Proportion Of Ill-defined Causes Research Articles

Factors associated with homicides of women in Brazil, by race or colour, 2016-2020.

This ecological, time-trend study examined rates of homicide against women residing in Brazil, by state and race/colour, from 2016 to 2020, by performing. Multiple analysis by regression model on longitudinal data. During the study period, 20,405 homicides of women were recorded in Brazil. Standardised homicides rates were higher among black women (6.1/100,000) than among white women (3.4/100,000). From 2016 to 2020, rates decreased 25.2%, from 4.7 deaths per 100,000 women in 2016 to 3.5 in 2020, with a statistically significant downward trend among both black and white women. Statistically significant inverse relationships were found between female homicide rates and HDI, illiteracy rate and proportion of ill-defined causes. The average homicide rate decreased in 2019 and 2020, as compared with 2016. Despite the decreasing time trend in homicide rates for both black and white women, they differed substantially by race, with worse outcomes for black women.

Factors associated with homicides of women in Brazil, by race or colour, 2016-2020

Factors associated with homicides of women in Brazil, by race or colour, 2016-2020

Вплив зрушень у структурі причин смерті на тривалість життя у великих містах України

Large cities are often at the forefront of social change, not only in their region, but throughout the country. Therefore, the analysis of their demographic trends, in particular mortality by causes of death, is important not only by itself, but also in the context of general demographic prospects of the country. The aim of this study is to make a comparative analysis of the gains in life expectancy in Dnipro, Kyiv, Lviv, Odesa and Kharkiv over the period 2005— 2019, and an estimation of the cause-specific mortality contributions to the life expectancy changes. For the first time, decompositions analyses are conducted to evaluate contributions to fluctuations in life expectancy not only by age and sex, but also by causes of death for each of the five largest cities of Ukraine. The following statistical measures and methods are used: calculation and analysis of demographic rates, life tables, graphic method and decomposition method. Our results show that, during the observed period, life expectancy at birth has increased in all cities, mostly due to changes in mortality from circulatory diseases, which have resulted in a one-year increase in life expectancy among men in Odesa to almost 2.5 years among women of Kharkiv. However, it might be possible that such a large contribution in Kharkiv is a result of a part of the deaths falling into the category of ill-defined causes, for which mortality has increased rapidly in that city. The second major contribution to the improvement in life expectancy is attributable to external causes of death: from 0.3 years of increase in females of Lviv to almost 1.9 years in females of Odesa. Males in Odesa benefited the most from the reduction in mortality due to infectious diseases (+2 years). In some cases, there was a significant positive contribution of the reduction in mortality from diseases of the digestive system (+0.5 years in men of Dnipro). The decline in cancer mortality also had a positive impact on life expectancy in all cities, except for Kharkiv. Overall, the increase in life expectancy for men was due to a reduction in mortality at younger ages than for women. In particular, the common age interval for all five cities, with men having the greatest gain in life expectancy, is 45-59 years, while for women it is 65 to 79 years. In men, the gain in life expectancy was accounted for by the decline in mortality at the age 45 to 59 years, with 24.4 per cent in Odesa and almost 46 per cent in Lviv and Kharkiv, mainly due to a reduction in mortality from circulatory diseases and external causes. In women, the decline in mortality at the age 65 to 79 years contributed 30.3-34.8 per cent of the increase in life expectancy in Dnipro, Kyiv and Lviv; however, in Odesa it was only 19.4 per cent, in Kharkiv it was almost 54.3 per cent, which seems unlikely due to an increase in the proportion of ill-defined causes of death. In all five cities, the main trend over 2005-2013 years was the decline in mortality from the major causes of death, while the period 2013-2019 was turbulent, with mortality by causes of death changing in different directions even in the same city. Some contradictory results may be explained by the deterioration in the quality of the registration of demographic events as well as changes in the age and sex structure of the population of cities, which have not been reflected in the current estimates of the State Statistical Committee of Ukraine due to the long absence of a population census.

Analysis of quality of information about deaths from neoplasms in Brazil between 2009 and 2019.

