Multiple Causes of Death Associated with Pediatric Cardiopulmonary Arrest from 1996 to 2019 in Brazil. / Causas Múltiplas de Morte Associadas à Parada Cardiorrespiratória Pediátrica de 1996 a 2019 no Brasil.

BACKGROUND: In pediatrics, cardiopulmonary arrest (CPA) is associated with high mortality and severe neurologic sequelae. Information on the causes and mechanisms of death below the age of 20 years could provide theoretical support for health improvement among children and adolescents. OBJECTIVES: To conduct a population analysis of mortality rates due to primary and multiple causes of death below the age of 20 years in both sexes from 1996 to 2019 in Brazil, and identify the frequency in which CPA was recorded in the death certificates (DCs) of these individuals and the locations where the deaths occurred, in order to promote strategies to improve the prevention of deaths. METHOD: Ecological time-series study of deaths below the age of 20 years from 1996 to 2019, evaluating the mortality rates (MRs) and proportional mortality (PM) by primary cause of death. We analyzed the percentages of CPA recorded in any line of the DC and the location where the deaths occurred. We calculated the MRs per 100,000 inhabitants and the PM by primary cause of death under the age of 20 years according to sex and age group, the percentages of death from primary causes by age group when CPA was described in any line of Parts I and II of the DC, and the percentage of deaths from primary causes according to their location of occurrence. We retrieved the data from DATASUS, IBGE, and SINASC. RESULTS: From 1996 to 2019, there were 2,151,716 deaths below the age of 20 years in Brazil, yielding a mortality rate of 134.38 per 100,000 inhabitants. The death rate was highest among male neonates. Of all deaths, 249,334 (11.6%) had CPA recorded in any line of the DC. Specifically, CPA was recorded in 49,178 DCs between the ages of 1 and 4 years and in 88,116 of those between the ages of 29 and 365 days, corresponding, respectively, to 26% and 22% of the deaths in these age groups. These two age groups had the highest rates of CPA recorded in any line of the DC. The main primary causes of death when CPA was recorded in the sequence of death were respiratory, hematologic, and neoplastic diseases. CONCLUSION: Perinatal and external causes were the primary causes of death, with highest MRs under the age of 20 years in Brazil from 1996 to 2019. When multiple causes of death were considered, the main primary causes associated with CPA were respiratory, hematologic, and neoplastic diseases. Most deaths occurred in the hospital environment. Better understanding of the sequence of events in these deaths and improvements in teaching strategies in pediatric cardiopulmonary resuscitation are needed.

FUNDAMENTO: Em pediatria, a parada cardiorrespiratória (PCR) está associada a alta mortalidade e graves sequelas neurológicas. Informações sobre as causas e mecanismos de morte abaixo de 20 anos poderiam fornecer subsídios teóricos para a melhoria da saúde de crianças e adolescentes. OBJETIVOS: Realizar uma análise populacional das taxas de mortalidade por causas primárias e múltiplas de morte abaixo de 20 anos, em ambos os sexos, no período de 1996 a 2019, no Brasil, e identificar a frequência com que a PCR foi registrada nas declarações de óbito (DOs) desses indivíduos e os locais de ocorrência dos óbitos, a fim de promover estratégias para melhorar a prevenção de mortes. MÉTODO: Estudo ecológico de séries temporais de óbitos em indivíduos menores de 20 anos, no período de 1996 a 2019, avaliando as taxas de mortalidade (TMs) e a mortalidade proporcional (MP) por causa básica de morte. Foram analisados os percentuais de PCR registrados em qualquer linha da DO e o local de ocorrência dos óbitos. Foram calculadas as TMs por 100 mil habitantes e a MP por causa básica de morte nos menores de 20 anos segundo sexo e faixa etária, os percentuais de óbito por causas básicas por faixa etária quando a PCR foi descrita em qualquer linha das Partes I e II da DO, e o percentual de óbitos por causas básicas segundo o local de ocorrência. Os dados foram retirados do DATASUS, IBGE e SINASC. RESULTADOS: De 1996 a 2019, ocorreram 2.151.716 óbitos de menores de 20 anos, no Brasil, gerando uma taxa de mortalidade de 134,38 por 100 mil habitantes. A taxa de óbito foi maior entre os recém-nascidos do sexo masculino. Do total de óbitos, 249.334 (11,6%) tiveram PCR registrada em qualquer linha da DO. Especificamente, a PCR foi registrada 49.178 vezes na DO na faixa etária entre 1 e 4 anos e em 88.116 vezes entre 29 e 365 dias, correspondendo, respectivamente, a 26% e 22% dos óbitos nessas faixas etárias. Essas duas faixas etárias apresentaram as maiores taxas de PCR registradas em qualquer linha da DO. As principais causas básicas de óbito quando a PCR foi registrada na sequência de óbitos foram doenças respiratórias, hematológicas e neoplásicas. CONCLUSÃO: As causas perinatais e externas foram as principais causas de morte, com maior TM nos menores de 20 anos no Brasil de 1996 a 2019. Quando consideradas as causas múltiplas de morte, as principais causas primárias associadas à PCR foram as doenças respiratórias, hematológicas e neoplásicas. A maioria dos óbitos ocorreu no ambiente hospitalar. Melhor compreensão da sequência de eventos nesses óbitos e melhorias nas estratégias de ensino em ressuscitação cardiopulmonar pediátrica são necessárias.

