Risk factors for the ill-defined causes of death in the Brazilian states: a multilevel analysis.

Nádia Cristina Pinheiro Rodrigues,Matthew Brian Flynn,Mônica Kramer De Noronha Andrade,Gisele O’Dwyer,Regina Paiva Daumas,Valéria Teresa Saraiva Lino,Andréa Sobral De Almeida

doi:10.1590/1413-812320182311.27182016

Nádia Cristina Pinheiro Rodrigues, Matthew Brian Flynn + Show 5 more

Open Access

https://doi.org/10.1590/1413-812320182311.27182016

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Abstract

This study describes the spatial-temporal changes of the proportion of ill-defined causes of death in Brazil (1998-2012) and investigates which demographic and socioeconomic factors affect this proportion. We collected information of the proportion of ill-defined causes of death by age (15-59 years), sex, period, locality, and socioeconomic data. We used a multilevel Poisson model to investigate which factors affect the risk of ill-defined causes of death. Unlike states located in the South and Midwest, we detected clusters with high proportional levels of these deaths in states in the North and Northeast regions. A greater proportion occurred in 1998-2002 (0.09), in the North and Northeast (0.14 and 0.12, respectively), in older age groups (0.09), and in places with poor socioeconomic conditions. The adjusted analysis showed differences in proportion according to the region, age, period, schooling, social inequality, and income. The results indicate that the lower the age group and the better the socioeconomic situation, the lower the risk to register the cause of death as ill-defined. Although over the past years, the quality of Brazil's mortality data has gradually increased, investments towards improving mortality registries cannot be discontinued.

Highlights

MethodsImproving vital registrations is a priority for the World Health Organization (WHO)[1] In 2003, only one quarter of the WHO member nations had high quality of vital statistics, while most countries (51%), including Brazil, had intermediate quality, covering between 70% and 90% of the country’s deaths or showing percentage of ill-defined causes between 10% and 20%2.In the 2008-2011 period, 30% of WHO member nations had high-quality death registrations
Using the Brazilian federative units, we evaluate the proportion of ill-defined causes of death along the 19982012 period, through descriptive techniques and statistical modeling
The results of the present study indicated that the highest proportions of ill-defined causes of death are found in the North and Northeast regions of the country

Summary

Introduction

Improving vital registrations is a priority for the World Health Organization (WHO)[1] In 2003, only one quarter of the WHO member nations had high quality of vital statistics, while most countries (51%), including Brazil, had intermediate quality, covering between 70% and 90% of the country’s deaths or showing percentage of ill-defined causes between 10% and 20%2. In the 2008-2011 period, 30% of WHO member nations had high-quality death registrations. The United Kingdom, United States of America and Chile figured among these countries, but Brazil still showed 76% of average usability of mortality data for this period[3]. Some authors, which investigated the underlying cause of death related with neoplastic diseases, showed high reliability of the registered information[7,8]. Deaths classified as ill-defined affect the quality of data, reducing its reliability. The lack of accuracy of the mortality data makes the adequate allocation of health resources difficult[4,9]

Results

Discussion

Conclusion