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1.
Am J Forensic Med Pathol ; 41(1): 11-17, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31977347

RESUMEN

Errors in death certification can directly affect the decedent's survivors and the public register. We assessed the effectiveness of an educational seminar targeting frequent and important errors identified by local death certificate (DC) evaluation. Retrospective review of 1500 DCs categorized errors and physician specialty. A 60-minute didactic/case-based seminar was subsequently designed for family medicine physician (FAM) participants, with administration of presurvey, immediate post, and 2-month postsurveys. Most DCs were completed by FAM (73%), followed by internists (18%) and surgeons (3%). Error occurrence (EO) rate ranged between 32 and 75% across all specialities. Family medicine physician experienced in palliative care had the lowest EO rate (32%), significantly lower (P < 0.001) than FAM without interest in palliative care (62%), internal medicine (62%), and surgery (75%). Common errors were use of abbreviations (26%), mechanism as underlying cause of death (23%), and no underlying cause of death recorded (22%). Presurvey participants (n = 72) had an overall EO rate of 72% (64% excluding formatting errors). Immediate postsurvey (n = 75) and 2-month postsurvey (n = 24) participants demonstrated significantly lower overall EO (34% and 24%, respectively), compared with the Pre-S (P < 0.05). A 60-minute seminar on death certification reduced EO rate with perceived long-term effects.


Asunto(s)
Certificado de Defunción , Documentación/normas , Capacitación en Servicio , Médicos de Familia/educación , Alberta , Causas de Muerte , Evaluación Educacional , Docentes Médicos/estadística & datos numéricos , Humanos , Internado y Residencia , Evaluación de Necesidades , Estudios Retrospectivos
2.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190010.supl.3, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800849

RESUMEN

INTRODUCTION: Brazil presented a high proportion of ill-defined causes of death (IDCD) in 2000, compromising accurate cause-of-death analysis. OBJECTIVE: 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. METHOD: 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. RESULTS: 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. DISCUSSION: 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. CONCLUSION: 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.


Asunto(s)
Causas de Muerte , Recolección de Datos/métodos , Sistemas de Información/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Factores de Edad , Anciano , Autopsia/estadística & datos numéricos , Brasil/epidemiología , Niño , Preescolar , Certificado de Defunción , Femenino , Humanos , Lactante , Entrevistas como Asunto/estadística & datos numéricos , Masculino , Registros Médicos/estadística & datos numéricos , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
3.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190011.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800850

RESUMEN

BACKGROUND: Unspecified causes of death are among the traditional indicators of quality of information. OBJECTIVE: To verify the performance of the 60 cities in the Data for Health Initiative project and to analyze the reclassification of unspecified external causes of death (UEC). METHODS: Using the 2017 records from the Mortality Information System, the proportion and percent change in UEC were compared after investigation between project cities and other cities, and the percent of reclassification to specific external causes was calculated. RESULTS: The project cities comprised 52% (n = 11,759) of the total UEC in Brazil, of which 64.5% were reclassified after investigation, whereas the other cities reclassified 31% of UEC. Results were similar for men, youth, blacks, metropolitan cities, the Southeast region, and deaths attested by forensic institutes. In the project cities, pedestrian traffic accidents were external causes with greater reclassification. In men, the UEC was reclassified to homicides (23.8%) and accident of terrestrial transportation (ATT) (11.1%), with motorcyclists (4.4%) and pedestrians (4.3%) being the most prominent. In women, these causes were changed to other accident causes (20.8%), ATT (10.6%) and homicides (7.9%). UEC changed to ATT (18.3%) in the age groups of 0-14 years old and to homicides (32.5%) in the age groups of 15-44 years. CONCLUSION: The project cities obtained better results after investigation of UEC, enabling analysis of the reclassification to specific causes by sex and age groups.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Sistemas de Información/normas , Accidentes/mortalidad , Accidentes de Tránsito/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Niño , Preescolar , Ciudades/epidemiología , Exactitud de los Datos , Femenino , Homicidio/estadística & datos numéricos , Humanos , Lactante , Masculino , Registros Médicos , Persona de Mediana Edad , Distribución por Sexo , Suicidio/estadística & datos numéricos , Violencia/estadística & datos numéricos , Adulto Joven
4.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190012.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800851