Misclassification of causes of death among a small all-autopsied group of former nuclear workers: Death certificates vs. autopsy reports.

The U.S. Transuranium and Uranium Registries performs autopsies on each of its deceased Registrants as a part of its mission to follow up occupationally-exposed individuals. This provides a unique opportunity to explore death certificate misclassification errors, and the factors that influence them, among this small population of former nuclear workers. Underlying causes of death from death certificates and autopsy reports were coded using the 10th revision of the International Classification of Diseases (ICD-10). These codes were then used to quantify misclassification rates among 268 individuals for whom both full autopsy reports and death certificates with legible underlying causes of death were available. When underlying causes of death were compared between death certificates and autopsy reports, death certificates correctly identified the underlying cause of death's ICD-10 disease chapter in 74.6% of cases. The remaining 25.4% of misclassified cases resulted in over-classification rates that ranged from 1.2% for external causes of mortality to 12.2% for circulatory disease, and under-classification rates that ranged from 7.7% for external causes of mortality to 47.4% for respiratory disease. Neoplasms had generally lower misclassification rates with 4.3% over-classification and 13.3% under-classification. A logistic regression revealed that the odds of a match were 2.8 times higher when clinical history was mentioned on the autopsy report than when it was not. Similarly, the odds of a match were 3.4 times higher when death certificates were completed using autopsy findings than when autopsy findings were not used. This analysis excluded cases where it could not be determined if autopsy findings were used to complete death certificates. The findings of this study are useful to investigate the impact of death certificate misclassification errors on radiation risk estimates and, therefore, improve the reliability of epidemiological studies.

[The Trend in Places of Death Over Two Decades in the City of Muenster - an Observational Study Based on evaluated Death Certificates]. / Sterbeortentwicklung über zwei Jahrzehnte in der Stadt Münster ­ eine Observationsstudie auf Basis ausgewerteter Todesbescheinigungen.

Aim of the study The study examined the distribution of places of death in the Westphalian city of Muenster over an observation period of 20 years.Methods All death certificates issued in the city of Muenster from 2001, 2011, 2017, 2021 were evaluated by places of death (home (HO), hospital (HT), hospice (HP), nursing home (NH), other place (OP)). For hospital patients, deaths on intensive care units (ICU) and palliative care units (PAL) were also considered separately. Any medical information on cause of death was used to identify decedents with malignant tumor or dementia disease.Results A total of 14,240 death certificates were evaluated. A malignant tumor disease was documented in 34.0%, dementia in 11.1%. For the general population, the distribution of places of death was as follows (2001/2021; %): HO (24.0/14.6); HT (63.2/60.2) [ICU (13.3/24.6), PAL (0.0/10.9)], HP (3.8/4.9), NH (7.8/19.5), OP (1.1/0.7). Most tumor patients died in hospital (2021: 60.6%), fewer patients at home (2021: 15.4%). From 2001 to 2021, the proportion of cancer patients who died in a PAL increased significantly (+24.4%); hospices showed a moderate increase (+5.0%). A majority of dementia patients died in nursing homes (2021: 66.6%) and fewer patients at home (2021: 12.2%).Conclusion For the general population and for tumor patients, the hospital is the most common place of death and the nursing home for patients with dementia. Overall, deaths at home decreased continuously over time. For tumor patients, palliative care units and hospices are becoming increasingly important as places of death, and for dementia patients, nursing homes in particular.

Deaths: Leading Causes for 2020.

Objectives-This report presents final 2020 data on the 10 leading causes of death in the United States by age, race and Hispanic origin, and sex. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2020," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2020. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD-10) are ranked according to the number of deaths. Cause-of-death statistics are based on the underlying cause of death. Race and Hispanicorigin data are based on the Office of Management and Budget's 1997 standards for reporting race and Hispanic origin. Results-In 2020, many of the 10 leading causes of death changed rank order due to the emergence of COVID-19 as a leading cause of death in the United States. The 10 leading causes of death in 2020 were, in rank order: Diseases of heart; Malignant neoplasms; COVID-19; Accidents (unintentional injuries); Cerebrovascular diseases; Chronic lower respiratory diseases; Alzheimer disease; Diabetes mellitus; Influenza and pneumonia; and Nephritis, nephrotic syndrome and nephrosis. They accounted for 74.1% of all deaths occurring in the United States. Differences in the rankings are evident by age, race and Hispanic origin, and sex. Leading causes of infant death for 2020 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage.

Effects of inappropriate cause-of-death certification on mortality from cardiovascular disease and diabetes mellitus in Tonga.

