Qualidade dos registros de ocupação das doenças associadas ao asbesto no sistema de informação sobre mortalidade, Brasil / Quality of occupation records of asbestos-related diseases in the mortality information system, Brazil

Resumo Introdução: Registros de ocupações de trabalhadores em sistemas de informação significam muito mais que um dado sociodemográfico. Na Medicina do Trabalho e na Epidemiologia em Saúde do Trabalhador, são especialmente relevantes por indicarem possíveis fatores de risco ocupacionais. Objetivo: Estimar indicadores de qualidade do registro da ocupação das doenças associadas ao asbesto no Sistema de Informação sobre Mortalidade (SIM), Brasil. Método: Estudo transversal conduzido com registros de óbito de maiores de 16 anos de idade, registrados no SIM, entre 2000-2016, com diagnósticos de doenças tipicamente associadas ao asbesto (DAA): mesotelioma, asbestose e placas pleurais. O registro da "ocupação" foi analisado para a completude e consistência. Resultados: Foram identificados 3.764 registros de óbito, para os quais observou-se 60,3% (n=2.268) de incompletude/inconsistência do registro da ocupação. Dados inválidos da ocupação representaram 40,1% (n=1.508), concentrando-se em registros de aposentados e donas de casa, não reconhecidos como ocupações. A má qualidade do registro de ocupação entre os óbitos por DAA foi superior a 50,0% em todas as regiões do país. Conclusões: A qualidade do registro da ocupação no SIM foi ruim tanto para as DAA quanto outros diagnósticos, especialmente no que se refere a completude e consistência dos dados, em relação à Classificação Brasileira de Ocupações.

Abstract Background: Records from occupations of workers in information systems mean much more than just sociodemographic data. In Occupational Medicine and Occupational Health Epidemiology, they are especially relevant as they indicate possible occupational risk factors. Objective: To estimate quality indicators of the record of occupation of asbestos-related diseases in the Mortality Information System (SIM), Brazil. Method: Cross-sectional study, conducted with death records of people over 16 years of age, registered in SIM, from 2000 to 2016, with diagnoses of asbestos-related diseases (ARD): mesothelioma, asbestosis, and pleural plaques. The "occupation" field was analyzed for completeness and consistency. Results: From a total of 3,764 death records, for which 60.3% (n=2,268) of missed/inconsistent occupation records were observed. Invalid occupation data accounted for 40.1% (n=1,508), mainly filled with "retired" or "housewives", not recognized as formal job titles. The poor occupancy record quality among ARD records was over 50.0% in all regions of the country. Conclusions: The quality of the occupation records in SIM was poor for both ARD and other diagnoses, especially regarding the completeness and consistency of the data, in relation to the Brazilian Classification of Occupations.

Fatores ocupacionais associados a neoplasias hematológicas em um polo fruticultor: estudo de caso-controle / Occupational factors associated with hematological neoplasms in a fruit production pole: a case-control study

Resumo Objetivos: identificar fatores de risco ocupacionais para neoplasias hematológicas, leucemia, linfomas e mieloma múltiplo. Métodos: estudo caso-controle conduzido com casos de neoplasias hematológicas e controles recrutados do mesmo serviço, com outros diagnósticos, pareados por frequência, sexo e idade. Entrevistas individuais foram realizadas por pesquisadores treinados, utilizando um questionário estruturado. Informações sobre a história ocupacional, uso e características de exposições a substâncias químicas, em geral, e a agrotóxicos foram registradas. Foram estimadas odds ratios (OR), por meio de modelos de regressão logística não-condicional multivariável para análise exploratória. Resultados: foram incluídos 61 casos e 146 controles. Trabalho na agropecuária (OR: 2,18; intervalo de confiança de 95% (IC95%): 1,10;4,30), exposição ocupacional a agrotóxicos (OR: 2,37; IC95%: 1,18;4,77), e tempo total de exposição ocupacional a agrotóxicos na vida laboral em horas - curto (OR: 3,52; IC95%: 1,25;9,87) e longo (OR: 3,95; IC95%: 1,54;10,14) - foram fatores de risco para neoplasias hematológicas, em comparação aos não expostos. Essas medidas foram ajustadas por consumo de álcool e tabagismo, prática de atividade física, renda, escolaridade e história de exposição ocupacional a produtos químicos. Conclusão: a exposição ocupacional a agrotóxicos se associa a neoplasias hematológicas, independentemente de características do estilo de vida e nível socioeconômico.