RESUMEN

INTRODUCTION: Sepsis represents the occurrence of systemic inflammatory response syndrome triggered by the initial infection of an organ or system. When sepsis is certified as the cause of death, the first diagnosis is lost, leading to inaccurate information as to its origin. OBJECTIVE: To analyze the underlying causes of death from sepsis after investigation in 60 Brazilian municipalities in 2017. METHODOLOGY: All deaths recorded in the Mortality Information System (SIM) as sepsis in 2017 were selected, and the proportions of reclassified deaths were calculated based on the results of research conducted in hospitals and other health services. RESULTS: Of the 6,486 deaths from sepsis that occurred in the 60 municipalities, 1,584 (24.4%) were investigated, and of these, 1,308 (82.6%) were reclassified with other underlying causes. Individuals aged from 70 to 89 years old showed the highest concentration in the records, with 49.3% of cases. More than 60% of the deaths from sepsis reclassified after the investigation had chronic non-communicable diseases as underlying causes (65.6%), with diabetes being the most common specific cause in this group. Communicable diseases (9.6%) and external causes (5.6%) such as falls were also detected as underlying causes. CONCLUSION: The investigation of deaths from sepsis made it possible to identify the true causes of death and the proportions of reclassification. This information will improve the quality of mortality data and support the planning of public health actions in Brazil.


Asunto(s)
Causas de Muerte , Sepsis/mortalidad , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Ciudades/epidemiología , Certificado de Defunción , Femenino , Geografía , Humanos , Lactante , Sistemas de Información/normas , Masculino , Persona de Mediana Edad , Sepsis/etiología , Distribución por Sexo , Adulto Joven
5.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190013.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800852

RESUMEN

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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). CONCLUSION: 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.


Asunto(s)
Causas de Muerte , Accidente Cerebrovascular/mortalidad , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Ciudades/epidemiología , Estudios Transversales , Certificado de Defunción , Femenino , Geografía , Humanos , Sistemas de Información , Masculino , Persona de Mediana Edad , Distribución por Sexo , Accidente Cerebrovascular/etiología
6.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e190014.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800853

RESUMEN

INTRODUCTION: A smartphone application named AtestaDO was developed to support physicians with medical certification of the cause of death. The objective of this study is to evaluate the acceptability of the app. METHODS: Physicians were invited to attend meetings on the proper certification of cause of death, and to evaluate the application in a national workshop in Natal (first stage) and in two large hospitals in Belo Horizonte (second and third stages). RESULTS: In Natal, 82% of 38 physicians had more than 20 years of experience and in Belo Horizonte, more than 67% of 58 physicians had less than 5 years of experience. The sections "Application interface", "How to certify the causes of death", "Practice with exercises" and "Other information for physicians" were positively evaluated by more than 50% of physicians in Belo Horizonte. In Natal, all sections were positively evaluated by at least 80% of participants. More than 70% of the participants in both Natal and the second stage of Belo Horizonte indicated they would possibly use AtestaDO to guide filling of a death certificate. The probability of using AtestaDO to teach classes on filling death certificates was 83.3% for Natal's physicians but less than 60% in Belo Horizonte. In the three stages, most physicians would recommend using the application to other colleagues. CONCLUSION: The evaluation of AtestaDO showed good acceptability. We expect that the use of this tool enables improvements in medical certification of causes of death.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Médicos/normas , Teléfono Inteligente/normas , Programas Informáticos/normas , Brasil , Humanos , Médicos/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Mejoramiento de la Calidad , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Factores de Tiempo
7.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19002.supl.3, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800854

