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

Ana Maria Nogales Vasconcelos,Lenice Ishitani,Daisy Maria Xavier Abreu,Elisabeth França

doi:10.3389/fpubh.2021.788932

Ana Maria Nogales Vasconcelos, Lenice Ishitani + Show 2 more

Open Access

https://doi.org/10.3389/fpubh.2021.788932

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Abstract

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.

Highlights

The importance of vital statistics to support the planning, evaluation, and monitoring of health programs and policies is widely recognized [1, 2]
To better describe and understand the morbid process of COVID-19 mortality and its association with non-communicable diseases (NCD), the present study aims to analyze the chain of events and contributing causes associated with COVID-19 adult mortality (30–69 years old), based on qualified data on causes of death (CoD) from the three capitals cities in 2020
In Part I of the death certificate, we considered conditions that appeared more frequently (60% or more) in the same line or above the mentions B34.2, U0.7.1, U07.2, as a chain-of-event of COVID-19 mortality

Summary

Introduction

The importance of vital statistics to support the planning, evaluation, and monitoring of health programs and policies is widely recognized [1, 2]. In the current scenario of the COVID-19 pandemic, the availability of vital statistics data is essential to follow the evolution and characteristics of cases and deaths [3]. This information must be timely and with a satisfactory level of quality for its use. In Brazil, the Mortality Information System (SIM) from the Ministry of Health (MS) provides data on mortality for the whole country since 1976. Recent studies have shown that SIM has a high completeness level, there are still problems with the quality of information on causes of death (CoD) [5]

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