Abstract Objectives: to identify the occupational risk factors for hematological neoplasms, specifically leukemia, lymphomas, and multiple myeloma. Methods: this is a case-control study. Cases were individuals with hematological neoplasms and controls were individuals with other diagnoses; frequency-matched by sex and age. Individual interviews were conducted by trained researchers using a structured questionnaire. We collected information on participants' occupational history and chemicals use and exposure, in general, and pesticides, in particular. Odds ratios (OR) were used as association measurements, estimated by multivariate non-conditional logistic regression models for exploratory analysis. Results: 61 cases and 146 controls were included. We found that agricultural work (OR: 2.18; 95% confidence interval (95%CI): 1.10;4.30), occupational exposure to pesticides (OR: 2.37; 95%CI: 1.18;4.77), and total occupational exposure to pesticides throughout their working life (in hours) - both short (OR: 3.52; 95%CI: 1.25;9.87) and long (OR: 3.95; 95%CI: 1.54;10.14) - constituted risk factors for hematological neoplasms, when compared to those unexposed. We adjusted these measures for alcohol consumption and smoking, physical activity, income, education, and history of occupational exposure to chemicals. Conclusion: occupational exposure to pesticides is associated with hematological neoplasms regardless of lifestyle and socioeconomic status.

Recovering records on cancer of the larynx from anonymous health information databases.

OBJECTIVE: To develop a linkage algorithm to match anonymous death records of cancer of the larynx (ICD-10 C32X), retrieved from the Mortality Information System (SIM) and the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in Brazil. METHODOLOGY: Death records containing ICD-10 C32X codes were retrieved from SIM and SIH-SUS, limited to individuals aged 30 years and over, between 2002 and 2012, in the state of São Paulo. The databases were linked using a unique key identifier developed with sociodemographic data shared by both systems. Linkage performance was ascertained by applying the same procedure to similar non-anonymous databases. True pairs were those having the same identification variables. RESULTS: A total of 14,311 eligible death records were found. Most records, 10,674 (74.6%), were exclusive to SIM. Only 1,853 (12.9%) deaths were registered in both systems, representing true pairs. A total of 1,784 (12.5%) cases of laryngeal cancer in the SIH-SUS database were tracked in SIM with different causes of death. The linkage failed to match 167 (9.4%) records due to inconsistencies in the key identifier. CONCLUSION: The authors found that linking anonymous data from mortality and hospital records is a feasible measure to track missing records and may improve cancer statistics.

Occupation and maternal mortality in Brazil.

OBJECTIVE: To estimate maternal mortality ratio according to occupation in Brazil. METHODS: This is a mortality study conducted with national data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC) in 2015. Maternal mortality ratios were estimated according to the occupation recorded in death certificates, using the Brazilian Classification of Occupation (CBO), version 2002. RESULTS: A total of 1,738 maternal deaths records were found, corresponding to a maternal mortality ratio of 57.6/100,000 live births. It varied among occupational groups, with higher estimates among service and agricultural workers, particularly for domestic workers (123.2/100,000 live births), followed by general agricultural workers (88.3/100,000 live births). Manicurists and nursing technicians also presented high maternal mortality ratio. Maternal occupation was not reported in 17.0% of SIM registers and in 13.2% of SINASC data. Inconsistent records of occupation were found."Housewife" prevailed in SIM (35.5%) and SINASC (39.1%). CONCLUSIONS: Maternal mortality ratio differs by occupation, suggesting a work contribution, which requires further research focusing occupational risk factors. Socioeconomic factors are closely related to occupation, and their combination with work exposures and the poor access to health services need to be also addressed.

Occupational exposure to organophosphate pesticides and hematologic neoplasms: a systematic review. / Exposição ocupacional a agrotóxicos organofosforados e neoplasias hematológicas: uma revisão sistemática.

OBJECTIVE: To update findings of observational analytical studies on the association between occupational exposure to organophosphates and hematologic malignancies. METHODOLOGY: Systematic literature review, including cohort and case-control studies, without limitation of publication time, in Portuguese and English. The articles were traced from June 2017 to July 2019 in PubMed, MEDLINE, LILACS, Web of Science, and Scopus databases. The qualitative bias risk assessment was performed using the Newcastle-Ottawa Scale and the Downs and Black Checklist. Results were presented according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). RESULTS: Seventeen studies evaluated as good/high methodological quality were eligible. Exposure to diazinon (1 cohort), phonophos (1 cohort), dichlorvos, crotoxiphos and famphur (1 case control) was associated with leukemia, while exposure to organophosphate was associated to lymphomas (6 case control); the risk of non-Hodgkin's lymphoma was higher in those exposed to diazinon (1 control case) and malathion (3 control case) than non-exposed ones. Multiple myeloma occurred more commonly in organophosphate exposed than in non-exposed individuals (1 case-control). CONCLUSION: Occupational exposure to organophosphates increases the risk of hematologic malignancies, especially among individuals with longer exposure periods. Worker monitoring and exposure control measures are recommended.

