Quality of cause-of-death data in Brazil: Garbage codes among registered deaths in 2000 and 2015

ABSTRACT Introduction: reliability of mortality data is essential for health assessment and planning. In Brazil, a high proportion of deaths is attributed to causes that should not be considered as underlying causes of deaths, named garbage codes (GC). To tackle this issue, in 2005, the Brazilian Ministry of Health (MoH) implements the investigation of GC-R codes (codes from chapter 18 “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified, ICD-10”) to improve the quality of cause-of-death data. This study analyzes the GC cause of death, considered as the indicator of data quality, in Brazil, regions, states and municipalities in 2000 and 2015. Methods: death records from the Brazilian Mortality Information System (SIM) were used. Analysis was performed for two GC groups: R codes and non-R codes, such as J18.0-J18.9 (Pneumonia unspecified). Crude and age-standardized rates, number of deaths and proportions were considered. Results: an overall improvement in the quality of mortality data in 2015 was detected, with variations among regions, age groups and size of municipalities. The improvement in the quality of mortality data in the Northeastern and Northern regions for GC-R codes is emphasized. Higher GC rates were observed among the older adults (60+ years old). The differences among the areas observed in 2015 were smaller. Conclusion: the efforts of the MoH in implementing the investigation of GC-R codes have contributed to the progress of data quality. Investment is still necessary to improve the quality of cause-of-death statistics.

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Improving quality of medical certification of causes of death in health facilities in Tanzania 2014–2019

BMC Health Services Research ◽

10.1186/s12913-021-06189-7 ◽

2021 ◽

Vol 21 (S1) ◽

Author(s):

Trust Nyondo ◽

Gisbert Msigwa ◽

Daniel Cobos ◽

Gregory Kabadi ◽

Tumaniel Macha ◽

...

Keyword(s):

Quality Improvement ◽

Health Policy ◽

Cause Of Death ◽

Causes Of Death ◽

Health Facilities ◽

Mortality Data ◽

Medical Certification ◽

Specific Mortality ◽

Icd 10

Abstract Background Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. Methods We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. Results 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. Conclusion Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.

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Are there sex differences in completeness of death registration and quality of cause of death statistics? Results from a global analysis

BMJ Global Health ◽

10.1136/bmjgh-2021-006660 ◽

2021 ◽

Vol 6 (10) ◽

pp. e006660

Author(s):

Tim Adair ◽

U S H Gamage ◽

Lene Mikkelsen ◽

Rohina Joshi

Keyword(s):

Sex Differences ◽

Cause Of Death ◽

Global Analysis ◽

Age Distribution ◽

Mortality Data ◽

Death Registration ◽

Quality Of Data ◽

Uncertainty Interval ◽

Death Data

IntroductionRecent studies suggest that more male than female deaths are registered and a higher proportion of female deaths are certified as ‘garbage’ causes (ie, vague or ill-defined causes of limited policy value). This can reduce the utility of sex-specific mortality statistics for governments to address health problems. To assess whether there are sex differences in completeness and quality of data from civil registration and vital statistics systems, we analysed available global death registration and cause of death data.MethodsCompleteness of death registration for females and males was compared in 112 countries, and in subsets of countries with incomplete death registration. For 64 countries with medical certificate of cause of death data, the level, severity and type of garbage causes was compared between females and males, standardised for the older age distribution and different cause composition of female compared with male deaths.ResultsFor 42 countries with completeness of less than 95% (both sexes), average female completeness was 1.2 percentage points (p.p.) lower (95% uncertainty interval (UI) −2.5 to –0.2 p.p.) than for males. Aggregate female completeness for these countries was 7.1 p.p. lower (95% UI −12.2 to −2.0 p.p.; female 72.9%, male 80.1%), due to much higher male completeness in nine countries including India. Garbage causes were higher for females than males in 58 of 64 countries (statistically significant in 48 countries), but only by an average 1.4 p.p. (1.3–1.6 p.p.); results were consistent by severity and type of garbage.ConclusionAlthough in most countries analysed there was no clear bias against females in death registration, there was clear evidence in a few countries of systematic undercounting of female deaths which substantially reduces the utility of mortality data. In countries with cause of death data, it was only of marginally poorer quality for females than males.