RESUMEN

INTRODUCTION: reliability of mortality data is essential for health assessment and planning. In Brazil, a high proportion of deaths is attributed to causes that should not be considered as underlying causes of deaths, named garbage codes (GC). To tackle this issue, in 2005, the Brazilian Ministry of Health (MoH) implements the investigation of GC-R codes (codes from chapter 18 "Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified, ICD-10") to improve the quality of cause-of-death data. This study analyzes the GC cause of death, considered as the indicator of data quality, in Brazil, regions, states and municipalities in 2000 and 2015. METHODS: death records from the Brazilian Mortality Information System (SIM) were used. Analysis was performed for two GC groups: R codes and non-R codes, such as J18.0-J18.9 (Pneumonia unspecified). Crude and age-standardized rates, number of deaths and proportions were considered. RESULTS: an overall improvement in the quality of mortality data in 2015 was detected, with variations among regions, age groups and size of municipalities. The improvement in the quality of mortality data in the Northeastern and Northern regions for GC-R codes is emphasized. Higher GC rates were observed among the older adults (60+ years old). The differences among the areas observed in 2015 were smaller. CONCLUSION: the efforts of the MoH in implementing the investigation of GC-R codes have contributed to the progress of data quality. Investment is still necessary to improve the quality of cause-of-death statistics.


Asunto(s)
Causas de Muerte , Exactitud de los Datos , Sistemas de Información/normas , Adolescente , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Niño , Ciudades/epidemiología , Certificado de Defunción , Femenino , Geografía , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Distribución por Sexo , Factores de Tiempo , Adulto Joven
8.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19003.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800855

RESUMEN

INTRODUCTION: The study objective was to analyze the quality of data on causes of death in southern Brazil. METHODS: 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. RESULTS: 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. CONCLUSION: 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.


Asunto(s)
Causas de Muerte , Exactitud de los Datos , Sistemas de Información/normas , Adolescente , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Niño , Preescolar , Certificado de Defunción , Femenino , Geografía , Humanos , Lactante , Masculino , Persona de Mediana Edad , Mortalidad/tendencias , Factores de Tiempo , Adulto Joven
9.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19004.supl.3, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31800856

RESUMEN

INTRODUCTION: Reliable cause-of-death statistics are an important source of information on trends and differentials in population health. In Brazil, the Mortality Information System is responsible for compiling cause of death (CoD) data. Despite the success in reducing R-codes ill-defined causes of death, other garbage codes (GC), classified as causes that cannot be the underlying CoD, according to the Global Burden of Disease study, remain a challenge. The Ministry of Health (MoH) aims to decrease the proportion of all GCs, and a pilot study tested a comprehensive strategy to investigate GC deaths that occurred in 2015. METHODS: The research was conducted in seven Brazilian cities during five months in 2016: two rural cities, one metropolitan area, and four capitals. For all GCs selected, municipal healthcare workers collected information about the terminal disease from hospital records, autopsies, family health teams, and home investigation. The fieldwork was coordinated at Federal level in partnership with State and municipal teams. RESULTS: Out of 1,242 deaths selected, physicians analyzed the information collected and certified the CoD in 1,055 deaths, resulting in 92.6% of cases having their underlying cause changed to a usable ICD-10 code. DISCUSSION: It is noteworthy the capacity the health teams in the seven cities showed during the implementation of the pilot. CONCLUSION: After results analysis, the GC investigation protocol was modified, and the implementation scaled up to 60 cities in 2017.


Asunto(s)
Causas de Muerte , Exactitud de los Datos , Sistemas de Información/normas , Mejoramiento de la Calidad/normas , Adulto , Brasil/epidemiología , Ciudades/epidemiología , Certificado de Defunción , Femenino , Geografía , Humanos , Clasificación Internacional de Enfermedades , Masculino , Persona de Mediana Edad , Proyectos Piloto , Reproducibilidad de los Resultados , Población Rural , Población Urbana , Adulto Joven
10.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19005.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800857

RESUMEN

INTRODUCTION: Knowing the number of deaths and their causes is relevant information for public health managers. However, the cause of death is often classified with codes that are not useful for mortality analysis, called garbage codes (GC). OBJECTIVE: To describe and evaluate the impact of investigation of the underlying cause of poorly classified deaths on death certificates in 2017. METHODS: Based on a standardized protocol, GC deaths from 60 municipalities were investigated, mainly in hospital records and autopsy services. Managers at the state level of the Mortality Information System also developed procedures to improve the classification of causes of death, with the consequent adherence of other municipalities (n = 4022). This made it possible to compare the results of GC research between these two groups of municipalities. RESULTS: In the country, among the 108,826 GC investigated in 2017, 48% were reclassified to specific causes. In the 60 focus municipalities, 58% of the 35,366 investigated deaths from GC were reclassified. After the intervention, the proportion of deaths classified as GC decreased by 11% in the country and 17% in the municipalities. DISCUSSION: The research in hospital records enabled almost half of the deaths from GC investigated to be reclassified. This is the first study to investigate GC in hospital records of more than 100,000 deaths. The 60 cities targeted by the intervention had better results than the other cities. CONCLUSION: The intervention proved to be an appropriate initiative to improve the quality of information on cause of death and should be encouraged.