Fatores associados à qualidade de registros de acidentes de trabalho no Sistema de Informações sobre Mortalidade no Brasil / Factors associated with quality of work accident records in Brazil's Mortality Information System / Factores asociados a la calidad de registros de accidentes de trabajo en el Sistema de Informaciones sobre Mortalidad en Brasil

Resumo: Este estudo teve como objetivo identificar fatores associados à qualidade do registro de acidentes de trabalho fatais no Sistema de Informações sobre Mortalidade (SIM), ocorridos com pessoas de 18 a 65 anos, entre 1998 e 2013, no Brasil. A qualidade do registro da possível relação causal de acidentes com o trabalho <acidtrab>, campo existente em declarações de óbitos, exclusivo para acidentes dentre as causas externas, foi analisada com duas variáveis: (1) registro "ignorado" (R-IGN, sim/não); (2) registros ausentes ou inconsistentes (R-AUS, sim/não). Foram encontrados 665.531 óbitos dentre os quais 67,7% dos registros de <acidtrab> eram de má qualidade. Fatores associados a registro "ignorado" foram: sexo masculino; cor da pele branca; escolaridade menor que a superior; não operários ou não agricultores; atestante Instituto Médico Legal (IML); regiões Sudeste e Nordeste; e óbito em hospital. Registros ausentes ou inconsistentes se associaram: à idade acima de 34 anos; à cor da pele não branca; a sem escolaridade; a todas as regiões, exceto à Sudeste; a óbito em hospital ou no domicílio; a boletim de ocorrência como fonte; e a atestante IML. Esses fatores, independentemente associados à má qualidade de preenchimento do campo <acidtrab>, compreendiam dimensões individuais, da fonte de emissão, do local do óbito e geográficas. Isso revela a necessidade de melhoria da qualidade de declarações de óbito em hospitais, IML e boletins de ocorrência, treinando e supervisionando equipes em todo o Brasil.

Abstract: This study aimed to identify factors associated with the quality of fatal work accident records in the Brazilian Mortality Information System in individuals 18 to 65 years of age from 1998 to 2013. The quality of the record of possible causal relationship between accidents and the work <acidtrab>, a field that appears on death certificates and is exclusive to accidents among external causes, was analyzed with two variables: (1) record "ignored" (R-IGN, yes/no); (2) missing or inconsistent records (R-AUS, yes/no). A total of 665,531 deaths were located, of which 67.7% of the <acidtrab> records showed poor quality. Factors associated with record "ignored" were: male sex; white skin color; schooling less than university; non-blue-collar workers or non-farmers; death certificate issued by the Forensic Medical Office (IML); Southeast and Northeast regions of the country; and death in hospital. Missing or inconsistent records were associated with: age greater than 34 years; non-white skin color; no schooling; all regions of Brazil except the Southeast; death in hospital or at home; police report as the source of information; and death certificate issued by the IML. The factors independently associated with poor quality of completion of the field <acidtrab> included individual dimensions, source issuing the death certificate, place of death, and geographic variables. The findings reveal the need to improve the quality of death records in hospitals, the IML, and police reports, besides training and supervising teams throughout Brazil.

Resumen: El objetivo de este estudio fue identificar factores asociados a la calidad del registro de accidentes de trabajo fatales en el Sistema de Información sobre Mortalidad (SIM), ocurridos con personas de 18 a 65 años, entre 1998 y 2013, en Brasil. La calidad del registro de la posible relación causal de accidentes con el trabajo <acidtrab>, campo existente en las declaraciones de fallecimiento, exclusivo para accidentes entre las causas externas, se analizó con dos variables: (1) registro "ignorado" (R-IGN, sí/no); (2) registros ausentes o inconsistentes (R-AUS, sí/no). Se encontraron 665.531 óbitos entre los cuales un 67,7% de los registros de <acidtrab> eran de mala calidad. Los factores asociados al registro "ignorado" fueron: sexo masculino; color de piel blanco; escolaridad menor que la superior; no obreros o no agricultores; con atestado del Instituto Médico Legal (IML); región sudeste y nordeste; y fallecimiento en hospital. Los registros ausentes o inconsistentes se asociaron a: edad por encima de 34 años; color de piel no blanca; sin escolaridad; todas las regiones, excepto la sudeste; fallecimiento en hospital o en el domicilio; boletín de ocurrencia como fuente; y con atestado IML. Estos factores independientemente asociados a la mala calidad en la cumplimentación del campo <acidtrab> incluían dimensiones individuales, de la fuente de emisión, del lugar del fallecimiento y geográficas. Esto revela la necesidad de mejora en la calidad de las declaraciones de óbito en hospitales, IML y boletines de ocurrencia, entrenando y supervisando equipos en todo Brasil.

Occupation and maternal mortality in Brazil / Ocupação e mortalidade materna

ABSTRACT OBJECTIVE To estimate maternal mortality ratio according to occupation in Brazil. METHODS This is a mortality study conducted with national data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC) in 2015. Maternal mortality ratios were estimated according to the occupation recorded in death certificates, using the Brazilian Classification of Occupation (CBO), version 2002. RESULTS A total of 1,738 maternal deaths records were found, corresponding to a maternal mortality ratio of 57.6/100,000 live births. It varied among occupational groups, with higher estimates among service and agricultural workers, particularly for domestic workers (123.2/100,000 live births), followed by general agricultural workers (88.3/100,000 live births). Manicurists and nursing technicians also presented high maternal mortality ratio. Maternal occupation was not reported in 17.0% of SIM registers and in 13.2% of SINASC data. Inconsistent records of occupation were found."Housewife" prevailed in SIM (35.5%) and SINASC (39.1%). CONCLUSIONS Maternal mortality ratio differs by occupation, suggesting a work contribution, which requires further research focusing occupational risk factors. Socioeconomic factors are closely related to occupation, and their combination with work exposures and the poor access to health services need to be also addressed.