To assess the quality of information about mortality from neoplasm within the Mortality Information System. Descriptive observational study evaluating the quality of the Mortality Information System, with an outcome referring to data on deaths from neoplasm between 2009 and 2019 in the Brazilian population (≥15 years). Information Quality (IQ) was measured through coverage, specificity and completeness of data, at national and state level. The quality of the coverage dimension ranged from "good" to "excellent" in the national and state coverages. Specificity was classified as inadequate mainly in the states of the North and Northeast regions. The proportion of ill-defined causes was classified as "poor" quality in most units of analysis throughout the series. Data completeness varied according to indicator. Gender and age indicators were proven "excellent" for the entire period and units of analysis, while educational level varied in quality across units and periods, marital status had its quality improved over the period, as well as ethnicity/skin color. The quality of data on mortality from neoplasm in the Brazilian population (≥15 years) is mostly adequate, but there are important gaps to be filled, as the expansion of IQ seeks to give visibility to the health condition of the Brazilian population and to propose public actions for its improvement.

Análise da qualidade da informação sobre óbitos por neoplasias no Brasil, entre 2009 e 2019

ABSTRACT Objective To assess the quality of information about mortality from neoplasm within the Mortality Information System. Methods: Descriptive observational study evaluating the quality of the Mortality Information System, with an outcome referring to data on deaths from neoplasm between 2009 and 2019 in the Brazilian population (≥15 years). Information Quality (IQ) was measured through coverage, specificity and completeness of data, at national and state level. Results: The quality of the coverage dimension ranged from “good” to “excellent” in the national and state coverages. Specificity was classified as inadequate mainly in the states of the North and Northeast regions. The proportion of ill-defined causes was classified as “poor” quality in most units of analysis throughout the series. Data completeness varied according to indicator. Gender and age indicators were proven “excellent” for the entire period and units of analysis, while educational level varied in quality across units and periods, marital status had its quality improved over the period, as well as ethnicity/skin color. Conclusions: The quality of data on mortality from neoplasm in the Brazilian population (≥15 years) is mostly adequate, but there are important gaps to be filled, as the expansion of IQ seeks to give visibility to the health condition of the Brazilian population and to propose public actions for its improvement.

Improving cause of death certification in the Philippines: implementation of an electronic verbal autopsy decision support tool (SmartVA auto-analyse) to aid physician diagnoses of out-of-facility deaths

BackgroundThe majority of deaths in the Philippines occur out-of-facility and require a medical certificate of cause of death by Municipal Health Officers (MHOs) for burial. MHOs lack a standardised certification process for out-of-facility deaths and when no medical records are available, certify a high proportion of ill-defined causes of death. We aimed to develop and introduce SmartVA Auto-Analyse, a verbal autopsy (VA) based electronic decision support tool in order to assist the MHOs in certifying out-of-facility deaths.MethodWe conducted a stakeholder consultation, process mapping and a pre-test to assess feasibility and acceptability of SmartVA Auto-Analyse. MHOs were first asked to conduct an open-ended interview from the family members of the deceased, and if they were not able to arrive at a diagnosis, continue the interview using the standardised SmartVA questionnaire. Auto-Analyse then presented the MHO with the three most likely causes of death. For the pilot, the intervention was scaled-up to 91 municipalities. We performed a mixed-methods evaluation using the cause of death data and group discussions with the MHOs.ResultsOf the 5649 deaths registered, Auto-Analyse was used to certify 4586 (81%). For the remaining 19%, doctors believed they could assign a cause of death based on the availability of medical records and the VA open narrative. When used, physicians used the Auto-Analyse diagnosis in 85% of cases to certify the cause of death. Only 13% of the deaths under the intervention had an undetermined cause of death. Group discussions identified two themes: Auto-Analyse standardized the certification of home deaths and assisted the MHOs to improve the quality of death certification.ConclusionStandardized VA combined with physician diagnosis using the SmartVA Auto-Analyse support tool was readily used by MHOs in the Philippines and can improve the quality of death certification of home deaths.

Analysis of the correlation of socioeconomic, sanitary, and demographic factors with homicide deaths - Bahia, Brazil, 2013-2015.

To analyze the correlation of socioeconomic, sanitary, and demographic factors with homicides in Bahia, from 2013 to 2015. Ecological study, using data from the Information System on Mortality and from the Superintendence of Economic and Social Studies. The depending variable is the corrected homicide rate. Explanatory variables were categorized in four axes. Simple and multiple negative binomial regression models were used. Positive associations were found between homicides and the Index of Economy and Finances (IEF), the Human Development Index, the Gini Index, population density, and legal intervention death rates (LIDR). The variables Index of Education Levels (IEL), rates of death with undetermined intentions (RDUI), and the proportion of ill-defined causes (IDC) presented a negative association with the homicide rates. The specific features of the context of each community, in addition to broader socioeconomic municipal factors, directly interfere in life conditions and increase the risk of dying by homicide.

