Abstract
Unspecified stroke (UnST) is of great importance in mortality statistics, as it is the fourth leading cause of death in Brazil. The objective of this study was to identify the profile of reclassified causes of death after investigation of deaths caused by UnST in Brazil. All deaths registered as UnST in 2017 in the Mortality Information System (SIM) were considered as garbage codes. The specific causes, detected after investigation in 60 selected cities, were analyzed by age and sex. Of the total deaths due to UnST identified in these 60 cities (n = 11,289), 25.8% were investigated. Of these, 56.3% were reclassified to ischemic stroke, 12.7% to hemorrhagic stroke, and 23.3% to other specific causes, such as diabetes and chronic kidney disease, in both sexes. The higher proportion of deaths due to ischemic stroke in comparison to hemorrhagic stroke was expected. However, the detection of other specific causes outside the stroke group indicates possible quality problems in the filling of death certificate (DC). The investigations allowed the identification of subgroups of deaths due to stroke. In addition to the research, however, it is important to conduct physician training in the adequate filling in of the DC, in order to improve estimates of specific stroke mortality, and to enable appropriate targeting of health actions and services.
Highlights
Unspecified stroke (UnST) is of great importance in mortality statistics, as it is the fourth leading cause of death in Brazil
Concerning the region of residence, 6.9% and 3.6% of the total deaths from UnST were of residents of the South and Midwest regions, which contributed with 17.8% and 6.4% of the investigated deaths, respectively
Worldwide indirect estimates based on the Global Burden of Disease study (GBD) 2013 study, confirm higher proportions of redistribution of UnST to ischemic stroke (64.7%) and lower for hemorrhagic stroke (30.8%), with variable fractions according to age groups and regions of the world[18]
Summary
Unspecified stroke (UnST) is of great importance in mortality statistics, as it is the fourth leading cause of death in Brazil. The specific causes, detected after investigation in 60 selected cities, were analyzed by age and sex. Results: Of the total deaths due to UnST identified in these 60 cities (n = 11,289), 25.8% were investigated. 56.3% were reclassified to ischemic stroke, 12.7% to hemorrhagic stroke, and 23.3% to other specific causes, such as diabetes and chronic kidney disease, in both sexes. Stroke is defined as a sudden neurological deficit resulting from a vascular lesion. This lesion has an acute, variable-duration installation and can lead to death. There is still no country in the world where the stroke burden, in terms of the absolute number of people affected or who died from stroke, has declined in the last two decades[6]
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