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Garbage codes as causes of death and quality of mortality statistics in Belo Horizonte, Brazil

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.053 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

L Ishitani ◽

R Teixeira ◽

D Abreu ◽

L Paixão ◽

E França

Keyword(s):

Causes Of Death ◽

Health Planning ◽

Age Groups ◽

International Classification Of Diseases ◽

Mortality Statistics ◽

Classification Of Diseases ◽

Icd 10 ◽

Hospital Deaths ◽

Belo Horizonte

Abstract Background Quality of cause-of-death information is fundamental for health planning. Traditionally, this quality has been assessed by the analysis of ill-defined causes from chapter XVIII of the International Classification of Diseases - 10th revision (ICD-10). However, studies have considered other useless diagnoses for public health purposes, defined, in conjunction with ill-defined causes, as garbage codes (GC). In Brazil, despite the high completeness of the Mortality Information System, approximately 30% of deaths are attributable to GCs. This study aims to analyze the frequency of GCs in Belo Horizonte municipality, the capital of Minas Gerais state, Brazil. Methods Data of deaths from 2011 to 2013 in Belo Horizonte were analyzed. GCs were classified according to the GBD 2015 study list. These codes were classified in: a) GCs from chapter XVIII of ICD-10 (GC-R), and b) GC from other chapters of ICD-10 (GC-nonR). Proportions of GC were calculated by sex, age, and place of occurrence. Results In Belo Horizonte, from the total of 44,123 deaths, 5.5% were classified as GC-R. The majority of GCs were GC-nonR (25% of total deaths). We observed a higher proportion of GC in children (1 to 4 years) and in people aged over 60 years. GC proportion was also higher in females, except in the age-groups under 1 year and 30-59 years. Home deaths (n = 7,760) had higher proportions of GCs compared with hospital deaths (n = 30,182), 36.9% and 28.7%, respectively. The leading GCs were the GC-R other ill-defined and unspecified causes of death (ICD-10 code R99)), and the GCs-nonR unspecified pneumonia (J18.9), unspecified stroke (I64), and unspecified septicemia (A41.9). Conclusions Analysis of GCs is essential to evaluate the quality of mortality information. Key messages Analysis of ill-defined causes (GC-R) is not sufficient to evaluate the quality of information on causes of death. Causes of death analysis should consider the total GC, in order to advance the discussion and promote adequate intervention on the quality of mortality statistics.

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The decomposition of life expectancy for age and cause of death in Tuscany, Italy

European Journal of Public Health ◽

10.1093/eurpub/ckz185.638 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

N Nante ◽

L Kundisova ◽

F Gori ◽

A Martini ◽

F Battisti ◽

...

Keyword(s):

Life Expectancy ◽

Causes Of Death ◽

National Level ◽

Age Groups ◽

Resistant Bacteria ◽

Mortality Data ◽

Life Expectancy At Birth ◽

Icd 10 ◽

Reduction Of Mortality ◽

The Impact

Abstract Introduction Changing of life expectancy at birth (LE) over time reflects variations of mortality rates of a certain population. Italy is amongst the countries with the highest LE, Tuscany ranks fifth at the national level. The aim of the present work was to evaluate the impact of various causes of death in different age groups on the change in LE in the Tuscany region (Italy) during period 1987-2015. Material and methods Mortality data relative to residents that died during the period between 1987/1989 and 2013/2015 were provided by the Tuscan Regional Mortality Registry. The causes of death taken into consideration were cardiovascular (CVS), respiratory (RESP) and infective (INF) diseases and cancer (TUM). The decomposition of LE gain was realized with software Epidat, using the Pollard’s method. Results The overall LE gain during the period between two three-years periods was 6.7 years for males, with a major gain between 65-89, and 4.5 years for females, mainly improved between 75-89, <1 year for both sexes. The major gain (2.6 years) was attributable to the reduction of mortality for CVS, followed by TUM (1.76 in males and 0.83 in females) and RESP (0.4 in males; 0.1 in females). The major loss of years of LE was attributable to INF (-0.15 in females; -0.07 in males) and lung cancer in females (-0.13), for which the opposite result was observed for males (gain of 0.62 years of LE). Conclusions During the study period (1987-2015) the gain in LE was major for males. To the reduction of mortality for CVS have contributed to the tempestuous treatment of acute CVS events and secondary CVS prevention. For TUM the result is attributable to the adherence of population to oncologic screening programmes. The excess of mortality for INF that lead to the loss of LE can be attributed to the passage from ICD-9 to ICD-10 in 2003 (higher sensibility of ICD-10) and to the diffusion of multi-drug resistant bacteria, which lead to elevated mortality in these years. Key messages The gain in LE during the period the 1987-2015 was higher in males. The major contribution to gain in LE was due to a reduction of mortality for CVS diseases.