RESUMO OBJETIVO Estimar a razão de mortalidade materna segundo a ocupação no Brasil. MÉTODOS Trata-se de estudo de mortalidade realizado com dados nacionais do Sistema de Informação sobre Mortalidade (SIM) e do Sistema de Informação sobre Nascidos Vivos (Sinasc) no ano de 2015. Foram estimadas as razões de mortalidade materna de acordo com a ocupação registrada em declarações de óbito, utilizando a Classificação Brasileira de Ocupações, versão 2002. RESULTADOS Foram encontrados 1.738 registros de óbitos maternos, correspondendo a uma razão de mortalidade materna de 57,6/100.000 nascidos vivos. Esse índice variou entre as categorias ocupacionais, sendo maior entre as trabalhadoras dos serviços e da agropecuária, particularmente para as empregadas domésticas (123,2/100.000 nascidos vivos), seguidas pelas trabalhadoras agropecuárias em geral (88,3/100.000 nascidos vivos). Também apresentaram elevada razão de mortalidade materna as manicures e técnicas de enfermagem. A ocupação materna não foi informada em 17,0% dos casos do SIM e em 13,2% do Sinasc. Foram encontrados registros inconsistentes, como "dona de casa", o mais frequente no SIM (35,5%) e no Sinasc (39,1%). CONCLUSÕES A razão de mortalidade materna difere de acordo com a ocupação, sugerindo uma contribuição do trabalho, o que requer pesquisas adicionais para identificar os fatores de risco ocupacionais. Fatores socioeconômicos estão intimamente relacionados à ocupação, e sua combinação com exposições no trabalho e acesso a serviços de saúde precisa ser abordada.

Exposição ocupacional a agrotóxicos organofosforados e neoplasias hematológicas: uma revisão sistemática / Occupational exposure to organophosphate pesticides and hematologic neoplasms: a systematic review

RESUMO: Objetivo: Atualizar achados de estudos observacionais analíticos sobre a associação entre exposição ocupacional a organofosforados e neoplasias hematológicas. Métodos: Revisão sistemática de literatura, incluindo estudos de coorte e caso controle, sem limitação de tempo de publicação, nos idiomas português e inglês. O rastreamento de artigos foi feito no período de junho de 2017 a julho de 2019 nas bases de dados PubMed, MEDLINE, LILACS, Web of Science e Scopus. A avaliação qualitativa de risco de viés foi feita com a Escala Newcastle-Otawa e com o Checklist Downs e Black. Os resultados foram apresentados segundo as recomendações da Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Resultados: Foram elegíveis 17 estudos avaliados como de boa/alta qualidade metodológica. A exposição a diazinon (um coorte), fonofós (um coorte), diclorvós, crotoxifós e fanfur (um caso controle) associou-se à leucemia, enquanto a exposição a organofosforados associou-se aos linfomas (seis caso controle). O risco de linfoma não-Hodgkin foi maior para os indivíduos expostos a diazinon (um caso controle) e malation (três caso controle), em relação aos não expostos. O mieloma múltiplo ocorreu mais comumente em expostos a organofosforados do que entre os não expostos (um caso controle). Conclusão: A exposição ocupacional a organofosforados aumenta o risco de neoplasias hematológicas, sobretudo entre os indivíduos com maior período de exposição. Medidas de monitoramento de trabalhadores e de controle da exposição são recomendadas.

ABSTRACT: Objective: To update findings of observational analytical studies on the association between occupational exposure to organophosphates and hematologic malignancies. Methodology: Systematic literature review, including cohort and case-control studies, without limitation of publication time, in Portuguese and English. The articles were traced from June 2017 to July 2019 in PubMed, MEDLINE, LILACS, Web of Science, and Scopus databases. The qualitative bias risk assessment was performed using the Newcastle-Ottawa Scale and the Downs and Black Checklist. Results were presented according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Results: Seventeen studies evaluated as good/high methodological quality were eligible. Exposure to diazinon (1 cohort), phonophos (1 cohort), dichlorvos, crotoxiphos and famphur (1 case control) was associated with leukemia, while exposure to organophosphate was associated to lymphomas (6 case control); the risk of non-Hodgkin's lymphoma was higher in those exposed to diazinon (1 control case) and malathion (3 control case) than non-exposed ones. Multiple myeloma occurred more commonly in organophosphate exposed than in non-exposed individuals (1 case-control). Conclusion: Occupational exposure to organophosphates increases the risk of hematologic malignancies, especially among individuals with longer exposure periods. Worker monitoring and exposure control measures are recommended.

The recording of fatal work-related injuries in information systems in Brazil. / Registro de dados sobre acidentes de trabalho fatais em sistemas de informação no Brasil.