BACKGROUND: Cardiovascular disease (CVD) and diabetes mellitus are major health issues in Tonga and other Pacific countries, although mortality levels and trends are unclear. We assess the impacts of cause-of-death certification on coding of CVD and diabetes as underlying causes of death (UCoD). METHODS: Tongan records containing cause-of-death data (2001-2018), including medical certificates of cause-of-death (MCCD), had UCoD assigned according to International Classification of Diseases 10th revision (ICD-10) coding rules. Deaths without recorded cause were included to ascertain total mortality. Diabetes and hypertension causes were reallocated from Part 1 of the MCCD (direct cause) to Part 2 (contributory cause) if potentially fatal complications were not recorded, and an alternative UCoD was assigned. Proportional mortality by cause based on the alternative UCoD were applied to total deaths then mortality rates calculated by age and sex using census/intercensal population estimates. CVD and diabetes mortality rates for unaltered and alternative UCoD were compared using Poisson regression. RESULTS: Over 2001-18, in ages 35-59 years, alternative CVD mortality was higher than unaltered CVD mortality in men (p = 0.043) and women (p = 0.15); for 2010-18, alternative versus unaltered measures in men were 3.3/103 (95%CI: 3.0-3.7/103) versus 2.9/103 (95%CI: 2.6-3.2/103), and in women were 1.1/103 (95%CI: 0.9-1.3/103) versus 0.9/103 (95%CI: 0.8-1.1/103). Conversely, alternative diabetes mortality rates were significantly lower than the unaltered rates over 2001-18 in men (p < 0.0001) and women (p = 0.013); for 2010-18, these measures in men were 1.3/103 (95%CI: 1.1-1.5/103) versus 1.9/103 (95%CI: 1.6-2.2/103), and in women were 1.4/103 (95%CI: 1.2-1.7/103) versus 1.7/103 (95%CI: 1.5-2.0/103). Diabetes mortality rates increased significantly over 2001-18 in men (unaltered: p < 0.0001; alternative: p = 0.0007) and increased overall in women (unaltered: p = 0.0015; alternative: p = 0.014). CONCLUSIONS: Diabetes reporting in Part 1 of the MCCD, without potentially fatal diabetes complications, has led to over-estimation of diabetes, and under-estimation of CVD, as UCoD in Tonga. This indicates the importance of controlling various modifiable risks for atherosclerotic CVD (including stroke) including hypertension, tobacco use, and saturated fat intake, besides obesity and diabetes. Accurate certification of diabetes as a direct cause of death (Part 1) or contributory factor (Part 2) is needed to ensure that valid UCoD are assigned. Examination of multiple cause-of-death data can improve understanding of the underlying causes of premature mortality to better inform health planning.

Collider and reporting biases involved in the analyses of cause of death associations in death certificates: an illustration with cancer and suicide.

BACKGROUND: Mortality data obtained from death certificates have been studied to explore causal associations between diseases. However, these analyses are subject to collider and reporting biases (selection and information biases, respectively). We aimed to assess to what extent associations of causes of death estimated from individual mortality data can be extrapolated as associations of disease states in the general population. METHODS: We used a multistate model to generate populations of individuals and simulate their health states up to death from national health statistics and artificially replicate collider bias. Associations between health states can then be estimated from such simulated deaths by logistic regression and the magnitude of collider bias assessed. Reporting bias can be approximated by comparing the estimates obtained from the observed death certificates (subject to collider and reporting biases) with those obtained from the simulated deaths (subject to collider bias only). As an illustrative example, we estimated the association between cancer and suicide in French death certificates and found that cancer was negatively associated with suicide. Collider bias, due to conditioning inclusion in the study population on death, increasingly downwarded the associations with cancer site lethality. Reporting bias was much stronger than collider bias and depended on the cancer site, but not prognosis. RESULTS: The magnitude of the biases ranged from 1.7 to 9.3 for collider bias, and from 4.7 to 64 for reporting bias. CONCLUSIONS: These results argue for an assessment of the magnitude of both collider and reporting biases before performing analyses of cause of death associations exclusively from mortality data. If these biases cannot be corrected, results from these analyses should not be extrapolated to the general population.

Análise de casos e óbitos relacionados à esquistossomose no Brasil: padrões epidemiológicos e distribuição espaçotemporal, 2010-2022 / Analysis of schistosomiasis cases and deaths in Brazil: epidemiologic patterns and spatio-temporal distribution, 2010-2022 / Análisis de los casos y muertes relacionados con la esquistosomiasis en Brasil: patrones epidemiológión espaciotemporal, 2010-2022cos y distribuci

A esquistossomose é uma infecção parasitária causada por um grupo de vermes chatos chamados Schistosoma. A doença encontra-se, sobretudo, nos países em desenvolvimento, especialmente nas zonas rurais com más condições de saneamento e acesso limitado à água potável. A esquistossomose é transmitida através do contato com água doce contaminada, como de rios, lagos e lagoas em que vivem as larvas dos parasitas. O objetivo deste artigo foi analisar as variáveis epidemiológicas dos casos (2010-2022) e dos óbitos (2010-2020) por esquistossomose no Brasil. Trata-se de um estudo epidemiológico transversal, descritivo e quantitativo. A estratégia metodológica envolveu análise dos boletins epidemiológicos disponibilizados pelo Sistema de Informação de Agravos de Notificação (Sinan) e pelo Sistema de Informação sobre Mortalidade (SIM) no período de 2010 a 2022. Foram notificados 93.521 casos de esquistossomose e 5.495 óbitos devido a complicações dessa infecção. A forma intestinal foi a mais identificada. Minas Gerais, São Paulo, Bahia e Espírito Santo foram os estados com maior prevalência da doença. Constatou-se que homens pardos com idade entre 20 e 39 anos e com baixo nível de escolaridade são os mais afetados. Identificaram-se 732 casos da infecção em gestantes. Ademais, 62,56% dos casos evoluíram para cura e 5,88% para óbito pelo agravo notificado. Em conclusão, é crucial adotar medidas de prevenção e acesso à educação para combater efetivamente a esquistossomose.