Asunto(s)
Causas de Muerte , Exactitud de los Datos , Certificado de Defunción , Sistemas de Información/normas , Mejoramiento de la Calidad/normas , Brasil/epidemiología , Ciudades/epidemiología , Femenino , Geografía , Humanos , Masculino , Reproducibilidad de los Resultados
11.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19006.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800858

RESUMEN

INTRODUCTION: The term "garbage code" (GC) is used to designate an underlying cause of death that is not very useful for the health policy, since it does not adequately identify actions to prevent and control diseases and health problems. OBJECTIVE: To evaluate the results of GC investigation on changing causes of death in 17 municipalities in the Brazilian Northern region in 2017. METHODS: This is a cross-sectional study on the results of the investigation of deaths with GC in selected hospitals in 17 cities in the seven states of the Northern region, as part of the Data for Health Initiative of the Ministry of Health (MH). In these hospitals, the underlying causes of deaths occurring in 2017 were reviewed, and the GC investigation protocol was applied to deaths with GC. RESULTS: In 2017, 37,082 deaths occurred in the 17 municipalities studied, of which 29.3% (n = 10,878) were GC and 83.2% were priority GC. Among the priority GCs, 25.9% were investigated, of which 79.1% had a change in the underlying cause. DISCUSSION: There is great variation among the 17 municipalities in relation to the proportion of GC. In 13 of the municipalities studied, the underlying cause of death was reclassified in at least 70% of the cases investigated for the priority GC. CONCLUSION: Despite the improvement in reducing the proportion of underlying causes of death with GC in this study, there is still a need for greater investment in training professionals and increasing services to carry out death investigations, in order to ensure the sustainability of the project in the region.


Asunto(s)
Causas de Muerte , Sistemas de Información/normas , Brasil/epidemiología , Ciudades/epidemiología , Estudios Transversales , Exactitud de los Datos , Certificado de Defunción , Femenino , Geografía , Hospitales Públicos/estadística & datos numéricos , Humanos , Masculino , Características de la Residencia
12.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19007.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800859

RESUMEN

OBJECTIVE: to evaluate the impact of investigation of deaths classified as garbage codes (GC) on the quality of the causes-of-death information in municipalities in the Northeast region of Brazil in 2017. METHOD: an investigation was conducted on the deaths classified as GC in 18 municipalities in the Northeast region as follows: identification of deaths with priority GC; review of medical records from health services and forensic institutes; and evaluation of the reclassification of causes of death according to the International Classification of Diseases (ICD-10) and groupings of the Global Burden of Disease 2015 (GBD 2015). RESULTS: among 18,681 deaths classified as priority GC, 7,352 (39%) were investigated and, of these, 5,160 (70%) had reclassified causes, of which 4,087 (79%) were changed to specified causes. Ill-defined causes (n = 4,392) were the most frequent among GC and those with a higher proportion of cause change (80%), and 57% were changed to specified causes. The reduction of GC contributed to the detection of a wide variety of specific causes according to groups of level 3 of the GBD 2015, being the interpersonal violence the cause that obtained the highest percentage change (11.8%). CONCLUSION: The investigation of deaths with priority GC proved to be an important strategy to specify causes of death, and it may influence the formulation, execution and evaluation of health policies.


