Quality of data on causes of death in southern Brazil: the importance of garbage causes.

Abstract

The study objective was to analyze the quality of data on causes of death in southern Brazil. Mortality Information System (SIM - Sistema de Informações sobre Mortalidade) data were used to evaluate the occurrence of Garbage Causes (GC) in death certificates (DCs) of residents of South states and their capitals between 2015 and 2016. The GC of each state were compared to the other states and grouped by severity level (N1 to N4, according to decreasing potential impact on mortality profile). We evaluated the N1 and N2 GC in the 0-74 years, in accordance with local of occurrence and attesting professional. The occurrence of GC ranged from 29 to 31% among the three states, below the national average (34%). The GC of levels N1 and N2 were similar between states and heterogeneous between capitals. Most deaths were in-hospital, between 55%-64% of N1 and N2 GC occurred in the states and 39%-55% in the capitals. As for home deaths, this number ranged between 25%-31% and 25%-40%, respectively. More than 30% of the attesting professionals (except in Florianópolis) were declared as "others" in the corresponding DC field. Physicians from the Forensic Medical Institute (IML) and Death Verification Service (SVO) attested 15 to 24% of N1 and N2 GC in the states and 33 to 66% in the state capitals. The improvement of mortality data should involve strategies aimed at hospital physicians, in accordance with the volume of deaths and the IML and SVO services in addition to support for the emission of home DC, due to the importance in generating more severe GC.