Schistosomiasis is a parasitic infection caused by a group of flatworms called Schistosoma. The disease is primarily found in developing countries, especially in rural areas with poor sanitation and limited access to clean water. Schistosomiasis is transmitted by contact with contaminated freshwater, such as rivers, lakes, and ponds, where the parasites' larvae live. The aim of this article was to analyze the epidemiological variables of schistosomiasis cases (2010-2022) and deaths (2010-2020) in Brazil. This is a cross-sectional, descriptive, and quantitative epidemiologic study. The methodological strategy involved the analysis of epidemiological bulletins provided by the Sistema de Informação de Agravos de Notificação (SINAN) and the Sistema de Informação sobre Mortalidade (SIM) from 2010 to 2022. There were 93.521 reported cases of schistosomiasis and 5.495 deaths due to complications of this infection. The intestinal form was the most identified. Minas Gerais, São Paulo, Bahia, and Espírito Santo were the states with the highest prevalence of the disease. Males, of mixed race, aged between 20 and 39 years, and with a low level of education were the most affected. There were 732 cases of infection in pregnant women. Furthermore, 62.56% of the cases evolved to cure and 5.88% evolved to death by the notified disease. In conclusion, it is crucial to adopt prevention measures and access to education to effectively combat schistosomiasis.

La esquistosomiasis es una enfermedad parasitaria causada por un grupo de platelmintos conocidos como Schistosoma. La enfermedad es más frecuente sobre todo en países en desarrollo, especialmente en zonas rurales con saneamiento deficiente y acceso limitado al agua potable. La transmisión de la esquistosomiasis se da por el contacto con agua dulce contaminada, como ríos, lagos y lagunas donde viven las larvas de los parásitos. El objetivo de este artículo fue analizar las variables epidemiológicas de los casos (2010-2022) y muertes (2010-2020) por esquistosomiasis en Brasil. Se trata de un estudio epidemiológico transversal, descriptivo y cuantitativo. La estrategia metodológica contó con el análisis de los informes epidemiológicos que pone a disposición el Sistema de Información de Enfermedades de Declaración Obligatoria (Sinan) y el Sistema de Información sobre Mortalidad (SIM) en el período de 2010 a 2022. Se notificaron 93.521 casos de esquistosomiasis y 5.495 muertes por complicaciones de esta infección. La forma intestinal fue la más identificada. Minas Gerais, São Paulo, Bahia y Espírito Santo fueron los estados con mayor prevalencia de la enfermedad. Se constató que hombres pardos, de edad entre 20 y 39 años, y bajo nivel de escolaridad son los más afectados. Se identificaron 732 casos de infección en mujeres embarazadas. El 62,56% de los casos evolucionaron a cura; y el 5,88% tuvieron muerte confirmada por el agravio notificado. Se concluye con la necesidad de adoptar medidas de prevención y acceso a la educación para combatir eficazmente la esquistosomiasis.

[Places of death of COVID-19 patients: an observational study based on evaluated death certificates from the city of Muenster, Germany (2021)]. / Sterbeorte von COVID-19-Patienten: eine Observationsstudie auf Grundlage ausgewerteter Todesbescheinigungen der Stadt Münster (2021).

INTRODUCTION: The places of death of COVID-19 patients have so far hardly been investigated in Germany. METHODS: In a places of death study in Westphalia (Germany), statistical evaluations were carried out in the city of Muenster on the basis of all death certificates from 2021. Persons who had died with or from a COVID-19 infection were identified by medical information on cause of death and analyzed with descriptive statistical methods using SPSS. RESULTS: A total of 4044 death certificates were evaluated, and 182 deceased COVID-19 patients were identified (4.5%). In 159 infected patients (3.9%), the viral infection was fatal, whereby the distribution of places of death was as follows: 88.1% in hospital (57.2% in the intensive care unit; 0.0% in the palliative care unit), 0.0% in hospice, 10.7% in nursing homes, 1.3% at home, and 0.0% in other places. All infected patients < 60 years and 75.4% of elderly patients ≥ 80 years died in hospital. Only two COVID-19 patients, both over 80 years old, died at home. COVID-19 deaths in nursing homes (17) affected mostly elderly female residents. Ten of these residents had received end-of-life care from a specialized outpatient palliative care team. DISCUSSION: The majority of COVID-19 patients died in hospital. This can be explained by the rapid course of the disease with a high symptom burden and the frequent young age of the patients. Inpatient nursing facilities played a certain role as a place of death in local outbreaks. COVID-19 patients rarely died at home. Infection control measures may be one reason why no patients died in hospices or palliative care units.

[Causes of death in the Moscow region according to medical death certificates]. / Prichiny smerti v Moskovskoi oblasti po dannym meditsinskikh svidetel'stv o smerti.

