Islas del 2008 Caribe No- Enfermedades Enfermedades Latino isquémicas del corazón cerebrovasculares Diabetes mellitus México 2009 Enfermedades isquémicas Cirrosis y otras enfermedades del Diabetes mellitus del corazón hígado Nicaragua 2009 Enfermedades isquémicas Cirrosis y otras enfermedades del Diabetes mellitus del corazón hígado Panamá 2009 Enfermedades Enfermedades isquémicas del corazón cerebrovasculares Diabetes mellitus Paraguay 2009 Enfermedades Enfermedades isquémicas Ciertas afecciones originadas en el cerebrovasculares del corazón período perinatal Perú 2007 Enfermedades isquémicas Influenza y neumonía del corazón Enfermedades cerebrovasculares Puerto Rico 2007 Enfermedades Demencia y enfermedad de isquémicas del corazón Diabetes mellitus Alzheimer República 2004 Enfermedades Enfermedades Ciertas afecciones originadas en el Dominicana isquémicas del corazón cerebrovasculares período perinatal Suriname 2007 Enfermedades Enfermedades isquémicas cerebrovasculares del corazón Diabetes mellitus Territorios 2005 Enfermedades franceses cerebrovasculares Diabetes mellitus Neoplasia maligna de la próstata Trinidad y 2007 Enfermedades Tobago isquémicas del corazón Diabetes mellitus Enfermedades cerebrovasculares Uruguay 2004 Enfermedades Enfermedades isquémicas Neoplasia maligna de la tráquea, cerebrovasculares del corazón de los bronquios y del pulmón Venezuela 2007 Enfermedades Enfermedades isquémicas del corazón cerebrovasculares Agresiones/homicidios Enfermedades Enfermedades Américas 2007 isquémicas del corazón cerebrovasculares Diabetes mellitus
    35. 35. Diabetes MellitusAmericas, 2000-2009 100.00% 80.00% 60.00% % 40.00% 20.00% 0.00% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Insulin-dependent diabetes mellitus E10 Non-insulin-dependent diabetes mellitus E11 Malnutrition-related diabetes mellitus E12 Other specified diabetes mellitus E13 Unspecified diabetes mellitus E14 Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    36. 36. Diabetes MellitusBrazil, 2000-2009 100.00% 80.00% 60.00% % 40.00% 20.00% 0.00% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Insulin-dependent diabetes mellitus E10 Non-insulin-dependent diabetes mellitus E11 Malnutrition-related diabetes mellitus E12 Other specified diabetes mellitus E13 Unspecified diabetes mellitus E14 Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    37. 37. Diabetes MellitusMexico, 2000-2009 100.00% 80.00% 60.00% % 40.00% 20.00% 0.00% 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Insulin-dependent diabetes mellitus E10 Non-insulin-dependent diabetes mellitus E11 Malnutrition-related diabetes mellitus E12 Other specified diabetes mellitus E13 Unspecified diabetes mellitus E14 Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    38. 38. Diabetes MellitusCuba, 2000-2009 100.00% 80.00% 60.00% % 40.00% 20.00% 0.00% 2001 2002 2003 2004 2005 2006 2007 2008 2009 Insulin-dependent diabetes mellitus E10 Non-insulin-dependent diabetes mellitus E11 Malnutrition-related diabetes mellitus E12 Unspecified diabetes mellitus E14 Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    39. 39. Mortality total and due tocardiovascular diseasesBelize, 2000-2007 Adjusted mortality rates due to CVD dropped 43.7% from 2000 to 2007, very higher than the average of the Region. The CVD mortality trend for Belize wasn’t showed individually in the Americas profile.Source: PAHO/WHO. Mortality Information System; Washington DC:2011
    40. 40. Mortality due to cardiovascular diseasesby major group of causes Limitations to compare Argentina mortality rates due to Ischaemic heart disease to other countriesSource: PAHO/WHO. Mortality Information System; Washington DC:2011
    41. 41. Mortality due to cardiovasculardiseases by major group of causes Americas 43 22 9 12 14 Guatemala 42 22 29 52 10 Ecuador 27 44 37 26 17 Canada 57 21 3 7 19 Argentina 35 35 10 53 31 0% 20% 40% 60% 80% 100% Ischaemic (I20-I25) Cerebrovascular (I60-I69) Hypertensive (I10-I15) Cardiac Arrest (I46)+Heart faillure (I50) OtherSource: PAHO/WHO. Mortality Information System; Washington DC:2011
    42. 42. Cardiovascular diseases mortality Selected countriesSource: PAHO/WHO. Mortality Information System; Washington DC:2011
    43. 43. Diabetes mellitus mortality Selected countriesSource: PAHO/WHO. Mortality Information System; Washington DC:2011
    44. 44. What do we need?• Unify criteria for measuring quality (definitions, standards)• Encourage the development and consolidation of a critical mass of research on causes of death ….. Evaluation in The Region• Policy focused on countries with major needs• Promote the use of standards to improve the quality of information• Use and dissemination of statistics locally corrected

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