Abstract
OBJECTIVE To propose a method of redistributing ill-defined causes of death (IDCD) based on the investigation of such causes.METHODS In 2010, an evaluation of the results of investigating the causes of death classified as IDCD in accordance with chapter 18 of the International Classification of Diseases (ICD-10) by the Mortality Information System was performed. The redistribution coefficients were calculated according to the proportional distribution of ill-defined causes reclassified after investigation in any chapter of the ICD-10, except for chapter 18, and used to redistribute the ill-defined causes not investigated and remaining by sex and age. The IDCD redistribution coefficient was compared with two usual methods of redistribution: a) Total redistribution coefficient, based on the proportional distribution of all the defined causes originally notified and b) Non-external redistribution coefficient, similar to the previous, but excluding external causes.RESULTS Of the 97,314 deaths by ill-defined causes reported in 2010, 30.3% were investigated, and 65.5% of those were reclassified as defined causes after the investigation. Endocrine diseases, mental disorders, and maternal causes had a higher representation among the reclassified ill-defined causes, contrary to infectious diseases, neoplasms, and genitourinary diseases, with higher proportions among the defined causes reported. External causes represented 9.3% of the ill-defined causes reclassified. The correction of mortality rates by the total redistribution coefficient and non-external redistribution coefficient increased the magnitude of the rates by a relatively similar factor for most causes, contrary to the IDCD redistribution coefficient that corrected the different causes of death with differentiated weights.CONCLUSIONS The proportional distribution of causes among the ill-defined causes reclassified after investigation was not similar to the original distribution of defined causes. Therefore, the redistribution of the remaining ill-defined causes based on the investigation allows for more appropriate estimates of the mortality risk due to specific causes.
Highlights
Mortality indicators are important for understanding the epidemiological profile of a population; they support both the planning and evaluation of health actions and are, relevant to analyze the health situation to direct public policies
The proportional distribution of causes among the illdefined causes reclassified after investigation was not similar to the original distribution of defined causes
The redistribution of the remaining ill-defined causes based on the investigation allows for more appropriate estimates of the mortality risk due to specific causes
Summary
Mortality indicators are important for understanding the epidemiological profile of a population; they support both the planning and evaluation of health actions and are, relevant to analyze the health situation to direct public policies. The places with major problems related to the quality of information about deaths have the heaviest disease burden.[9] some methodological proposals for indirect estimates and analyses of corrected data from vital statistics systems have been used in Brazil[4,6] to include the population groups most at risk from death and disease. The high proportions of deaths from ill-defined causes in Brazil are worrisome, as they indicate problems related to the access and quality of medical care received by the population, in addition to compromising the reliability of mortality statistics for causes of death.[8,10,20] These deaths corresponded to 14.3% of the total in 2000, with wide variability between cities and even regions: proportions ranged from 28.4% in the Northeast to 6.3% in the South.a a Ministério da Saúde.
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