OBJECTIVE: Determination of the leading causes of death based on data from primary medical death certificates (MDCs) depending on the place of death. MATERIAL AND METHODS: From the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (the USR registry office system) for 2021, all cases were selected in which diseases were indicated as the primary cause of death (PCD); all codes of external causes, injuries and poisonings were excluded. A total of 109.126 cases, 50.6% died in the hospital, 34% died at home, and 16.4% died elsewhere. Bureau of Forensic Medical Examination (BFME) issued 45.2% of MSS. Taking into account the frequency of use of ICD codes, the clinical similarity of individual codes, 20 groups were formed, which accounted for 90.1% of deaths from diseases. RESULTS: The frequency of registration of individual groups of causes of death largely depends on the place of death. 5 leading groups of causes of death were established: 1) in general from COVID-19 23.55%, chronic ischemic heart disease (CIHD-1) without postinfarction cardiosclerosis, aneurysm and ischemic cardiomyopathy (CMP) 14.5%, from encephalopathy indefinite (EI) 11.4%, malignant neoplasms (MN) 11.3%, stroke 6.2%; 2) in a hospital from COVID-19 45%, stroke 10%, MN 8.3%; CIHD-1 7.1%, CIHD with a history of MI/ischemic CMP 2.7%; 3) at home from CIHD-1 21.8%, EI 21.5%, MN 15.5%, from diseases associated with alcohol 3.3% and brain cyst 3.3%; 4) elsewhere from CIHD-1 22.7%, EI 21.6%, MN 12%, from other forms of acute coronary artery disease 5.4%, alcohol-associated diseases 4.8%. Acute MI ranked 6th among deaths in general - 2.7%. PCD is also associated with the place of issue of the MDCs - 90% of the MDC with the indication of EI and «other degenerative diseases of the nervous system¼ as the cause of death were issued by the BFME. Not a single MDC issued by the BFME contained such PCDs as "old age" or "brain cyst". CONCLUSION: The nosological structure of the causes of death and the issuance of individual ICD codes in the MDC as a PCD varies significantly depending on the place of death and the issuance of the MDC. The reasons need to be further clarified. The use of codes that are not permitted for use has been registered.

Autopsy histology data suggest cirrhosis is frequently under-reported on death certificates.

BACKGROUND: Cirrhosis may be asymptomatic yet contribute to ill health. Here, we studied how often cirrhosis is discovered first at an autopsy. We also examined how frequent this finding was not reported on formal death certificates. METHODS: We used register-based data from all liver biopsies in Sweden performed after death. Cross-linkage to national registers was performed to examine how often such patients had accurate coding for cirrhosis on their death certificates. FINDINGS: A total of 6187 patients with a liver biopsy performed after death, showing cirrhosis. Of these, 2523 (41%) did not have a diagnosis corresponding to cirrhosis on their final death certificate.

Availability of death review of children using death certificates and forensic autopsy results.

The Model Project for Child Death Review (CDR) was initiated in Japan, but parental consent is required for detailed investigations. We proposed an alternative method to review child deaths using death certificates and forensic autopsy results when parental consent is not provided. We extracted and reviewed death certificates for the deceased younger than 18 years from among all certificates submitted in Shiga Prefecture between 2015 and 2017. In addition, we analyzed autopsy records in cases that underwent forensic autopsy. The prevalence of each cause of death was compared among age groups. The situation and circumstances of unnatural deaths were analyzed in detail. Of 131 certificates, unnatural deaths accounted for 29.7 %. The prevalence of each cause of death significantly differed among age groups. Malignant disease and suicide were most common in school-aged children and congenital disease was most common in infants. Suicide was the leading cause of unnatural death, followed by suffocation, which was most common in infants. Situations where suffocation was reported included co-sleeping with the mother and breastfeeding. Despite parental consent not being obtained, the trends of regional child deaths and the circumstances of accidental deaths were clarified by the present method. However, the results of detailed investigation were lacking. This study provided basic information for implementing detailed methods and procedures for CDR at the governmental level. To perform optimal CDR, legislation for collecting detailed information without parental consent is required.

Excesso de óbitos classificados com códigos garbage na pandemia de Covid-19, no estado da Paraíba / Excess of deaths classified with garbage codes in the COVID-19 pandemic / Exceso de muertes clasificados con códigos garbage en la pandemia COVID-19

Resumo No cenário de calamidade assistido durante a pandemia de Covid-19, o ato de definir a causa básica de um óbito não foi trivial e o aumento da utilização dos códigos garbage (códigos mal definidos ou pouco específicos) traz preocupação em relação à qualidade da informação sobre as causas de morte nos estados do Brasil. Constatou-se um aumento significativo do número de óbitos no período pandêmico no estado da Paraíba, localizado na região Nordeste do Brasil, situação que se assemelhou ao contexto nacional. Em 2020 ocorreram 31.107 óbitos na Paraíba, enquanto no período de 2015 a 2019 foi identificada uma média de 27.000 óbitos. O objetivo do presente estudo é identificar e mensurar o excesso de óbitos classificados com códigos garbage em 2020, no estado da Paraíba, durante a pandemia de Covid-19. As séries temporais de óbitos foram obtidas do Painel de Monitoramento da Mortalidade por Causas Básicas Inespecíficas ou Incompletas (garbage codes) do Ministério da Saúde, para todos os meses de 2015 a 2020. Foram calculadas as projeções de óbitos totais e dos óbitos por códigos garbage (CG). O cálculo do excesso da proporção de óbitos classificados por códigos garbage no estado da Paraíba, em 2020, resultou em 8,58%, destacando-se o mês de junho com o maior valor (19,42%). Espera-se contribuir para avanços no conhecimento da realidade da qualidade da informação da notificação dos óbitos em uma área do país que almeja avanços nesse sentido e evidenciar a necessidade da investigação em outras localidades do Brasil.