This study aims to identify information systems having fatal work-related (ATF) data in Brazil, describing their characteristics, flows and barriers to information quality. Using a documental research approach, we found: the Mortality Information System (SIM), the Hospital Admission Register from the Unified Health System (SIH-SUS), the Notifiable Diseases Information System (SINAN) and the Violence and Injuries Surveillance Program (VIVA) from the Health Ministry; the Work-related Injuries Reporting System (SISCAT) of the Ministry of Social Insurance; and the Annual Report of Social Information (RAIS), Ministry of Labour and Employment. A lack of key common variables limits the construction of a single database composed by all ATF recorded cases. From several barriers identified, the most relevant for data quality was the lack of work-relatedness recognition and recording, a task performed by the health team.

O objetivo deste estudo é identificar sistemas de informação que dispõem de dados sobre acidentes de trabalho fatais (ATF) no Brasil, descrever suas características, fluxos e barreiras para a qualidade da informação. Empregando-se o método da pesquisa documental, foram encontrados: o Sistema de Informações sobre Mortalidade (SIM), o Sistema de Informações Hospitalares do SUS (SIH/SUS), o Sistema de Informação de Agravos de Notificação (Sinan) e o Sistema do Programa Vigilância de Violência e Acidentes (VIVA) do Ministério da Saúde; o Sistema de Informação de Comunicação de Acidentes do Trabalho (Siscat) da Previdência Social; e do Ministério do Trabalho e Emprego, a Relação Anual de Informações Sociais (RAIS). A falta de variáveis chave comuns limita a construção de uma base de dados única com todos os casos de ATF registrados. Dentre os vários filtros e barreiras identificados destaca-se o não reconhecimento da relação do acidente com o trabalho pelos profissionais registrantes.

Registro de dados sobre acidentes de trabalho fatais em sistemas de informação no Brasil / The recording of fatal work-related injuries in information systems in Brazil

Resumo O objetivo deste estudo é identificar sistemas de informação que dispõem de dados sobre acidentes de trabalho fatais (ATF) no Brasil, descrever suas características, fluxos e barreiras para a qualidade da informação. Empregando-se o método da pesquisa documental, foram encontrados: o Sistema de Informações sobre Mortalidade (SIM), o Sistema de Informações Hospitalares do SUS (SIH/SUS), o Sistema de Informação de Agravos de Notificação (Sinan) e o Sistema do Programa Vigilância de Violência e Acidentes (VIVA) do Ministério da Saúde; o Sistema de Informação de Comunicação de Acidentes do Trabalho (Siscat) da Previdência Social; e do Ministério do Trabalho e Emprego, a Relação Anual de Informações Sociais (RAIS). A falta de variáveis chave comuns limita a construção de uma base de dados única com todos os casos de ATF registrados. Dentre os vários filtros e barreiras identificados destaca-se o não reconhecimento da relação do acidente com o trabalho pelos profissionais registrantes.

Abstract This study aims to identify information systems having fatal work-related (ATF) data in Brazil, describing their characteristics, flows and barriers to information quality. Using a documental research approach, we found: the Mortality Information System (SIM), the Hospital Admission Register from the Unified Health System (SIH-SUS), the Notifiable Diseases Information System (SINAN) and the Violence and Injuries Surveillance Program (VIVA) from the Health Ministry; the Work-related Injuries Reporting System (SISCAT) of the Ministry of Social Insurance; and the Annual Report of Social Information (RAIS), Ministry of Labour and Employment. A lack of key common variables limits the construction of a single database composed by all ATF recorded cases. From several barriers identified, the most relevant for data quality was the lack of work-relatedness recognition and recording, a task performed by the health team.

[Factors associated with quality of work accident records in Brazil's Mortality Information System]. / Fatores associados à qualidade de registros de acidentes de trabalho no Sistema de Informações sobre Mortalidade no Brasil.

This study aimed to identify factors associated with the quality of fatal work accident records in the Brazilian Mortality Information System in individuals 18 to 65 years of age from 1998 to 2013. The quality of the record of possible causal relationship between accidents and the work , a field that appears on death certificates and is exclusive to accidents among external causes, was analyzed with two variables: (1) record "ignored" (R-IGN, yes/no); (2) missing or inconsistent records (R-AUS, yes/no). A total of 665,531 deaths were located, of which 67.7% of the records showed poor quality. Factors associated with record "ignored" were: male sex; white skin color; schooling less than university; non-blue-collar workers or non-farmers; death certificate issued by the Forensic Medical Office (IML); Southeast and Northeast regions of the country; and death in hospital. Missing or inconsistent records were associated with: age greater than 34 years; non-white skin color; no schooling; all regions of Brazil except the Southeast; death in hospital or at home; police report as the source of information; and death certificate issued by the IML. The factors independently associated with poor quality of completion of the field included individual dimensions, source issuing the death certificate, place of death, and geographic variables. The findings reveal the need to improve the quality of death records in hospitals, the IML, and police reports, besides training and supervising teams throughout Brazil.