Asunto(s)
Causas de Muerte , Exactitud de los Datos , Sistemas de Información/normas , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Ciudades/epidemiología , Certificado de Defunción , Femenino , Geografía , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven
13.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19008.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800860

RESUMEN

INTRODUCTION: Deaths classified as Garbage Cause (GC) are considered to be of little use in triggering public health prevention actions. OBJECTIVE: Evaluate the impact of hospital research on recovering the true root cause of death. METHODOLOGY: Descriptive study on the investigation of deaths with root causes classified as garbage code in ten selected hospitals with the highest number of this cause of death in the states of Rio de Janeiro (RJ) and São Paulo (SP), Brazil, in 2017. The investigation considered the patient's medical record, which contains the information collected by hospital surveillance professionals in a standardized form. RESULTS: 2,579 deaths with a GC and 2,116 with GC priorities. The highest proportion occurred in the 70-year-old or older group with differences in the predominant causes as a function of the life cycle. The GC reclassification was 41.9% and 93.6% of deaths investigated in RJ and SP, respectively. Deaths which had altered causes and remained as garbage code were analyzed for change in severity level, which take into account the potential impact of GC in the mortality profile. Thus, 70.7% and 73.6% of GC deaths with very high and with high level, respectively, were reclassified to lower levels. Among the garbage codes that went to well-defined causes, the ICD-10 External Causes chapter was the one that rendered the highest number of deaths. CONCLUSION: The investigation allowed to qualify causes of death and demonstrated the need for professional training on the definition of the root cause of death.


Asunto(s)
Causas de Muerte , Mortalidad Hospitalaria , Sistemas de Información/normas , Mejoramiento de la Calidad/normas , Adolescente , Adulto , Distribución por Edad , Anciano , Brasil/epidemiología , Niño , Preescolar , Certificado de Defunción , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estándares de Referencia , Factores de Riesgo , Adulto Joven
14.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19009.supl.3, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31800861

RESUMEN

INTRODUCTION: Deaths certified with ill-defined causes or garbage codes (GC) compromise the analysis of mortality and its use for planning and evaluation of public health policies. The hospital investigation of these causes is one of the strategies qualifying the profile of mortality in the country. OBJECTIVE: To evaluate the change in the hospital mortality profile after investigation of deaths certified with GC in 2017 in Belo Horizonte, Brazil. METHODS: A sample of hospital deaths reported with GC in the Mortality Information System (SIM) of Belo Horizonte in 2017 was investigated and subsequently certified by a physician to compare the mortality profile before and after investigation. RESULTS: After investigating 1,395 deaths out of 3,038 reported with GC, a reduction of 35.5% of these causes was observed. Groups of all ages presented decreases in GC occurrence. A higher proportional increase was observed for deaths due to ischemic heart diseases, Alzheimer's disease, chronic obstructive pulmonary disease, ischemic and hemorrhagic stroke, and external causes of death (accidental falls, homicides and traffic/transport accidents). CONCLUSION: The investigation on reported hospital deaths is one of the strategies to improve mortality statistics, reducing the occurrence of GC among reported deaths and changing the mortality profile in these facilities. The importance of continuous physician training in cause-of-death certification is emphasized.


Asunto(s)
Causas de Muerte , Mortalidad Hospitalaria , Sistemas de Información/normas , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Exactitud de los Datos , Certificado de Defunción , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Mejoramiento de la Calidad , Distribución por Sexo , Adulto Joven
15.
Rev Med Chil ; 147(6): 727-732, 2019 Jun.
Artículo en Español | MEDLINE | ID: mdl-31859825

RESUMEN

BACKGROUND: With the aim to inform end of life public policies, the place of death in Chile, its trends and associated factors were analysed. MATERIALS AND METHODS: A cross sectional using publically available death database from 1990 to 2014 was conducted. The proportion of hospital deaths was selected as the main outcome. A logistic regression was used to assess the association between place of death, age, and main diagnosis at death. Also, a Prais-Winsten regression and a Chi2 test were used to assess a time series and regional analysis, respectively. RESULTS: 2,063,615 deaths were analysed. Overall, deaths 898,871 (43.6%) occurred at hospital. Those who died over 85 years (OR 2,52 IC95% 2.49-2.55) and those who died from cancer (OR 2.43 IC95% 2.42-2.45) had higher risk for dying outside de hospital. For the general population and those who die form cancer, there is no evidence for an increase or decrease trend in the proportion of hospital deaths over time (p = 0,75 and p = 0.68, respectively). However, there is an increase of the proportion of hospital deaths in those who died over 85 years (p < 0.001,27% in 1990 to 32% in 2014). Also, there are geographic differences between country regions (p < 0.001) (Eg. Magallanes 52.9%). CONCLUSIONS: The proportion of hospital deaths has been stable over time in the general population and has increased in those over 85 years.