Improving the usefulness of mortality data: reclassification of ill-defined causes based on medical records and home interviews in Brazil.

Brazil presented a high proportion of ill-defined causes of death (IDCD) in 2000, compromising accurate cause-of-death analysis. To analyze specific underlying causes for deaths originally assigned as IDCD in the Mortality Information System (SIM - Sistema de Informação sobre Mortalidade), after investigation activities implemented in country between 2006 and 2017. For all IDCD identified in the SIM, municipal health professionals collected information about the final disease obtained from hospital records, autopsies, forms of family health teams, and home investigation. Specific causes among reclassified IDCD after investigation were evaluated according to age groups and four calendar periods. Proportions of IDCD reassigned to other causes after review increased over time, reaching 30.1% in 2017. From a total of 257,367 IDCD reclassified in 2006-2017, neonatal-related conditions, injury, ischemic heart disease and stroke were the leading causes detected in the age groups 0-9 years, 10-29 years, 30-69 years, 70 years and over, respectively. The similarity and plausibility of cause-specific proportions derived from the reclassification of IDCD by age group over time indicate the accuracy of the investigation data. High proportions of IDCD reassigned to more informative causes after review indicate the success of this approach to correct misclassification in the SIM, an initiative that should be maintained. Training physicians on death certification along with better quality of medical care and access to health services would lead to further improvement.

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

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.

Myanmar mortality registration: an assessment for system improvement

BackgroundThe vital registration system in Myanmar has a long history and geographical coverage is currently high. However, a recent assessment of vital registration systems of 148 countries showed poor performance of the death registration system in Myanmar, suggesting the need for improvement. This study assessed the quality of mortality data generated from the vital registration system with regard to mortality levels and patterns, quality of cause of death data, and completeness of death registration in order to identify areas for improvement.MethodsThe study used registered deaths in 2013 from the vital registration system, data from the 2014 Myanmar Population and Housing Census, and mortality indicators and COD information for the country estimated by international organizations. The study applied the guidelines recommended by AbouZahr et al. 2010 to assess mortality levels and patterns and quality of cause of death data. The completeness of death registration was assessed by a simple calculation based on the estimated number of deaths.ResultsFindings suggested that the completeness of death registration was critically low (less than 60%). The under-registration was more severe in rural areas, in states and regions with difficult transportation and poor accessibility to health centers and for infant and child deaths. The quality of cause of death information was poor, with possible over-reporting of non-communicable disease codes and a high proportion of ill-defined causes of death (22.3% of total deaths).ConclusionThe results indicated that the vital registration system in Myanmar does not produce reliable mortality statistics. In response to monitoring mortalities as mandated by the Sustainable Development Goals, a significant and sustained government commitment and investment in strengthening the vital registration system in Myanmar is recommended.

Disparities in time trends of cervical cancer mortality rates in Brazil.

This study aimed to correct and describe cervical cancer mortality rates and trends by regions and age-groups in Brazil. It may help planning and implementing policies for cervical cancer control. Data from 2003 to 2012 were accessed through the centralized national mortality database. Correction of the age-specific mortality rates was done by proportional redistribution of ill-defined causes of death and deaths coded as 'uterine, part unspecified'. Annual percentage change (APC) was obtained by trend analysis (Joinpoint regression). In the 10-year period, cancer and ill-defined causes corresponded, respectively, to 18.9 and 10.8% of all deaths (except injuries). The proportion of ill-defined causes was reduced by more than a half in the period. The age-standardized cervical cancer mortality rate was 7.2 per 100,000 women-years after correction. The total increase in rates after corrections was 50.5%. A significant decreasing trend in rates was observed at the national level (APC=-0.17, p<0.001). North was the only region that did not show a decreasing significant trend (APC+0.07, p=0.28). Decreasing trends were restricted to age-groups over 40years. A consistent decreasing trend of cervical cancer mortality rates in Brazil from 2003 to 2012 was observed, although this was not consistent in all regions and restricted to older age-groups. Quality of data needs to be improved. Cancer control policies may consider the differences in access to care and the characteristics of regions to improve their efficiency.

Linking mortuary data improves vital statistics on cause of death of children under five years in the Western Cape Province of South Africa.

