Abstract
BackgroundRegistered 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.MethodsWe 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.ResultsAge-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.ConclusionOccurrence 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.
Highlights
Registered causes in vital statistics classified as garbage codes (GC) are considered indicators of quality of cause-of-death data
We describe temporal changes in the quality of vital statistics in Brazil, and the leading GCs according to levels assembled for the Global Burden of Disease (GBD) study
We investigate the temporal relationship between level 1–2 and 3–4 GC rates in states by the Sociodemographic Index (SDI), a composite measure proposed in the GBD study based on the average total fertility under the age of 25 years, educational attainment in those aged 15 years or older, and lag distributed income per capita
Summary
Registered causes in vital statistics classified as garbage codes (GC) are considered indicators of quality of cause-of-death data. The traditional approach to assess the accuracy of mortality information is to measure completeness (percent of all deaths registered), and the proportion of total deaths coded to R codes from the ICD 10-chapter 18 of general signs and symptoms, denominated as ill-defined causes [1, 3]. Quality of cause-of-death data on registered deaths remains a problem, as the country presented high levels of ill-defined causes during the last decade [4]. A national official intervention by the Ministry of Health (MoH) was started in 2005 to investigate ill-defined causes of death in health facilities and at home in the whole country, in the poorest North and Northeast regions [5]. Reported results indicate that this investigation has been effective [6]
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