Asunto(s)
Mortalidad Hospitalaria/tendencias , Mortalidad/tendencias , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Chile/epidemiología , Estudios Transversales , Certificado de Defunción , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Probabilidad , Política Pública , Análisis Espacio-Temporal , Cuidado Terminal , Factores de Tiempo
16.
Artículo en Ruso | MEDLINE | ID: mdl-31884765

RESUMEN

The statistics of causes of death is the informational basis for identifying public health problems. That is why the accurately accounting for mortality from diabetes mellitus, which is a global medical and social problem for society, is important. The study was carried out to analyze the correctness of coding death causes of diabetes mellitus and the frequency of alleged death. MATERIALS AND METHODS: The Moscow deceased population database of July 2018 - July 2019 was analyzed. Using the decision tables on codes linkages from ICD-10, incorrect codes for underline cause were established for 342 death cases from diabetes mellitus. Among 43044 cases of cardiovascular death the cases of presumed death from diabetes were detected. The analysis was carried out in the Microsoft Access 2007 software. THE RESULTS: In 18.4% of cases, the cause of death from diabetes was encoded incorrectly. If a modification of the underline death cause is assumed due to the mention of certain diseases in any line of the Death Certificate, cases of coding for death from diabetes with wrong fourth character are more often detected when mentioning kidney diseases. If modification of the underline cause is provided for cases when information in the Death Certificate indicates that diabetes has caused the development of some diseases then the largest number of cases with incorrect coding was detected when mentioning circulatory diseases. Only in one medical organization the frequency of incorrect coding is 3.4%, in the rest it varies from 15.4% to 52.2%. Among all death causes, diabetes was only 0.41%. If to add cases of presumptive death from diabetes mellitus, then the proportion of diabetes in the structure of death causes will almost triple and reach up to 1.2%. CONCLUSIONS: The quality of diagnosis and coding of death causes from diabetes has not improved in recent years. To increase it, it is advisable to organize and establish the institution of coders. It is advisable to indicate the presence of diabetes mellitus in the Death Certificate without fail and use the information from the diabetes register. It is proposed to encode the death cause from diabetes mellitus with multiple complications use line D in the Death Certificate to indicate damage to various organs and systems if it is necessary.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Diabetes Mellitus/mortalidad , Humanos , Clasificación Internacional de Enfermedades , Moscú/epidemiología
17.
Aust N Z J Public Health ; 43(6): 570-576, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31667984

RESUMEN

OBJECTIVE: To investigate the under-identification of Indigenous∗ infants in death records and examine the impact of a multi-stage algorithm on disparities in sudden unexpected deaths in infancy (SUDI). METHODS: Data on SUDI in Queensland between 2010 and 2014 were linked to birth and death registrations, health data, and child protection and coronial records. An algorithm was applied to cases of SUDI and population data to derive Indigenous status. Numbers, proportions and rates of SUDI were compared. RESULTS: Using multiple sources of Indigenous status resulted in a 64.9% increase in the number of infants identified as Indigenous. The Indigenous SUDI rate increased by 54.3%, from 1.38 to 2.13 per 1,000 live births after applying the algorithm to SUDI and live births data. CONCLUSIONS: Applying an algorithm to both numerator and denominator data reduced numerator-denominator incompatibility, to more accurately report rates of Indigenous SUDI and measure the gap in Indigenous infant mortality. Implications for public health: Estimation of the true magnitude of the disparity is restricted by under-identification of Indigenous status in death records. Data linkage improved the reporting of Indigenous infant mortality. Accuracy in reporting of measures is integral to determining genuine progress towards Closing the Gap.