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A haláloki diagnózisok megbízhatóságának javítása a népegészségügyi hatóság és a Központi Statisztikai Hivatal együttműködésével

Orvosi Hetilap ◽

10.1556/650.2016.30398 ◽

2016 ◽

Vol 157 (13) ◽

pp. 504-511

Author(s):

Mária Szücs ◽

Dojna Pintérné Grósz ◽

János Sándor

Keyword(s):

Public Health ◽

Cause Of Death ◽

Health Authority ◽

Control Method ◽

International Classification Of Diseases ◽

Public Health Authority ◽

Central Statistical ◽

Central Statistical Office ◽

Death Data

Introduction: The diagnosis of cause of death is based on the sequence of diagnoses declared by the physician who completes the death certificate that is processed by Central Statistical Office in Hungary. The validity control of the data requires the active involvement of the public health authority. Aim: The authors analyzed the death certificates from Tolna county in order to elaborate and evaluate methods for cause of death data validity control. Method: Diagnoses of cause of death declared by the physician, corrected by the social statistical review in the Central Statistical Office, and revised by public health authority were compared to evaluate the quality of cause of death data. Results: It was found that 5–10% of the cause of death diagnoses declared by physicians required some modification, resulting more than 1% change in county specific mortality statistics of the main International Classification of Diseases groups. Physicians who reported inaccurate cause of death data were identified. 10 indicators were defined to monitor the process elaborated in the project. Conclusions: Co-operation between the Central Statistical Office and public health authorities to improve the quality of cause of death data should be continued because evaluation of public health interventions needs more and more reliable and detailed cause of death statistics. Orv. Hetil., 2016, 157(13), 504–511.

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Comparison of anthropometric data quality in children aged 6-23 and 24-59 months: lessons from population-representative surveys from humanitarian settings

BMC Nutrition ◽

10.1186/s40795-020-00385-0 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Oleg Bilukha ◽

Alexia Couture ◽

Kelly McCain ◽

Eva Leidman

Keyword(s):

Data Quality ◽

Age Groups ◽

Older Age ◽

Demographic And Health Surveys ◽

Age Group ◽

Anthropometric Data ◽

Digit Preference ◽

Anthropometric Indicators ◽

Younger Age

Abstract Background Ensuring the quality of anthropometry data is paramount for getting accurate estimates of malnutrition prevalence among children aged 6–59 months in humanitarian and refugee settings. Previous reports based on data from Demographic and Health Surveys suggested systematic differences in anthropometric data quality between the younger and older groups of preschool children. Methods We analyzed 712 anthropometric population-representative field surveys from humanitarian and refugee settings conducted during 2011–2018. We examined and compared the quality of five anthropometric indicators in children aged 6–23 months and children aged 24–59 months: weight for height, weight for age, height for age, body mass index for age and mid-upper arm circumference (MUAC) for age. Using the z-score distribution of each indicator, we calculated the following parameters: standard deviation (SD), percentage of outliers, and measures of distribution normality. We also examined and compared the quality of height, weight, MUAC and age measurements using missing data and rounding criteria. Results Both SD and percentage of flags were significantly smaller on average in older than in younger age group for all five anthropometric indicators. Differences in SD between age groups did not change meaningfully depending on overall survey quality or on the quality of age ascertainment. Over 50% of surveys overall did not deviate significantly from normality. The percentage of non-normal surveys was higher in older than in the younger age groups. Digit preference score for weight, height and MUAC was slightly higher in younger age group, and for age slightly higher in the older age group. Children with reported exact date of birth (DOB) had much lower digit preference for age than those without exact DOB. SD, percentage flags and digit preference scores were positively correlated between the two age groups at the survey level, such as those surveys showing higher anthropometry data quality in younger age group also tended to show higher quality in older age group. Conclusions There should be an emphasis on increased rigor of training survey measurers in taking anthropometric measurements in the youngest children. Standardization test, a mandatory component of the pre-survey measurer training and evaluation, of 10 children should include at least 4–5 children below 2 years of age.