Abstract In the disaster scenario witnessed during the pandemic caused by COVID-19, the act of defining the underlying cause of a death was no trivial matter and the increased use of Garbage Codes (poorly defined or not very specific codes) raises concerns regarding the quality of the information on causes of death in the states of Brazil. There was a significant increase in the number of deaths during the pandemic in the state of Paraíba, located in the Northeast region of Brazil, a situation similar to the national context. There were 31,107 deaths in 2020 in Paraíba, while an average of 27,000 deaths were identified for the period 2015 to 2019. Our goal was to identify and measure the excess of deaths classified with Garbage Codes in the COVID-19 pandemic in the geographic space of the state of Paraíba in 2020. The time series of deaths were obtained from the Mortality Monitoring Panel for Unspecific or Incomplete Basic Causes (Garbage Codes) of the Ministry of Health, for all months of the years 2015 to 2020. Projections of total deaths and deaths by Garbage Codes (GC) were calculated. The calculation of the excess proportion of deaths classified by Garbage Codes in the state of Paraíba resulted in 8.58%, highlighting the month of June 2020, which reached the maximum value equal to 19.42%. We expect to contribute to advance knowledge regarding the current reality of quality information on death notifications in an area of the country that seeks to make progress in this direction and to highlight the need for research in other locations in Brazil.

Resumen En el escenario de desastre que se vivió durante la pandemia de COVID-19, definir la causa subyacente de una muerte no fue baladí y el aumento del uso de códigos garbage (códigos mal definidos o poco específicos) genera preocupaciones acerca la calidad de la información sobre las causas de muerte en los estados de Brasil. En cuanto al aumento del número de muertes en el período de la pandemia en el estado de Paraíba, en la región Nordeste de Brasil, la situación fue similar al contexto nacional: 31.107 muertes en 2020, mientras que durante el período 2015-2019 el promedio fue de 27.000 muertes. El objetivo de este trabajo fue identificar y medir el exceso de muertes clasificadas con códigos Garbage en la pandemia de COVID-19 en el estado de Paraíba en 2020. Las series temporales de defunciones se obtuvieron del Panel de Seguimiento de Mortalidad por Causas Básicas Inespecíficas o Incompletas del Ministerio de Salud, para todos los meses de 2015 a 2020. Se calcularon proyecciones de muertes totales y muertes por códigos basura, para los que el cálculo de la proporción de exceso de muertes resultó en 8,58 %, con un valor de 19,42 % durante junio. Se espera contribuir a la calidad de la información sobre las notificaciones de muerte en un área del país que busca avances en esa dirección y resaltar la necesidad de investigaciones en otras localidades de Brasil.

Maternal mortality committee and death surveillance in Recife in improving information: ex-ante and ex-post evaluation / Comitê de mortalidade materna e a vigilância do óbito em Recife no aprimoramento das informações: avaliação ex-ante e ex-post

Abstract Objectives: to evaluate the contribution of the Maternal Mortality and Death Surveillance Committee for women of childbearing age (WCA) and maternal mortality in the magnitude of maternal mortality and in the qualification of the causes of death in Recife, Brazil. Methods: ex ante/ex post evaluation, ecological, of the annual indicators of mortality of WCA, maternal and case study of declared maternal deaths according to causes of death before and after surveillance. Deaths of WCA (2010 and 2017) were analyzed. The percentage of investigation of deaths of WCA was calculated; their rates and maternal mortality ratio (MMR) were estimated; the groups of causes of death, classification of death, the moment of death, the proportional variation before and after surveillance, and the relocation of the causes after this process were described. Results: 4.327 (97.0%) of deaths of WCA were investigated (increase of 40.7% of maternal deaths) and MMR of 62.9/100 thousand live births. Improved notifications of immediate/late (75.0%) and remote (300.0%) postpartum; there was a difference in direct obstetric causes, total maternal deaths and late maternal death (p<0.001). Conclusion: the surveillance and the Maternal Mortality Committee showed potential in identifying the magnitude and qualification of causes of maternal death in order to propose the interventions directed to obstetric care.

