scholarly journals Covid Adult Mortality in Brazil: An Analysis of Multiple Causes of Death

2022 ◽  
Vol 9 ◽  
Author(s):  
Ana Maria Nogales Vasconcelos ◽  
Lenice Ishitani ◽  
Daisy Maria Xavier Abreu ◽  
Elisabeth França
Keyword(s):  
Cause Of Death ◽  
Death Certificate ◽  
Respiratory Infections ◽  
Kidney Diseases ◽  
Adult Mortality ◽  
Belo Horizonte ◽  
Underlying Cause Of Death ◽  
A Chain ◽  
Morbid Process

ObjectiveThis study aimed to analyze the chain of events and contributing causes associated with COVID-19 adult mortality (30–69 years old), based on qualified data on CoD from three Brazilian capitals cities, Belo Horizonte, Salvador, and Natal, in 2020.MethodsData of all deaths among residents in the three capitals in 2020 were provided by these municipalities' routine Mortality Information System (SIM). Mentions B34.2 with the markers U07.1 and U07.2 in the death certificate identified COVID-19 deaths. We used a multiple-cause-of-death approach better to understand the complexity of the morbid process of COVID-19. Conditions that appeared more frequently in the same line or above the COVID-19 mentions in the death certificate were considered a chain-of-event. Conditions that occurred more often after the codes for COVID-19 were considered as contributing.ResultsIn 2020, 7,029 records from COVID-19 as the underlying cause of death were registered in SIM in the three capitals. Among these, 2,921 (41.6%) were deceased between 30 and 69 years old, representing 17.0% of deaths in this age group. As chain-of-events, the most frequent conditions mentioned were sepsis (33.4%), SARS (32.0%), acute respiratory failure (31.9%), unspecified lower respiratory infections (unspecified pneumonia) (20.1%), and other specified respiratory disorders (14.1%). Hypertension (33.3%), diabetes unspecified type (21.7%), renal failure (12.7%), obesity (9.8%), other chronic kidney diseases (4.9%), and diabetes mellitus type 2 (4.7%) were the most frequent contributing conditions. On average, 3.04 conditions were mentioned in the death certificate besides COVID-19. This average varied according to age, place of death, and capital.ConclusionThe multiple-cause analysis is a powerful tool to better understand the morbid process due to COVID-19 and highlight the importance of chronic non-communicable diseases as contributing conditions.

scholarly journals The impact of errors in medical certification on the accuracy of the underlying cause of death

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259667
Author(s):  
U. S. H. Gamage ◽  
Tim Adair ◽  
Lene Mikkelsen ◽  
Pasyodun Koralage Buddhika Mahesh ◽  
John Hart ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Death Certificate ◽  
International Classification Of Diseases ◽  
High Impact ◽  
Error Type ◽  
Medical Certification ◽  
Underlying Cause Of Death ◽  
The Impact ◽  
Very High ◽  
Death Data

Background Correct certification of cause of death by physicians (i.e. completing the medical certificate of cause of death or MCCOD) and correct coding according to International Classification of Diseases (ICD) rules are essential to produce quality mortality statistics to inform health policy. Despite clear guidelines, errors in medical certification are common. This study objectively measures the impact of different medical certification errors upon the selection of the underlying cause of death. Methods A sample of 1592 error-free MCCODs were selected from the 2017 United States multiple cause of death data. The ten most common types of errors in completing the MCCOD (according to published studies) were individually simulated on the error-free MCCODs. After each simulation, the MCCODs were coded using Iris automated mortality coding software. Chance-corrected concordance (CCC) was used to measure the impact of certification errors on the underlying cause of death. Weights for each error type and Socio-demographic Index (SDI) group (representing different mortality conditions) were calculated from the CCC and categorised (very high, high, medium and low) to describe their effect on cause of death accuracy. Findings The only very high impact error type was reporting an ill-defined condition as the underlying cause of death. High impact errors were found to be reporting competing causes in Part 1 [of the death certificate] and illegibility, with medium impact errors being reporting underlying cause in Part 2 [of the death certificate], incorrect or absent time intervals and reporting contributory causes in Part 1, and low impact errors comprising multiple causes per line and incorrect sequence. There was only small difference in error importance between SDI groups. Conclusions Reporting an ill-defined condition as the underlying cause of death can seriously affect the coding outcome, while other certification errors were mitigated through the correct application of mortality coding rules. Training of physicians in not reporting ill-defined conditions on the MCCOD and mortality coders in correct coding practices and using Iris should be important components of national strategies to improve cause of death data quality.