Asunto(s)
Mortalidad Infantil/etnología , Grupo de Ascendencia Oceánica , Muerte Súbita del Lactante/etnología , Algoritmos , Causas de Muerte , Certificado de Defunción , Documentación/normas , Femenino , Humanos , Lactante , Recién Nacido , Almacenamiento y Recuperación de la Información , Masculino , Queensland/epidemiología , Factores de Riesgo , Muerte Súbita del Lactante/epidemiología
18.
Artículo en Alemán | MEDLINE | ID: mdl-31690975

RESUMEN

BACKGROUND: Death certificates are the basis for German mortality statistics, including suicide statistics. OBJECTIVES: To examine death certificates that are issued in the context of suicide with special focus on the quality of doctors' entries, especially indications of suicide and the stated association between underlying illness and cause of death. MATERIALS AND METHODS: Data from the Allgäu Suicide Study were used. Police records (N = 626) containing the results of suicide investigations as well as death certificates were analysed. RESULTS: There is great heterogeneity as to how physicians issue death certificates in the context of suicide. Clear indications of suicide are often missing and underlying illnesses are seldom mentioned. Nevertheless, there are only minor differences between the number of suicides recorded by the police compared to official statistics. CONCLUSIONS: To improve the quality of death certificates in the context of suicide, physicians should give clearer indications of suicide and put more focus on logically explaining the causes of death. The mortality of mental illnesses might be underestimated when mental illnesses are not regularly mentioned as a potential cause for suicide.


Asunto(s)
Certificado de Defunción , Suicidio , Causas de Muerte , Alemania , Humanos , Policia
19.
Artículo en Alemán | MEDLINE | ID: mdl-31720737

RESUMEN

BACKGROUND: As a complete survey, cause-of-death statistics are often used for research purposes, but they react sensitively to methodological changes. OBJECTIVES: To show how sensitive the signing of the underlying cause reacts to methodological changes and what potential there is in the use of multicausal analyses. MATERIALS AND METHODS: The methodological examples are based on a sample of the 2016 annual material from Bavaria (age: 65 years or older). It includes n = 24,752 cases of death with information on underlying cause and multiple causes of death. The standardized ratio of multiple to underlying cause (SRMU) value was used to investigate the extent to which dementia and Parkinson's disease are underestimated in the mortality process and which other diseases are noted on the death certificate besides these causes of death. RESULTS: Changes in the set of rules, in the decision tables, and in the confidentiality concept can have an important influence on the signing of the underlying cause. This can lead to changes in the ranking of causes of death or to underestimation or overestimation of certain diseases. Dementia and Parkinson's disease are underestimated as a cause of death in the dying process if only the underlying disease is used for analysis. CONCLUSIONS: Temporal and regional comparisons must always be interpreted against the background of changing methodological guidelines and procedures. Multicausal analyses in this respect offer the chance for the future to mitigate the difficulties of a unicausal approach.


Asunto(s)
Causas de Muerte , Demencia , Enfermedad de Parkinson , Anciano , Certificado de Defunción , Demencia/mortalidad , Alemania/epidemiología , Humanos , Enfermedad de Parkinson/mortalidad
20.
Artículo en Alemán | MEDLINE | ID: mdl-31720738

RESUMEN

The time of death and the diseases leading to death provide important information for health research and disease registries. They facilitate conclusions about the state of health of a population and contribute to the assessment of health promotion measures as well as disease prevention and care. In many countries, these data are provided through mortality registries.In Germany, these data are available on death certificates, which must be filled out by physicians with all information available for each death. However, use of these data for research is very difficult as there is no central registry. Instead, regional health authorities archive the respective death certificates locally. Furthermore, the data provided on death certificates are partly uncoded or only available in paper form. Bremen is the only federal state that has more than 20 years of expertise with a regional mortality registry that demonstrates how health research can benefit from an efficient processing and provision cause of death (CoD) data and how this may also improve the quality of cancer registration.Currently, automatic coding of the CoD by the statistical offices is being implemented on a national level. As a consequence, the free-text information from death certificates will have to be recorded electronically. This requires organizational restructuring that offers a unique opportunity to make all the necessary provisions that are needed for the establishment of mortality registries at the federal state level. This would be an important step towards the establishment of a long overdue national mortality registry - a research data infrastructure guaranteeing international competitiveness.


Asunto(s)
Causas de Muerte , Certificado de Defunción , Alemania/epidemiología , Humanos , Mortalidad/tendencias , Sistema de Registros
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