Dados para a saúde: impacto na melhoria da qualidade da informação sobre causas de óbito no Brasil

Abstract

RESUMO Introdução: Conhecer o número de óbitos e suas causas se constitui em informação de relevância para gestores de saúde pública. Entretanto, muitas vezes a causa do óbito é classificada com códigos pouco úteis para as análises de mortalidade, denominados códigos garbage (CG). Objetivo: Descrever e avaliar o impacto da investigação da causa básica de morte mal classificada no atestado de óbito em 2017. Métodos: Com base em protocolo padronizado, foram pesquisadas mortes com CG de 60 municípios que foram foco da intervenção, principalmente em prontuários hospitalares e serviços de autopsia. No nível estadual de gestão do Sistema de Informação de Mortalidade também foram desenvolvidas ações para melhoria da classificação da causa do óbito, com consequente adesão da maioria dos demais municípios (n = 4.022), o que permitiu comparações com os resultados da investigação de CG nas 60 cidades. Resultados: No país, de 108.826 CG investigadas em 2017, 48% foram reclassificadas para causas específicas. Já nos 60 municípios selecionados, 58% dos 35.366 óbitos por CG pesquisados foram reclassificados. A proporção de óbitos por CG declinou em 11% no país e 17% nos municípios em que houve intervenção. Discussão: Este é o primeiro estudo que investigou CG em registros médicos de mais de 100 mil mortes. A pesquisa possibilitou reclassificar para causas básicas específicas cerca de metade dos óbitos por CG investigados. As 60 cidades que foram alvo da intervenção tiveram melhor resultado que as demais cidades. Conclusão: A intervenção mostrou ser uma iniciativa adequada para a melhoria da qualidade da informação sobre causa de morte e deve ser estimulada.

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

“…As better correction is provided by empirical data [32], this study might also contribute to the recent effort made by the Ministry of Health who in 2017 implemented important interventions in 60 municipalities throughout the country, as part of the Bloomberg Data for Health Initiative, in which hospital deaths with garbage codes were investigated extracting information from hospital records using standardized questionnaires, which then were reviewed by physicians in order to identify the underlying or specific causes. This initiative, reinforced by adequate physician training on the filling in of the DC, has significantly improved data from the SIM [33]. So, it is imperative to have a comprehensive knowledge of GC distribution in the country, therefore permitting further advances in this intervention and the subsequent empirical corrections.…”

Premature mortality due to non-communicable diseases in Brazilian municipalities estimated for the three-year periods of 2010 to 2012 and 2015 to 2017

“…In spite of being an important data source, failure to correctly fill in death certificates (DC) hampers the quality of SIM, resulting in data cleansing regarding inconsistencies, as well as the adoption of methods for treating missing data, treating excessive registration of ill-defined causes of death 12 and garbage codes (GCs), to minimize bias 13 . GCs refer to causes that cannot be considered underlying causes of death or causes for which there is no detail in the codification of the International Statistical Classification of Diseases and Health Related Problems (ICD-10) 13 and should be redistributed to other causes to improve the validity of mortality analyses 14 .…”

“…In spite of being an important data source, failure to correctly fill in death certificates (DC) hampers the quality of SIM, resulting in data cleansing regarding inconsistencies, as well as the adoption of methods for treating missing data, treating excessive registration of ill-defined causes of death 12 and garbage codes (GCs), to minimize bias 13 . GCs refer to causes that cannot be considered underlying causes of death or causes for which there is no detail in the codification of the International Statistical Classification of Diseases and Health Related Problems (ICD-10) 13 and should be redistributed to other causes to improve the validity of mortality analyses 14 . In Brazil, there has been an improvement in the quality of mortality information in recent decades, advances related to the expansion of death coverage, more accurate notification of causes and a decrease in the proportion of GCs 13 ; however, there are still problems with the quality of this information in the country, especially in the North and more so the Northeast 15 .…”

Methodological proposal for the redistribution of deaths due to garbage codes in mortality estimates for Noncommunicable Chronic Diseases

“…These advances were the result of efforts by the Brazilian Ministry of Health in partnership with federative units and municipalities to better track deaths through MIS, such as the project to reduce ill-defined causes in 2005 and the project to reduce regional inequalities and infant mortality in the states of the Northeastern Region and the Legal Amazon. [24][25][26][27][28] The proactive search of deaths project is highlighted, which made it possible to define methodologies for redistributing underreported deaths. 29,30 This commitment, together with the corrections, was essential for the most adequate interpretation and comparability of the historical series in the different regions of the country.…”