Abstract
Knowing the number of deaths and their causes is relevant information for public health managers. However, the cause of death is often classified with codes that are not useful for mortality analysis, called garbage codes (GC). To describe and evaluate the impact of investigation of the underlying cause of poorly classified deaths on death certificates in 2017. Based on a standardized protocol, GC deaths from 60 municipalities were investigated, mainly in hospital records and autopsy services. Managers at the state level of the Mortality Information System also developed procedures to improve the classification of causes of death, with the consequent adherence of other municipalities (n = 4022). This made it possible to compare the results of GC research between these two groups of municipalities. In the country, among the 108,826 GC investigated in 2017, 48% were reclassified to specific causes. In the 60 focus municipalities, 58% of the 35,366 investigated deaths from GC were reclassified. After the intervention, the proportion of deaths classified as GC decreased by 11% in the country and 17% in the municipalities. The research in hospital records enabled almost half of the deaths from GC investigated to be reclassified. This is the first study to investigate GC in hospital records of more than 100,000 deaths. The 60 cities targeted by the intervention had better results than the other cities. The intervention proved to be an appropriate initiative to improve the quality of information on cause of death and should be encouraged.
Highlights
Knowing the number of deaths and their causes is relevant information for public health managers
The main objective of this study is to evaluate the impact of interventions of the Data for Health Initiative on improving the quality of cause-of-death notifications to the Mortality Information System (MIS) in 2017, by analyzing the reduction of underlying causes of death with garbage codes (GC), through research in hospital records, reports of the Death Verification Services (SVO), and reports of the Forensic Medical Institute (IML)
We considered the classification of GC at levels proposed in the 2016 Global Burden of Disease Study (GBD), according to the redistribution of these causes to the hierarchical levels of the GBD list of causes[11,12]
Summary
Knowing the number of deaths and their causes is relevant information for public health managers. Managers at the state level of the Mortality Information System developed procedures to improve the classification of causes of death, with the consequent adherence of other municipalities (n = 4022). This made it possible to compare the results of GC research between these two groups of municipalities. Significant human, physical and financial resources have been invested around the world in collecting data about population, health services, and health status, especially for levels of greater geographic disaggregation Among these statistics, information on causes of death and demographic characteristics of deceased persons are important indicators of health and socioeconomic conditions. In mortality analysis, the degree of coverage and the quality of information on cause of death should be observed in order to reduce the risk of having mortality estimates with problems of underreporting and/or incorrect record of cause of death[4]
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