Changes in the quality of cause-of-death statistics in Brazil: garbage codes among registered deaths in 1996–2016

Abstract

Background Registered causes in vital statistics classified as garbage codes (GC) are considered indicators of quality of cause-of-death data. Our aim was to describe temporal changes in this quality in Brazil, and the leading GCs according to levels assembled for the Global Burden of Disease (GBD) study. We also assessed socioeconomic differences in the burden of different levels of GCs at a regional level. Methods We extracted data from the Brazilian Mortality Information System from 1996 to 2016. All three- and four-digit ICD-10 codes considered GC were selected and classified into four categories, according to the GBD study proposal. GC levels 1 and 2 are the most damaging unusable codes, or major GCs. Proportionate distribution of deaths by GC levels according selected variables were performed. Age-standardized mortality rates after correction of underreporting of deaths were calculated to investigate temporal relationships as was the linear association adjusted for completeness between GC rates in states and the Sociodemographic Index (SDI) from the GBD study, for 1996–2005 and 2006–2016. We classified Brazilian states into three classes of development by applying tertiles cutoffs in the SDI state-level estimates. Results Age-standardized mortality rates due to GCs in Brazil decreased from 1996 to 2016, particularly level 1 GCs. The most important GC groups were ill-defined causes (level 1) in 1996, and pneumonia unspecified (level 4) in 2016. At state level, there was a significant inverse association between SDI and the rate of level 1–2 GCs in 1996–2005, but both SDI and completeness had a non-expected significant direct association with levels 3–4. In 2006–2016, states with higher SDIs tended to have lower rates of all types of GCs. Mortality rates due to major GCs decreased in all three SDI classes in 1996–2016, but GC levels 3–4 decreased only in the high SDI category. States classified in the low or medium SDI groups were responsible for the most important decline of major GCs. Conclusion Occurrence of major GCs are associated with socioeconomic determinants over time in Brazil. Their reduction with decreasing disparity in rates between socioeconomic groups indicates progress in reducing inequalities and strengthening cause-of-death statistics in the country.

Mortalidade e perfil epidemiológico dos óbitos por causas mal definidas: revisão integrativa

“…Os resultados dos estudos apontam que a maioria dos óbitos por causas mal definidas ocorrem nos domicílios (Abreu et al, 2010;Costa, Marli Marcopito, 2008;E. França et al, 2020;Ishitani et al, 2017;Jorge et al, 2008).…”

“…França et al, 2020;Ishitani et al, 2017;Jorge et al, 2008). É provável que os percentuais de óbitos por causas mal definidas diminuem à medida que aumente o acesso à assistência médica na situação de risco de morte, particularmente em ambiente hospitalaronde existem, em teoria, mais recursos diagnósticos (Costa, Marli Marcopito, 2008), pois a maior proporção de óbitos domiciliares pode ser devido a dificuldades de diagnóstico ou a falta de conhecimento do diagnóstico por parte do médico (E. França et al, 2020). Dados divergentes foram observados na coorte de Bambuí em que óbitos aconteceram em maior proporção no hospital (Lima-Costa et al, 2010).…”

Data Sources for Drug Utilization Research in Brazil—DUR-BRA Study

“…SIM (not included in our inventory because it presents only data related to ICD-10 codes for drug poisoning mortality ( Mota et al, 2012 )) and SINASC are important sources of data for evaluating health outcomes and indicators. The quality of data in both systems has improved over time ( Szwarcwald et al, 2019 ; França et al, 2020 ); however, health outcomes of medication exposure (not related to poisoning) remain unexplored for most classes of medicines.…”

Intra-urban differentials of fetal mortality in clusters of social vulnerability in São Paulo Municipality, Brazil

“…The main change introduced was considering intrauterine hypoxia (P20) as an ill-defined cause. This syndrome has several origins and can be considered a “garbage code”, that is, it represents an indication of a non-specific cause of death, which hinders the implementation of measures for its prevention and indicates the absence of adequate information to define the underlying cause of death, and can also be used as an indicator of the quality of care provided 9 , 26 . However, this cause accounted for about 40% of all stillbirths.…”