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Death of adults by stroke in Santa Catarina

10.5327/1516-3180.737 ◽

2021 ◽

Author(s):

Maria Eduarda Coelho da Maia

Keyword(s):

Cause Of Death ◽

Ecological Study ◽

Age Groups ◽

Male Gender ◽

The State ◽

Mountainous Region ◽

Santa Catarina ◽

White Race ◽

Icd 10 ◽

White Adults

Background: Stroke is the second leading cause of death worldwide, including 10% of deaths. In addition to death, stroke can cause irreversible paralysis, permanently disabling the patient. Objectives: The present study proposes an analysis of the epidemiological variants that interfere with the number of adult deaths from stroke in the state of Santa Catarina (SC). Design and setting: This is an ecological study, whose area of analysis was the state of Santa Catarina, located in Brazil. The population studied was the group of individuals aged 20 to 59 years old living in the area studied and who died of a stroke (ICD-10 I64) in the period from January 2005 to December 2019. Methods: The data used were obtained from DATASUS. The variables analyzed were: sex, color/race, and region. Results: The present study found a greater predominance of the white race in both sexes in the state of SC with 86% of total deaths. The male gender was higher in all age groups and years analyzed presenting a percentage of 56%, and the female with 44%. The Mountainous and the South regions of Santa Catarina, two less industrialized regions and with the two lowest GDP’s in the state, had the first and third highest prevalence of deaths, respectively 20% and 16%. Conclusions: The state of Santa Catarina showed a higher prevalence of deaths from stroke in the analyzed period in white adults, males, and residents of the Mountainous region and South of the state.

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Main components of life expectancy increase during the cardiovascular revolution in spain

Empiria Revista de metodología de ciencias sociales ◽

10.5944/empiria.48.2020.28075 ◽

2020 ◽

pp. 167

Author(s):

Aina Faus-Bertomeu ◽

Ramón Domènech Giménez ◽

Svitlana Poniakina ◽

Noelia Cámara-Izquierdo ◽

Rosa Gómez-Redondo

Keyword(s):

Life Expectancy ◽

Cause Of Death ◽

Gender Gap ◽

Heart Diseases ◽

Age Groups ◽

Decomposition Analysis ◽

Health Trends ◽

Modifiable Factors ◽

Circulatory System Diseases ◽

Icd 10

The circulatory system diseases have contributed decisively to an increase in life expectancy (LE) in Spain. The contribution to LE is calculated through a decomposition analysis by sex and five-year age groups. We divide the years studied into two periods, 1980–1996 and 1996–2012. Using the Human Cause-of-Death Database (HCD), we examine specific subcauses at a 4-digit ICD-10 level and how they contribute to the change in LE among men and among women. The analysis shows that cerebrovascular diseases (CBVDs) contribute most to years gained until 1996, while ischemic heart diseases (IHDs) contribute most thereafter. Among women, the largest increase is due to specific CBVDs subcauses; among men IHD subcauses also have an important role. Regarding contribution by age, gains by CVDs are particularly significant at older ages, while contributions by IHDs are more relevant from the age of 50 onwards, especially among men. Furthermore, the gender gap in LE is influenced by the different evolution of various circulatory diseases during the period of study, but the evolution of these diseases is not always reflected equally in both sexes. The study evidences the need for greater precision in the registers in order to take advantage of the potentialities of the 4-digit classification of the ICD, thus leading to a better in depth knowledge in health trends. Finally, it shows the mortality due to modifiable factors mainly classified in IHDs, and the consequent need for the Spanish health system to act on them.Las enfermedades del sistema circulatorio, han contribuido de manera decisiva al aumento de la esperanza de vida (LE) en España. Las contribuciones a la LE se calculan a través de un análisis de descomposición por sexo y grupos de edad quinquenales. Dividimos los años estudiados en dos períodos, 1980–1996 y 1996–2012. Utilizando la Human Cause-of-Death Database (HCD), examinamos subcausas específicas a un nivel de 4 dígitos de ICD-10 y cómo contribuyen al aumento o disminución de LE tanto en hombres como en mujeres. El análisis muestra que las enfermedades cerebrovasculares (CBVD) son las que más contribuyen a los años ganados hasta 1996, mientras que las enfermedades isquémicas (IHD) son las que más contribuyen posteriormente. Entre las mujeres, el mayor aumento se debe a subcausas específicas de las CBVD; en los hombres, las subcausas de IHD también tienen un papel importante. En lo que respecta a la contribución por edad, las ganancias por CBVDs son particularmente significativas en las edades mayores, mientras que las contribuciones por las IHD son más relevantes a partir de los 50 años, especialmente entre los hombres. La brecha entre hombres y mujeres en la LE está influenciada por la evolución diferente de varias enfermedades circulatorias durante el período de estudio, pero la evolución de estas enfermedades no siempre se refleja por igual en ambos sexos. Además, se pone en evidencia la necesidad de una mayor precisión en los registros para aprovechar las potencialidades de la clasificación a 4 dígitos de la CIE, alcanzando de este modo un conocimiento más profundo de las tendencias de salud. Finalmente, el estudio muestra la mortalidad debida a factores modificables que se clasifican principalmente en las IHD, y la consiguiente necesidad de que el sistema de salud español actúe sobre ellas.