Resumo Objetivos: avaliar a contribuição do Comitê de Mortalidade Materna e da Vigilância do Óbito de mulheres em idade fértil (MIF) e materno na magnitude da mortalidade materna e na qualificação das causas dos óbitos no Recife, Brasil. Métodos: avaliação ex ante/ex post, ecológico, dos indicadores anuais de mortalidade de MIF, materna e estudo de caso de óbitos maternos declarados segundo causas de morte antes e após a vigilância. Analisaram-se óbitos de MIF (2010-2017) e calculou-se o percentual de investigação; estimaram-se suas taxas e a razão de mortalidade materna (RMM); descreveram-se: grupos de causa, classificação e momento do óbito, variação proporcional antes e após a vigilância/análise do comitê e a realocação das causas após esse processo. Resultados: investigou-se 4.327 (97,0%) dos óbitos de MIF (incremento de 40,7% das mortes maternas), e RMM de 62,9/100 mil nascidos vivos; melhoraram as notificações do puerpério imediato/ tardio (75,0%) e remoto (300,0%); houve diferença nas causas obstétricas diretas, total de óbitos maternos e morte materna tardia (p<0,001). Conclusão: mostrou-se o potencial da vigilância e do Comitê de Mortalidade Materna na identificação da magnitude e qualificação das causas de morte materna para proposição de medidas direcionadas aos cuidados obstétricos.

The Young were not Spared: What Death Certificates Reveal about Non-Covid Excess Deaths.

From April 2020 through at least the end of 2021, Americans died from non-Covid causes at an average annual rate of 97 000 in excess of previous trends. Hypertension and heart disease deaths combined were elevated 32 000. Diabetes or obesity, drug-induced causes, and alcohol-induced causes were each elevated 12 000 to 15 000 above previous (upward) trends. Drug deaths especially followed an alarming trend, only to significantly exceed it during the pandemic to reach 108 000 for calendar year 2021. Homicide and motor-vehicle fatalities combined were elevated almost 10 000. Various other causes combined to add 18 000. While Covid deaths overwhelmingly afflict senior citizens, absolute numbers of non-Covid excess deaths are similar for each of the 18 to 44, 45 to 64, and over-65 age groups, with essentially no aggregate excess deaths of children. Mortality from all causes during the pandemic was elevated 26% for working-age adults (18-64), as compared to 18% for the elderly. Other data on drug addictions, non-fatal shootings, weight gain, and cancer screenings point to a historic, yet largely unacknowledged, health emergency.

Ascertainment of Incident Cancer by US Population-Based Cancer Registries Versus Self-Reports and Death Certificates in a Nationwide Cohort Study, the US Radiologic Technologists Study.

Follow-up of US cohort members for incident cancer is time-consuming, is costly, and often results in underascertainment when the traditional methods of self-reporting and/or medical record validation are used. We conducted one of the first large-scale investigations to assess the feasibility, methods, and benefits of linking participants in the US Radiologic Technologists (USRT) Study (n = 146,022) with the majority of US state or regional cancer registries. Follow-up of this cohort has relied primarily on questionnaires (mailed approximately every 10 years) and linkage with the National Death Index. We compared the level of agreement and completeness of questionnaire/death-certificate-based information with that of registry-based (43 registries) incident cancer follow-up in the USRT cohort. Using registry-identified first primary cancers from 1999-2012 as the gold standard, the overall sensitivity was 46.5% for self-reports only and 63.0% for both self-reports and death certificates. Among the 37.0% false-negative reports, 27.8% were due to dropout, while 9.2% were due to misreporting. The USRT cancer reporting patterns differed by cancer type. Our study indicates that linkage to state cancer registries would greatly improve completeness and accuracy of cancer follow-up in comparison with questionnaire self-reporting. These findings support ongoing development of a national US virtual pooled registry with which to streamline cohort linkages.

Assessing the Diagnostic Accuracy of Physicians for Home Death Certification in Shanghai: Application of SmartVA.

Approximately 30% of deaths in Shanghai either occur at home or are not medically attended. The recorded cause of death (COD) in these cases may not be reliable. We applied the Smart Verbal Autopsy (VA) tool to assign the COD for a representative sample of home deaths certified by 16 community health centers (CHCs) from three districts in Shanghai, from December 2017 to June 2018. The results were compared with diagnoses from routine practice to ascertain the added value of using SmartVA. Overall, cause-specific mortality fraction (CSMF) accuracy improved from 0.93 (93%) to 0.96 after the application of SmartVA. A comparison with a "gold standard (GS)" diagnoses obtained from a parallel medical record review investigation found that 86.3% of the initial diagnoses made by the CHCs were assigned the correct COD, increasing to 90.5% after the application of SmartVA. We conclude that routine application of SmartVA is not indicated for general use in CHCs, although the tool did improve diagnostic accuracy for residual causes, such as other or ill-defined cancers and non-communicable diseases.

Trend of incompleteness of cancer death records in the Mortality Information System database, state of Mato Grosso, Brazil, 2000 to 2016.

OBJECTIVE: To describe the trend of incompleteness of cancer death records in the Mortality Information System (SIM, in Portuguese) database, state of Mato Grosso, Brazil, 2000 to 2016. METHODS: This is a descriptive, ecological, time series study of records of death from cancer of people living in the state of Mato Grosso (codes C00 to C97 of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems - ICD-10), collected from SIM. To asses incompleteness in the filling of the variables of race/skin color, education, marital status, occupation and underlying cause of death, the relative frequency was calculated in the percentage of null values. The time trend analyzes of the incomplete percentage of categories and variables of interest was performed using linear regression (p<0.05). RESULTS: From 2000 to 2016, there were 31,097 deaths from cancer among residents of the state of Mato Grosso. Race/skin color, marital status and occupation presented a stable trend of incompleteness; education and underlying cause of death were decreasing. An increasing trend was observed in the categories ignored (marital status) and retired (occupation); a decreasing trend was observed for blank (education), unidentified and housewife (occupation), and C76-other and ill-defined sites and C80-without specification of site (underlying cause of death). Incompleteness of occupation was classified as very poor, with emphasis on housewife and retired. For the remaining variables and categories, the classification was excellent or good. CONCLUSIONS: Although most of the indicators showed satisfactory trend and classification, the marital status and occupation variables stood out for indicating poorer quality in the records.