Reducing child mortality requires good information on its causes. Whilst South African vital registration data have improved, the quality of cause-of-death data remains inadequate. To improve this, data from death certificates were linked with information from forensic mortuaries in Western Cape Province. A local mortality surveillance system was established in 2007 by the Western Cape Health Department to improve data quality. Cause-of-death data were captured from copies of death notification forms collected at Department of Home Affairs Offices. Using unique identifiers, additional forensic mortuary data were linked with mortality surveillance system records. Causes of death were coded to the ICD-10 classification. Causes of death in children under five were compared with those from vital registration data for 2011. Cause-of-death data were markedly improved with additional data from forensic mortuaries. The proportion of ill-defined causes was halved (25-12%), and leading cause rankings changed. Lower respiratory tract infections moved above prematurity to rank first, accounting for 20.8% of deaths and peaking in infants aged 1-3 months. Only 11% of deaths from lower respiratory tract infections occurred in hospital, resulting in 86% being certified in forensic mortuaries. Road traffic deaths increased from 1.1-3.1% (27-75) and homicides from 3 to 28. The quality and usefulness of cause-of-death information for children in the WC was enhanced by linking mortuary and vital registration data. Given the death profile, interventions are required to prevent and manage LRTI, diarrhoea and injuries and to reduce neonatal deaths.

Verbal autopsy evaluation in Brazil: a description and a case study assessment

BackgroundCause-specific mortality statistics are important primary inputs for informed policy formulation. However, the proportion of ill-defined causes of death (CoD) was persistently high in some regions of Brazil even in 2004. After this date, the Brazilian Government implemented a project aimed at decreasing this proportion, especially in higher priority states and municipalities. In this project, verbal autopsy (VA) questionnaires have routinely been implemented as part of epidemiological surveillance activities since 2009. This study aims to evaluate the performance of this project and the completion rate of VA by performing a case study in a state from the northeast region. MethodsA probabilistic sample of 18 municipalities was selected from the state of Alagoas, Brazil, in 2011. For all ill-defined CoD identified in 2010, we collected the existing VA form and the Ministry of Health (MoH) form, which contains information about the final disease and death cause taken from hospital records, autopsies, family health teams, and civil registry office records. CoD assignment should be carried out by physician review. The completion rate of the MoH form and VA questionnaire was calculated using the number of deaths with specific causes assigned among investigated deaths. Interviews were carried out with local decision makers to evaluate specific gaps in the ill-defined CoD investigation process. FindingsA total of 681 ill-defined CoD were recorded in 2010 in the sample, of which just 25·7% (175 of 681) had a MoH or VA form or both completed. Although the majority of cases were attended by health service professionals during the terminal disease, the completion rate was 44·7% (95% CI 34·1–55·3) using the MoH form and 80·0% (71·7–88·3) when VA was performed. InterpretationThis study provides evidence that the training of the epidemiological surveillance team, including physicians, in the investigation and certification of CoD of ill-defined conditions could contribute to improving the quality of mortality data. FundingThe Ministry of Health of Brazil.

O6-5.1 Million death study mortality classification (MDS-MC) system for verbal autopsies

IntroductionThe Global Burden of Disease (GBD) disease classification system, based on ICD-10, is mostly based on hospitalised patients and medically-certified causes of death in developed countries. However, most deaths in...

Diferenciais geográficos, socioeconômicos e demográficos da qualidade da informação da causa básica de morte dos idosos no Brasil

This study identifies geographic, demographic, and socioeconomic differences in the quality of data on underlying causes of death in the Brazilian elderly population. We used three quality indicators: the proportion of ill-defined causes, the proportion of unspecified causes, and the two proportions combined. We analyzed the main ill-defined and unspecified causes and the association between these indicators and individual characteristics on death certificates (DC) and characteristics of the municipalities. Unspecified causes exceed ill-defined causes, and both increase with age. Schooling, race, size of municipality, and per capita GDP were associated with quality of data (especially with ill-defined as compared to unspecified causes). Having received medical care decreased the odds of cause of death being recorded as ill-defined and increased the odds of unspecified records. Programs to improve quality of information on death certificates should focus on ill-defined and unspecified causes in the elderly.