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COVID-19 mortality in Belgrade

Srpski medicinski casopis Lekarske komore ◽

10.5937/smclk2-33540 ◽

2021 ◽

Vol 2 (3) ◽

pp. 236-247

Author(s):

Nataša Rosić ◽

Milena Šantrić-Milićević

Keyword(s):

Cause Of Death ◽

Death Rate ◽

Premature Mortality ◽

Cross Sectional Study ◽

Mortality Data ◽

Cross Sectional ◽

Public Health Decision ◽

Health Decision ◽

Icd 10 ◽

The Republic

Introduction: Mortality data are the most reliable indicators of the number of lives that a community has lost due to COVID-19 and represent the minimum data necessary for public health decision-making. Aim: The aim of the study is to describe the basic characteristics of population mortality from COVID-19 in Belgrade in 2020. Methods: The unit of observation in this cross-sectional study for the description of mortality from COVID-19 in 2020 was the population of Belgrade (total, by sex, and by age intervals). COVID-19 was analyzed as the main cause of death (ICD-10: U071, U072). The number and the structure of deaths (%), the crude death rate (per 1,000 population) and the specific death rate (per 100,000 population) were analyzed. The data sources for the study were official statistics on vital events of the Statistical Office of the Republic of Serbia. Results: In 2020, 10.5% of the total number of deaths were due to COVID-19, and the majority of deaths was from the male contingent of Belgrade residents. The mortality rate due to COVID-19 was 158.78 per 100,000 population (211.7 for males and 111.4 for females). COVID-19 was the second leading cause of death in Belgrade. Conclusion: The results of this study indicate the existence of premature mortality in Belgrade. In 2020, COVID-19 was the second leading cause of death among the male residents of Belgrade, while in female residents, it was the third leading cause of mortality. This research provides evidence that can contribute to the international discussion about societal losses caused by the COVID-19 pandemic.

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Prion disease incidence in the United States: 2003–2015

Neurology ◽

10.1212/wnl.0000000000008680 ◽

2019 ◽

Vol 94 (2) ◽

pp. e153-e157 ◽

Cited By ~ 2

Author(s):

Ryan A. Maddox ◽

Marissa K. Person ◽

Janis E. Blevins ◽

Joseph Y. Abrams ◽

Brian S. Appleby ◽

...

Keyword(s):

United States ◽

Cause Of Death ◽

Prion Disease ◽

Disease Incidence ◽

The United States ◽

Annual Incidence ◽

Mortality Data ◽

Genetic Test Results ◽

Average Annual Incidence ◽

Death Data

ObjectiveTo report the incidence of prion disease in the United States.MethodsPrion disease decedents were retrospectively identified from the US national multiple cause-of-death data for 2003–2015 and matched with decedents in the National Prion Disease Pathology Surveillance Center (NPDPSC) database through comparison of demographic variables. NPDPSC decedents with neuropathologic or genetic test results positive for prion disease for whom no match was found in the multiple cause-of-death data were added as cases for incidence calculations; those with cause-of-death data indicating prion disease but with negative neuropathology results were removed. Age-specific and age-adjusted average annual incidence rates were then calculated.ResultsA total of 5,212 decedents were identified as having prion disease, for an age-adjusted average annual incidence of 1.2 cases per million population (range 1.0 per million [2004 and 2006] to 1.4 per million [2013]). The median age at death was 67 years. Ten decedents were <30 years of age (average annual incidence of 6.2 per billion); only 2 of these very young cases were sporadic forms of prion disease. Average annual incidence among those ≥65 years of age was 5.9 per million.ConclusionsPrion disease incidence can be estimated by augmenting mortality data with the results of neuropathologic and genetic testing. Cases <30 years of age were extremely rare, and most could be attributed to exogenous factors or the presence of a genetic mutation. Continued vigilance for prion diseases in all age groups remains prudent.

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