Decline in overall pulmonary embolism-related mortality and increasing prevalence of cancer-associated events in the Veneto region (Italy), 2008-2019

2021 ◽  
Author(s):  
Luca Valerio ◽  
Ugo Fedeli ◽  
Elena Schievano ◽  
Francesco Avossa ◽  
Stefano Barco
Keyword(s):  
Cause Of Death ◽  
Death Certificate ◽  
Northern Italy ◽  
Veneto Region ◽  
Diagnostic Practices ◽  
Epidemiological Changes ◽  
Underlying Cause Of Death ◽  
Standardized Mortality Rate ◽  
Prevalence Of Cancer ◽  
Related Mortality

Background. Despite evidence of ongoing epidemiological changes in deaths from venous thromboembolism in high-income countries, little recent information is available on the time trends in mortality related to PE as underlying or concomitant cause of death in Europe. Methods. We accessed the regional database of death certificates of Veneto Region (Northern Italy, population 4,900,000) from 2008 to 2019. We analysed the trends in crude and age-adjusted annual rates of mortality related to PE (reported either as underlying cause or in any position in the death certificate) using Joinpoint regression; in the contribution of PE to mortality (proportionate mortality); and, using logistic regression, in the association between PE and cancer at death. Results. Between 2008 and 2019, the age-standardized mortality rate related to PE in Veneto decreased from 20.7 to 12.6 annual deaths per 100,000 population for PE in any position of the death certificate, and from 4.6 to 2.2 annual deaths per 100,000 population for PE as underlying cause of death. PE-related proportionate mortality remained up to twice as high in women. The age- and sex-adjusted odds ratio for cancer in deaths with (vs. without) PE constantly increased from 1.01 (95% CI 0.88-1.16) in 2008 to 1.58 (95% CI 1.35-1.83) in 2019. Conclusions. The descending trend in PE-related mortality reported for Europe up to 2015 for both sexes continued thereafter in Northern Italy. However, sex differences in proportionate mortality persist, and the increasing association between PE and cancer at death may reflect changes in risk factor distribution or diagnostic practices.

scholarly journals Time series of diabetes attributable mortality from 2008 to 2017

2021 ◽  
Author(s):  
U. Fedeli ◽  
E. Schievano ◽  
S. Masotto ◽  
E. Bonora ◽  
G. Zoppini
Keyword(s):  
Cause Of Death ◽  
Causes Of Death ◽  
Death Certificate ◽  
Attributable Mortality ◽  
Joinpoint Regression ◽  
Annual Percent Change ◽  
Percent Change ◽  
Underlying Causes ◽  
Underlying Cause Of Death ◽  
Circulatory Diseases

Abstract Purpose Diabetes is a growing health problem. The aim of this study was to capture time trends in mortality associated with diabetes. Methods The mortality database of the Veneto region (Italy) includes both the underlying causes of death, and all the diseases mentioned in the death certificate. The annual percent change (APC) in age-standardized rates from 2008 to 2017 was computed by the Joinpoint Regression Program. Results Overall 453,972 deaths (56,074 with mention of diabetes) were observed among subjects aged ≥ 40 years. Mortality rates declined for diabetes as the underlying cause of death and from diabetes-related circulatory diseases. The latter declined especially in females − 4.4 (CI 95% − 5.3/− 3.4), while in males the APC was − 2.8 (CI 95% − 4.0/− 1.6). Conclusion We observed a significant reduction in mortality during the period 2008–2017 in diabetes either as underlying cause of death or when all mentions of diabetes in the death certificate were considered.