Este estudo teve como objetivo identificar fatores associados à qualidade do registro de acidentes de trabalho fatais no Sistema de Informações sobre Mortalidade (SIM), ocorridos com pessoas de 18 a 65 anos, entre 1998 e 2013, no Brasil. A qualidade do registro da possível relação causal de acidentes com o trabalho , campo existente em declarações de óbitos, exclusivo para acidentes dentre as causas externas, foi analisada com duas variáveis: (1) registro "ignorado" (R-IGN, sim/não); (2) registros ausentes ou inconsistentes (R-AUS, sim/não). Foram encontrados 665.531 óbitos dentre os quais 67,7% dos registros de eram de má qualidade. Fatores associados a registro "ignorado" foram: sexo masculino; cor da pele branca; escolaridade menor que a superior; não operários ou não agricultores; atestante Instituto Médico Legal (IML); regiões Sudeste e Nordeste; e óbito em hospital. Registros ausentes ou inconsistentes se associaram: à idade acima de 34 anos; à cor da pele não branca; a sem escolaridade; a todas as regiões, exceto à Sudeste; a óbito em hospital ou no domicílio; a boletim de ocorrência como fonte; e a atestante IML. Esses fatores, independentemente associados à má qualidade de preenchimento do campo , compreendiam dimensões individuais, da fonte de emissão, do local do óbito e geográficas. Isso revela a necessidade de melhoria da qualidade de declarações de óbito em hospitais, IML e boletins de ocorrência, treinando e supervisionando equipes em todo o Brasil.

El objetivo de este estudio fue identificar factores asociados a la calidad del registro de accidentes de trabajo fatales en el Sistema de Información sobre Mortalidad (SIM), ocurridos con personas de 18 a 65 años, entre 1998 y 2013, en Brasil. La calidad del registro de la posible relación causal de accidentes con el trabajo , campo existente en las declaraciones de fallecimiento, exclusivo para accidentes entre las causas externas, se analizó con dos variables: (1) registro "ignorado" (R-IGN, sí/no); (2) registros ausentes o inconsistentes (R-AUS, sí/no). Se encontraron 665.531 óbitos entre los cuales un 67,7% de los registros de eran de mala calidad. Los factores asociados al registro "ignorado" fueron: sexo masculino; color de piel blanco; escolaridad menor que la superior; no obreros o no agricultores; con atestado del Instituto Médico Legal (IML); región sudeste y nordeste; y fallecimiento en hospital. Los registros ausentes o inconsistentes se asociaron a: edad por encima de 34 años; color de piel no blanca; sin escolaridad; todas las regiones, excepto la sudeste; fallecimiento en hospital o en el domicilio; boletín de ocurrencia como fuente; y con atestado IML. Estos factores independientemente asociados a la mala calidad en la cumplimentación del campo incluían dimensiones individuales, de la fuente de emisión, del lugar del fallecimiento y geográficas. Esto revela la necesidad de mejora en la calidad de las declaraciones de óbito en hospitales, IML y boletines de ocurrencia, entrenando y supervisando equipos en todo Brasil.

Acidentes de trabalho fatais em Palmas, Tocantins, Brasil: oportunidades perdidas de informação / Fatal work accidents in Palmas, Tocantins, Brazil: missed opportunities of information

Resumo Objetivo: estimar o sub-registro de acidentes de trabalho fatais (ATF) nos sistemas de informação do Ministério da Saúde, Secretaria Estadual de Segurança Pública (SSP), Ministério do Trabalho e Secretaria da Previdência Social, de 2007 a 2015, em Palmas, Tocantins. Métodos: para identificação dos casos de ATF, as fontes de dados foram o Sistema de Informação sobre Mortalidade (SIM), o Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS), o Sistema de Informações de Agravos de Notificação (SINAN), a Relação Anual de Informações Sociais (RAIS), o Sistema de Informação de Comunicação de Acidentes de Trabalho (SISCAT), os boletins de ocorrência (BO), Guias de Encaminhamento Cadavérico (GEC) e Laudo de Exame Cadavérico (LEC). Para calcular a subnotificação de cada sistema, uma base de dados única foi criada com os registros de todas as fontes, eliminando-se repetições. Resultados: foram identificados 114 casos. Os sub-registros encontrados foram: SIM, 28,9%; SINAN, 44,7%; SSP, 55,3%; RAIS, 73,1%; SISCAT, 65,4%, para trabalhadores segurados. Conclusão: o melhor desempenho de registro é o do SIM. Observou-se extenso sub-registro em todas as demais fontes. Registros de mortalidade por ATF são subestimados. Ações de melhoria dos registros, especialmente no SIH-SUS, RAIS, SISCAT, SSP, seguidos pelo SINAN e SIM, são necessárias.