Análisis de causas de muerte intrahospitalarias mal definidas e imprecisas / Analysis of ill-defined and imprecise in-hospital causes of death

Introducción: la información sobre las causas de muerte es de gran importancia tanto para los países como para las instituciones sanitarias, en la medida en que contribuye a la evaluación y el seguimiento del estado de salud de la población y a la planificación de intervenciones sanitarias. El objetivo del estudio fue evaluar la proporción de causas de muerte mal definidas e imprecisas y su relación con el día de la semana y período lectivo de médicos residentes en el Hospital Italiano de Buenos Aires (HIBA) durante 2020. Métodos: se realizó un estudio analítico de corte transversal a partir de certificados médicos de defunción de pacientes fallecidos en el ámbito intrahospitalario, evaluando las causas de muerte mal definidas (términos médicos que no aportan información desde el punto de vista clínico y epidemiológico) y las imprecisas (no resultan lo suficientemente específicas como para identificar entidades nosológicas que permitan establecer acciones de prevención y control). Resultados: se analizaron 1030 certificados de defunción, con una proporción de certificados con causa básica de muerte mal definida del 2,3% (n = 24), mientras que en el 17,4% (n = 180) fue imprecisa. No se hallaron diferencias entre la proporción de causas básicas mal definidas y las imprecisas según el día de la semana o período lectivo. Al extender el análisis a todas las causas (básicas, mediatas e inmediatas), la proporción de causas mal definidas fue del 1,6% (n = 40) y la de imprecisas del 51% (n = 1212). Conclusiones: los resultados definen al HIBA como un centro de mediana calidad estadística en el registro de causas de muerte. Se concluye que es necesario mejorarla, para lo que resulta de interés la creación de un plan de capacitación y entrenamiento de los médicos en el grado y el posgrado. (AU)

Introduction: information on causes of death is of great importance both for countries and for health institutions, as it contributes to the evaluation and monitoring of the health status of the population and to the planning of health interventions. The purpose of this study was to evaluate the proportion of ill-defined and imprecise causes of death and its relationship with the day of the week and academic calendar during 2020 at the Hospital Italiano de Buenos Aires. Methods: a cross-sectional study was carried out from data recorded in the death certificates of patients who died in the intrahospital setting, evaluating ill-defined causes of death (medical terms that do not provide clinical or epidemiological information) and imprecise ones (not specific enough to identify nosological entities susceptible to prevention or control). Results: 1030 death certificates were analyzed. The proportion of certificates with ill-defined underlying causes of death was 2.3% (n=24), while 17.4% (n=180) was imprecise. No significant differences were found between the ill-defined and imprecise underlying causes of death and the day of the week and academic calendar. When extending the analysis to all causes (underlying, intermediate, and immediate) the percentage of ill-defined causes was 1.6% (n=40) and 51% (n=1212) was imprecise. Conclusions: results define our hospital as of medium statistical quality on medical death certification. It is concluded that it is necessary to improve the quality of the registry, for which the creation of a training plan for undergraduate and graduate physicians is of interest. (AU)

Accuracy of death certifications of diabetes, dementia and cancer in Australia: a population-based cohort study.

BACKGROUND: National mortality statistics are only based on the underlying cause of death, which may considerably underestimate the effects of some chronic conditions. METHODS: The sensitivity, specificity, and positive and negative predictive values for diabetes (a common precursor to multimorbidity), dementia (a potential accelerant of death) and cancer (expected to be well-recorded) were calculated from death certificates for 9 056 women from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health. Log binomial regression models were fitted to examine factors associated with the sensitivity of death certificates with these conditions as underlying or contributing causes of death. RESULTS: Among women who had a record of each of these conditions in their lifetime, the sensitivity was 12.3% (95% confidence interval, 11.0%, 13.7%), 25.2% (23.7%, 26.7%) and 57.7% (55.9%, 59.5%) for diabetes, dementia and cancer, respectively, as the underlying cause of death, and 40.9% (38.8%, 42.9%), 52.3% (50.6%, 54.0%) and 67.1% (65.4%, 68.7%), respectively, if contributing causes of death were also taken into account. In all cases specificity (> 97%) and positive predictive value (> 91%) were high, and negative predictive value ranged from 69.6% to 84.6%. Sensitivity varied with age (in different directions for different conditions) but not consistently with the other sociodemographic factors. CONCLUSIONS: Death rates associated with common conditions that occur in multimorbidity clusters in the elderly are underestimated in national mortality statistics, but would be improved if the multiple causes of death listed on a death certificate were taken into account in the statistics.