scholarly journals Qualifying information on the deaths and serious injuries caused by road traffic in five Brazilian capitals using record linkage

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Polyana Mandacaru ◽  
Otaliba Libânio Morais Neto ◽  
Ana Lucia Andradde ◽  
Marli Souza ◽  
Fernanda Aguiar
Keyword(s):  
Information System ◽  
Cause Of Death ◽  
Record Linkage ◽  
Hospital Information System ◽  
Injury Severity ◽  
Road Traffic ◽  
Public Health Problem ◽  
Belo Horizonte ◽  
Underlying Cause Of Death ◽  
Serious Injuries

IntroductionRoad traffic crashes (RTCs) represent an public health problem, accounting for 1.2 million deaths per year. However, these figures may be even greater if health databases are linked to police records. Objectives and ApproachMeasure the numbers of deaths and seriously injured victims and to estimate the percentage of corrections of the underlying cause of death, cause of hospitalization, and injury severity of the victims in five representative state capitals of the five macro-regions of Brazil. This was cross-sectional, study using the Hospital Information System, Mortality Information System and Police Road Traffic database. The RecLink III was used for the record linkage by identifying true pairs to calculate the correction percentage of the underlying cause of death, cause of hospitalization, and injury severity of the victims in the traffic records. ResultsChange in the diagnosis of hospitalization in the Hospital Information System with percentage of correction of the cause at 24.4% for Belo Horizonte, 96.9% for Campo Grande, 100.0% for Palmas, and 33.2% for Teresina. The correction of the underlying cause of death in the Mortality Information System were 29.9%, 11.9%, 4.2%, and 33.5% for Belo Horizonte, Campo Grande, Curitiba, and Teresina, respectively. Change in the classification of injury severity was observed with an overall percentage of 100.0% for Belo Horizonte and Teresina, 48.0% for Campo Grande, and 51.4% for Palmas. Conclusion/ImplicationsThe results showed the importance of the record linkage between health and police databases for the qualification of the RTCs and the victims in the five capital cities studied. This implies that deaths and serious injuries caused by RTCs are underestimated in the absence of integration of databases that record

scholarly journals Validity of death certificates for coding coronary heart disease as the cause of death in Bahrain

2000 ◽  
Vol 6 (4) ◽  
pp. 661-669
Author(s):  
R. Al Mahroos
Keyword(s):  
Public Health ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cause Of Death ◽  
Death Certificate ◽  
Death Certificates ◽  
Hospital Records ◽  
Mortality Statistics ◽  
National Mortality ◽  
Underlying Cause Of Death

This study aimed to examine the accuracy of death certificates for coding coronary heart disease [CHD] as the underlying cause of death in Bahrain. Of the 1714 deaths occurring in Bahrain in 1993, 371 were classified as resulting from CHD. In this study the hospital diagnosis of 109 deaths [52 as CHD and 57 as other causes]were reviewed and re-diagnosed using hospital records. The coding of 459 death certificates [151 as CHD and 308 as other causes]by the Directorate of Public Health was similarly reviewed. The sensitivity and specificity of the hospital diagnosis were 76% and 72% respectively and those of the Directorate of Public Health were 85% and 89% respectively. National mortality statistics in Bahrain, which are based on death certificate data, may overestimate the frequency of CHD. Therefore, it is important that measures are taken to improve the accuracy of certification

scholarly journals Sensitivity and Positive Predictive Value of Death Certificate Data Among Deaths Caused by Legionnaires’ Disease in New York City, 2008-2013

2018 ◽  
Vol 133 (5) ◽  
pp. 578-583
Author(s):  
Olivia C. Tran ◽  
David E. Lucero ◽  
Sharon Balter ◽  
Robert Fitzhenry ◽  
Mary Huynh ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Positive Predictive Value ◽  
Cause Of Death ◽  
York City ◽  
Predictive Value ◽  
Death Certificate ◽  
Death Certificates ◽  
Legionnaires Disease ◽  
Underlying Cause Of Death