Abstract Objective: to estimate the underreporting of fatal work accidents (FWA) in information systems of the Ministry of Health, State Secretariat of Public Security (SSP), Ministry of Labor and Social Security Secretariat, from 2007 to 2015, in Palmas, Tocantins. Methods: the data sources of the FWA cases were the Mortality Information System (SIM), the Hospital Information System of the Unified Health System (SIH-SUS), the Information System on Diseases of Compulsory Declaration (SINAN), the Annual Social Information Report (RAIS), the Information System of Communication of Work Accidents (SISCAT), police reports (PR), Cadaver Referrals (GEC) and Cadaveric Examination Reports (LEC). To calculate underreporting within each system, a single database was created with the records of all sources, eliminating repetitions. Results: 114 cases were identified. Under-reports identified were: SIM, 28.9%; SINAN, 44.7%; SSP, 55.3%; RAIS, 73.1%; SISCAT, 65.4%, for insured workers. Conclusion: the best performance in registry is from SIM. Extensive underreporting was observed in all other sources. Mortality records due to FWA are underestimated. Action to improve recording, especially at SIH-SUS, RAIS, SISCAT, and SSP, followed by SINAN and SIM, are required.

Quality of the record of data on fatal workplace injuries in Brazil.

OBJECTIVE: To evaluate the quality of the data on fatal workplace injuries in Brazil, in the Mortality Information System (SIM) and the Information System of Notifiable Diseases (SINAN-AT), analyzing the spatial and temporal distribution between 2007 and 2012. METHODS: We identified fields related to fatal workplace injuries, which were examined for completeness and the use of the "ignored" option. From the SIM, we extracted the records of deaths from external causes, which require the completing of the field about their relation with work. From the SINAN, we analyzed the field, which allows us to identify fatal cases among s severe workplace injuries. RESULTS: In the SIM, from 469,121 records, the field was left unfilled or filled as ignored in 84.2% of them; the Brazilian region with the highest proportion was the Northeast (79.1%), from which the state of Alagoas (94.4%) had the highest amount. There was a 5.5% decreasing trend between 2007 (86.6%) and 2012 (81.8%). Among the 251,681 records found in the SINAN-AT, 28.3% had unfilled or ignored responses for , varying from 39.7% in 2007 to 23.2% in 2012, a 41.6% decrease. CONCLUSIONS: The quality of the records on the fields of interest needed to identify fatal workplace injuries is poor in the SIM, but gradually improving. Recording quality was better for SINAN-AT, which has also been strongly getting better lately.

[Mesothelioma mortality in Argentina, 1980-2013]. / Mortalidad por mesotelioma en Argentina, 1980-2013.

Mesothelioma mortality and its socio-demographic and temporal patterns in Argentina from 1980 to 2013 were estimated using data from death certificates obtained from the Vital Statistics System of Argentina's National Ministry of Health. There were 3,259 mesothelioma deaths corresponding to an age-adjusted mortality of 3.1/1,000,000 in 1980 and 5.7/1,000,000 in 2013, an average increase of 84.1% in 34 years. This raising trend became clearer after 1997. Males had higher mortality estimates compared with women in every year of the series; these findings suggest past exposure to asbestos. It is plausible that the asbestos exposure was mostly occupational, which is more common among men. Actions related to reinforcing the asbestos ban already in place and strengthening health surveillance directed at workplaces, previously exposed workers, and the population in general are recommended.

Mortalidad por mesotelioma en Argentina, 1980-2013 / Mesothelioma mortality in Argentina, 1980-2013

RESUMEN Se estimó la tasa de mortalidad por mesotelioma y su distribución sociodemográfica y temporal en Argentina para el período 1980-2013 con datos del Sistema de Estadísticas Vitales del Ministerio de Salud de la Nación. Se encontraron 3.259 defunciones por mesotelioma, lo que resulta en una tasa de mortalidad estandarizada por edad de 3,1/1.000.000 en 1980 y de 5,7/1.000.000 en 2013, con un aumento promedio del 84,1% en 34 años. El incremento de la tendencia fue más claro a partir de 1997. En todos los años, la tasa de mortalidad fue mayor en hombres que en mujeres. Los resultados sugieren antecedentes de exposición al asbesto en el pasado. Aparentemente, la exposición predominante fue la ocupacional, más común entre los hombres que concentraron los casos. Se recomiendan acciones dirigidas a hacer más efectiva la prohibición ya en vigor y la vigilancia en salud orientada a los ambientes de trabajo, trabajadores previamente expuestos y la población en general.

ABSTRACT Mesothelioma mortality and its socio-demographic and temporal patterns in Argentina from 1980 to 2013 were estimated using data from death certificates obtained from the Vital Statistics System of Argentina’s National Ministry of Health. There were 3,259 mesothelioma deaths corresponding to an age-adjusted mortality of 3.1/1,000,000 in 1980 and 5.7/1,000,000 in 2013, an average increase of 84.1% in 34 years. This raising trend became clearer after 1997. Males had higher mortality estimates compared with women in every year of the series; these findings suggest past exposure to asbestos. It is plausible that the asbestos exposure was mostly occupational, which is more common among men. Actions related to reinforcing the asbestos ban already in place and strengthening health surveillance directed at workplaces, previously exposed workers, and the population in general are recommended.