A mortalidade de idosos no Brasil: a questão das causas mal definidas

The study of mortality of elderly persons according to underlying causes permits the understanding of their epidemio-logical profile; but there is a large proportion of ill-defined causes. The objective of this work is to describe the Brazilian elderly mortality according to ill-defined underlying causes. Data source was the System of Information on Mortality of the Ministry of Health. Among variables, the ill-defined underlying cause of death was the main one [Chapter XVIII, International Statistical Classification of Diseases and Related Health Problems – 10th Revision (ICD-10)]. There was a 35% decrease in the occurrence of them observing the elderly deaths, from 1996 to 2005. An increase on the ratios (ill-defined/all deaths) was detected in 2005 from the deaths of 60 to 69 years to the deaths of 80 and more years: 9.9% and 14.8%, respectively. Methodologies to diminish these proportions are suggested; however, the most relevant factor is an adequate report by the physicians of the actual causes of death – underlying, associated and complications – in the death certificates

Evaluation of cause-of-death statistics for Brazil, 2002–2004

Mortality statistics systems with reliable cause-of-death data constitute a major resource for effective health planning; however, many developing countries lack such information systems. Brazil has a long history of registering deaths, and a critical assessment of the quality of current cause-of-death statistics in its five different regions is crucial to identify strengths and weaknesses in the data, and present options for improvement. Quality of cause-of-death data from 2002 to 2004 was evaluated using an assessment framework based on four main attributes: generalizability, reliability, validity and policy relevance. A set of nine criteria: coverage, completeness, consistency of cause patterns with general mortality levels, consistency of cause specific mortality proportions over time, content validity, proportion of ill-defined causes and non-specific codes, incorrect or improbable age or sex patterns, timeliness, and geographical disaggregation were used to assess the four attributes of data quality. Completeness of death registration varies from 72 to 80% in the northeast regions, compared with 85-90% in the Southeast and Centre-West regions, and 94-97% in the wealthier South region. The proportion of ill-defined deaths is an important problem in reported causes of death from almost all regions. Lack of adequate evidence limits the assessment of content validity of registered causes of death. Coverage, consistency of causes with general level of mortality, consistency over time, age and sex patterns, timeliness and usability of statistics for subnational purposes were judged to be reasonable and increase confidence in using the statistics. There is considerable heterogeneity in the quality of cause-of-death statistics across Brazilian regions, especially for criteria such as completeness and ill-defined causes. These factors can influence generalizability and validity of reported causes of death, and must be considered in the interpretation and use of data for secondary descriptive analyses such as burden of disease estimation at regional level, with suitable adjustments to account for bias. The differences identified in this study could be a useful guide for defining measures and investments needed to improve data quality in Brazil.

Causas múltiplas de morte relacionadas à tuberculose no Estado do Rio de Janeiro entre 1999 e 2001

To evaluate deaths attributed to multiple causes in which tuberculosis was one of the causes listed. All deaths among residents of the state of Rio de Janeiro, Brazil, occurring between 1999 and 2001 and for which the death certificate mentioned tuberculosis, were investigated. The World Health Organization guidelines were used in characterizing the underlying and associated (non-underlying) causes of death. In deaths from tuberculosis, conditions related to its natural history were the principal associated causes, together with alcoholism and diabetes. In approximately three-fifths of all deaths for which tuberculosis was listed as an associated cause, the underlying cause of death was acquired immunodeficiency syndrome. High proportion of ill-defined causes of death, low values found for the number of causes informed per death certificate and for TB as an associated cause point towards a certain degree of underestimation of the actual number of TB-related deaths in Rio de Janeiro State. The study shows that the rates of tuberculosis-related mortality in the state of Rio de Janeiro, calculated based on the number of times tuberculosis was listed as a cause of death (underlying or associated), are the highest in the country. Epidemiological studies of mortality are recommended as a means of guiding the activities of the tuberculosis control program.

Distribuição espacial da mortalidade por infarto agudo do miocárdio no Município do Rio de Janeiro, Brasil

The study analyzes the spatial distribution of mortality from acute myocardial infarction (AMI) in Rio de Janeiro, Brazil. Data from the Mortality Information System refers to the year 2000. Empirical Bayes smoothing technique was used to minimize random variation in mortality coefficients due to the population size in the geographic analytical units. Spatial distribution of AMI mortality in the city of Rio de Janeiro is heterogeneous and displays a pattern associated with a strong socioeconomic gradient. The decreased AMI risk in the West Side of the city fails to reflect the social inequality and limited access to healthcare services observed there. A more likely hypothesis is that the risk of AMI death was underestimated in the West Side, due to the high proportion of ill-defined causes of death in that region. In the rest of the city, the spatial pattern of AMI mortality showed higher values in poorer areas. The various hospitals treating AMI also show a clear pattern in their areas of influence.