Objectives: Death certificates are an important source of information for understanding life expectancy and mortality trends; however, misclassification and incompleteness are common. Although deaths caused by Legionnaires’ disease might be identified through routine surveillance, it is unclear whether Legionnaires’ disease is accurately recorded on death certificates. We evaluated the sensitivity and positive predictive value of death certificates for identifying deaths from confirmed or suspected Legionnaires’ disease among adults in New York City. Methods: We deterministically matched death certificate data from January 1, 2008, through December 31, 2013, on New York City residents aged ≥18 years to surveillance data on confirmed and suspected cases of Legionnaires’ disease from January 1, 2008, through October 31, 2013. We estimated sensitivity and positive predictive value by using surveillance data as the reference standard. Results: Of 294 755 deaths, 27 (<0.01%) had an underlying cause of death of Legionnaires’ disease and 33 (0.01%) had any mention of Legionnaires’ disease on the death certificate. Of 1211 confirmed or suspected cases of Legionnaires’ disease, 267 (22.0%) matched to a record in the death certificate data set. The sensitivity of death certificates that listed Legionnaires’ disease as the underlying cause of death was 17.3% and of death certificates with any mention of Legionnaires’ disease was 20.9%. The positive predictive value of death certificates that listed Legionnaires’ disease as the underlying cause of death was 70.4% and of death certificates with any mention of Legionnaires’ disease was 69.7%. Conclusions: Death certificates had limited ability to identify confirmed or suspected deaths with Legionnaires’ disease. Provider trainings on the diagnosis of Legionnaires’ disease, particularly hospital settings, and proper completion of death certificates might improve the sensitivity of death certificates for people who die of Legionnaires’ disease.

scholarly journals Uncertainty and the reporting of intellectual disability on death certificates: a cross-sectional study of US mortality data from 2005 to 2017

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e045360
Author(s):  
Scott D Landes ◽  
Margaret A Turk ◽  
Erin Bisesti
Keyword(s):  
Intellectual Disability ◽  
Cause Of Death ◽  
Death Certificate ◽  
Medical Personnel ◽  
Vital Statistics ◽  
Bivariate Analysis ◽  
Mortality Data ◽  
Time Of Death ◽  
Cross Sectional ◽  
Underlying Cause Of Death

ObjectiveTo investigate whether uncertainty surrounding the death is associated with the inaccurate reporting of intellectual disability as the underlying cause of death.DesignNational Vital Statistics System 2005–2017 US Multiple Cause-of-Death Mortality files.SettingUSA.ParticipantsAdults with an intellectual disability reported on their death certificate, aged 18 and over at the time of death. The study population included 26 555 adults who died in their state of residence between 1 January 2005 and 31 December 2017.Primary outcome and measuresDecedents with intellectual disability reported on their death certificate were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for intellectual disability (F70–79). Bivariate analysis and multilevel logistic regression models were used to investigate whether individual-level and state-level characteristics indicative of increased uncertainty at the time of death were associated with the inaccurate reporting of intellectual disability as the underlying cause of death.ResultsInaccurate reporting of intellectual disability as the underlying cause of death was associated with sociodemographic characteristics, death context characteristics and comorbidities indicative of an increased amount of uncertainty surrounding the death. Most striking were increased odds of having intellectual disability reported as the underlying cause of death for decedents who had a choking event (OR=14.7; 95% CI 12.9 to 16.6, p<0.001), an external cause of death associated with a high degree of uncertainty, reported on their death certificate.ConclusionIt is imperative that medical personnel not let increased uncertainty lead to the inaccurate reporting of intellectual disability as the underlying cause of death as this practice obscures cause of death trends for this population. Instead, even in instances when increased uncertainty surrounds the death, certifiers should strive to accurately identify the disease or injury causing death, and report the disability in Part II of the death certificate.