Quality of the record of data on fatal workplace injuries in Brazil / Qualidade do registro de dados sobre acidentes de trabalho fatais no Brasil

ABSTRACT OBJECTIVE To evaluate the quality of the data on fatal workplace injuries in Brazil, in the Mortality Information System (SIM) and the Information System of Notifiable Diseases (SINAN-AT), analyzing the spatial and temporal distribution between 2007 and 2012. METHODS We identified fields related to fatal workplace injuries, which were examined for completeness and the use of the "ignored" option. From the SIM, we extracted the records of deaths from external causes, which require the completing of the <acidtrab> field about their relation with work. From the SINAN, we analyzed the <evolution> field, which allows us to identify fatal cases among s severe workplace injuries. RESULTS In the SIM, from 469,121 records, the <acidtrab> field was left unfilled or filled as ignored in 84.2% of them; the Brazilian region with the highest proportion was the Northeast (79.1%), from which the state of Alagoas (94.4%) had the highest amount. There was a 5.5% decreasing trend between 2007 (86.6%) and 2012 (81.8%). Among the 251,681 records found in the SINAN-AT, 28.3% had unfilled or ignored responses for <evolution>, varying from 39.7% in 2007 to 23.2% in 2012, a 41.6% decrease. CONCLUSIONS The quality of the records on the fields of interest needed to identify fatal workplace injuries is poor in the SIM, but gradually improving. Recording quality was better for SINAN-AT, which has also been strongly getting better lately.

RESUMO OBJETIVO Avaliar a qualidade do registro de dados sobre acidentes de trabalho fatais no Brasil nos Sistema de Informação sobre Mortalidade (SIM) e Sistema de Informação de Agravos de Notificação para acidentes de trabalho grave (Sinan-AT), analisando a distribuição espacial e temporal entre 2007 e 2012. MÉTODOS Identificaram -se os campos relacionados ao acidente de trabalho fatal, que foram examinados para a completude e uso da opção "ignorado". Do SIM, foram extraídos os registros de óbitos por causas externas, para os quais é requerido o preenchimento do campo <acidtrab>, sobre a relação com o trabalho. Do Sinan, analisou-se o campo <evolucao>, que permite a identificação dos casos fatais dentre os acidentes de trabalho graves. RESULTADOS No SIM, dos 469.121 registros, o campo <acidtrab> foi deixado sem preenchimento ou foi preenchido como ignorado em 84,2%, maior na região Nordeste (79,1%) e, em especial, no estado do Alagoas (94,4%). A tendência foi de queda de 5,5% entre 2007 (86,6%) e 2012 (81,8%). Para os 251.681 registros no Sinan-AT, a falta de preenchimento ou o uso de resposta ignorada no campo <evolucao> representaram, juntos, 28,3%, passando de 39,7% em 2007 para 23,2% em 2012, um declínio de 41,6%. CONCLUSÕES A qualidade do preenchimento de campos de interesse para o reconhecimento de casos de acidentes de trabalho fatais é ruim no SIM, mas vem gradualmente melhorando. No Sinan-AT, a qualidade dos registros foi melhor do que no SIM e vem melhorando acentuadamente.

[Occupational exposure to benzene in Brazil: estimates based on an occupational exposure matrix]. / Exposição ocupacional ao benzeno no Brasil: estimativas baseadas em uma matriz de exposição ocupacional.

This study estimates the number of exposed workers and the prevalence of occupational benzene exposure in Brazil. Due to the lack of available local measurements for the study, data were used from an occupational exposure matrix, the Finnish National Job-Exposure Matrix (FINJEM), which covers proportions of individuals exposed to benzene, calculated as environmental measures. In Brazil, the 2010 Demographic Census identified 86,353,839 workers in the workforce and employed. Applying the FINJEM parameters, an estimated 7,376,761 (8.5%) belonged to potentially exposed occupational groups, while 770,212 were considered exposed to benzene, corresponding to an occupational group-weighted prevalence of 0.9%, higher in men (1.1%) than in women (0.6%). Exposed individuals were concentrated in the category of Machine and Motor Operators and Mechanics (62%). The number of exposed and prevalence of occupational exposure to benzene are high, even when compared to Finnish parameters, suggesting the need for monitoring and control of this carcinogen in Brazil.

[Mortality from work-related accidents among agricultural workers in Brazil, 2000-2010]. / Mortalidade por acidentes de trabalho entre trabalhadores da agropecuária no Brasil, 2000-2010.

This study estimated annual mortality from work-related injuries in agriculture in Brazil, 2000-2010. The Mortality Information System (SIM) was used to identify cases. Missing data for occupation and work-related injuries were retrieved through other available individual records and incorporated into total cases. Population data were obtained from the official censuses. A total of 8,923 deaths from work-related injuries were identified, of which 44.8% were located by data retrieval. In the year 2000, estimated crude mortality from work-related injuries was 6.4/100,000 workers, increasing to 8.1/100,000 in 2003 and declining to 7.3/100,000 in 2010. The leading circumstances of deaths in men involved "riding animals or using animal-drawn vehicles", whereas pesticide poisoning was the leading cause in women. Overall mortality from work-related injuries in agriculture was low when compared to that of other countries, suggesting residual under-recording despite data retrieval and thus calling for quality improvement in records. Gender-sensitive preventive measures are necessary.