The Role of Dementia as Cause of Death: Certifiers’ Opinions versus Automated Coding

2020 ◽  
pp. 1-7
Author(s):  
Peter Harteloh
Keyword(s):  
Cause Of Death ◽  
Death Certificate ◽  
Sudden Change ◽  
International Comparisons ◽  
Coding System ◽  
Policy Makers ◽  
Automated Coding ◽  
Icd 10 ◽  
Underlying Cause Of Death

<b><i>Background:</i></b> Dementia is a major cause of death in many countries today. The way in which countries code causes of death determines the occurrence of dementia in statistics. The change over from manual to automated coding is accompanied by a 7–19% increase in the occurrence of dementia as the underlying cause of death. Because of this sudden change, researchers, physicians, policy makers, and press question the validity of the outcome of automated coding. Therefore, the role of dementia as a cause of death was investigated. <b><i>Methods:</i></b> A questionnaire was sent to a random sample of 700 certifiers who mentioned “dementia” on a death certificate in the second half of 2017. They were asked questions about the role of dementia as a cause of death. For each certificate, the opinion of the certifier was compared with the outcome of automated coding. <b><i>Results:</i></b> A response of 65% (<i>n</i> = 446) was obtained. The automated coding system selected dementia as the underlying cause of death 9.5% points (95% CI: 5.8–14.4%) more often than the certifier would do. This finding in the sample corresponded to an overestimation of dementia in the cause-of-death statistics with 22.7% (95% CI: 18–28%). Main reason for this overestimation was the selection of dementia as the underlying cause of death by the automated coding system, while it was noted as the contributory cause of death on part 2 of the death certificate by the certifier. <b><i>Conclusion:</i></b> For international comparisons of data on dementia as a cause of death, the outcome of automated coding can be used as the system adheres to international (ICD-10) guidelines and reduces coding variations in and between countries. However, for interpreting the local (national) impact of dementia as a cause of death, the opinion of the certifier should be taken into account.

scholarly journals Obscuring effect of coding developmental disability as the underlying cause of death on mortality trends for adults with developmental disability: a cross-sectional study using US Mortality Data from 2012 to 2016

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e026614 ◽  
Author(s):  
Scott D Landes ◽  
James Dalton Stevens ◽  
Margaret A Turk
Keyword(s):  
Down Syndrome ◽  
Cerebral Palsy ◽  
Intellectual Disability ◽  
Developmental Disabilities ◽  
Cause Of Death ◽  
Developmental Disability ◽  
Death Certificate ◽  
Death Certificates ◽  
Mortality Trends ◽  
Underlying Cause Of Death

ObjectiveTo determine whether coding a developmental disability as the underlying cause of death obscures mortality trends of adults with developmental disability.DesignNational Vital Statistics System 2012–2016 US Multiple Cause-of-Death Mortality files.SettingUSA.ParticipantsAdults with a developmental disability indicated on their death certificate aged 18 through 103 at the time of death. The study population included 33 154 adults who died between 1 January 2012 and 31 December 2016.Primary outcome and measuresDecedents with a developmental disability coded as the underlying cause of death on the death certificate were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for intellectual disability, cerebral palsy, Down syndrome or other developmental disability. Death certificates that coded a developmental disability as the underlying cause of death were revised using a sequential underlying cause of death revision process.ResultsThere were 33 154 decedents with developmental disability: 7901 with intellectual disability, 11 895 with cerebral palsy, 9114 with Down syndrome, 2479 with other developmental disabilities and 1765 with multiple developmental disabilities. Among all decedents, 48.5% had a developmental disability coded as the underlying cause of death, obscuring higher rates of choking deaths among all decedents and dementia and Alzheimer’s disease among decedents with Down syndrome.ConclusionDeath certificates that recorded the developmental disability in Part I of the death certificate were more likely to code disability as the underlying cause of death. While revising these death certificates provides a short-term corrective to mortality trends for this population, the severity and extent of this problem warrants a long-term change involving more precise instructions to record developmental disabilities only in Part II of the death certificate.

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