Changes in the quality of cause-of-death statistics in Brazil : garbage codes among registered deaths in 1996–2016

Background: Registered causes in vital statistics classified as garbage codes (GC) are considered indicators of quality of cause-of-death data. Our aim was to describe temporal changes in this quality in Brazil, and the leading GCs according to levels assembled for the Global Burden of Disease (GBD) study. We also assessed socioeconomic differences in the burden of different levels of GCs at a regional level. Methods: We extracted data from the Brazilian Mortality Information System from 1996 to 2016. All three- and fourdigit ICD-10 codes considered GC were selected and classified into four categories, according to the GBD study proposal. GC levels 1 and 2 are the most damaging unusable codes, or major GCs. Proportionate distribution of deaths by GC levels according selected variables were performed. Age-standardized mortality rates after correction of underreporting of deaths were calculated to investigate temporal relationships as was the linear association adjusted for completeness between GC rates in states and the Sociodemographic Index (SDI) from the GBD study, for 1996–2005 and 2006–2016. We classified Brazilian states into three classes of development by applying tertiles cutoffs in the SDI state-level estimates. Results: Age-standardized mortality rates due to GCs in Brazil decreased from 1996 to 2016, particularly level 1 GCs. The most important GC groups were ill-defined causes (level 1) in 1996, and pneumonia unspecified (level 4) in 2016. At state level, there was a significant inverse association between SDI and the rate of level 1–2 GCs in 1996– 2005, but both SDI and completeness had a non-expected significant direct association with levels 3–4. In 2006– 2016, states with higher SDIs tended to have lower rates of all types of GCs. Mortality rates due to major GCs decreased in all three SDI classes in 1996–2016, but GC levels 3–4 decreased only in the high SDI category. States classified in the low or medium SDI groups were responsible for the most important decline of major GCs. Conclusion: Occurrence of major GCs are associated with socioeconomic determinants over time in Brazil. Their reduction with decreasing disparity in rates between socioeconomic groups indicates progress in reducing inequalities and strengthening cause-of-death statistics in the country

La prensa y el diseño curricular de inglés

La autora propone el estudio de la lengua inglesa en su propio contexto a través del análisis de la prensa británica. Las diferentes secciones del periódico dan cabida a multitud de actividades con el idioma y consiguen el difícil reto de resultar atrayentes a los alumnos, al mismo tiempo que aportan nuevos contenidos educativos: un vocabulario acorde con la actualidad y un comocimiento más profundo del entorno donde se desarrolla la lengua inglesa.The author proposes the study of English language in its own context through the analysis of British press. The different sections of newspapers allow multitude of activities with language, and they accomplish the difficult challenge of being attractive for students and bringing at the same time new educational contents: a vocabulary used in current English and more profound knowledge of the environment where English language is developing

MORTALIDADE POR CAUSAS GARBAGE NOS MUNICÍPIOS BRASILEIROS: DIFERENÇAS ENTRE AS ESTIMATIVAS DIRETAS E INDIRETAS EM 2015 A 2017

Objectives: the present study aims to generate estimates of mortality rates due to garbage codes (GC) for municipalities in Brazil by comparing direct and indirect methods, based on deaths registered in the Mortality Information System (SIM) between 2015 and 2017. Methods: Data from the SIM were used. The analysis was performed in groups of GC, levels 1 and 2, levels 3 and 4 and total GC. Mortality rates were estimated directly and indirectly, Empirical Bayesian Estimators. Results: about 38% of CG were estimated and regional differences in mortality rates were observed, higher in the Northeast and Southeast and lower in the South and Midwest. The Southeast presented similar rates for the two groups of CG analyzed. The smallest differences between direct and indirect estimates were observed in large cities, above 500 thousand. The municipalities in the north of Minas Gerais and the states of Rio de Janeiro, São Paulo and Bahia presented municipalities with high rates at levels 1 and 2. Conclusion: there are differences in the quality of the definition of the underlying causes of death, even with the use of indirect methodology which assists in smoothing rates. The quality of the definition of causes of death is important since they are associated with the access and quality of health services and offer subsidies for health planning.Objetivos: o presente estudo tem como objetivo gerar estimativas das taxas de mortalidade por causas garbage (CG) para os municípios do Brasil fazendo a comparação entre métodos diretos e indiretos, tendo como base os óbitos registrados no SIM entre 2015 e 2017. Métodos: Os dados do Sistema de Informações sobre Mortalidade (SIM) foram utilizados. A análise foi realizada com grupos de GC, níveis 1 e 2, níveis 3 e 4 e total de GC. As taxas de mortalidade foram estimadas de forma direta e indireta, estimadores bayesianos empíricos. Resultados: observou-se cerca de 38% de CG e diferenças regionais nas taxas de mortalidade, maiores no Nordeste e Sudeste e menores no Sul e Centro-Oeste. O Sudeste apresentou taxas semelhantes para os dois grupos de CG analisados. As menores diferenças entre as estimativas diretas e indiretas foram observadas nas grandes cidades, acima de 500 mil. Os municípios do norte de Minas Gerais e estados do Rio de Janeiro, São Paulo e Bahia apresentaram municípios com altas taxas nos níveis 1 e 2. Conclusão: existem diferenças na qualidade da definição das causas básicas de morte, mesmo com o uso de metodologia indireta que auxilia na suavização das taxas. A qualidade da definição das causas de morte é importante, uma vez que se mostram associadas com o acesso e qualidade dos serviços de saúde e oferecem subsídios para o planejamento em saúde

Proposta metodológica para redistribuição de óbitos por causas garbage nas estimativas de mortalidade para Doenças Crônicas Não Transmissíveis

Objective: to propose a method for improving mortality estimates from non-communicable chronic diseases (NCD), including the redistribution of garbage causes in the municipalities of Brazil. Methods: Information Mortality System (SIM) data was used in the three-year periods from 2010 to 2012 and 2015 to 2017, with comparison of age standardized rates before and after correction of NCDs (cardiovascular, chronic respiratory, diabetes and neoplasms). The treatment for data correction included missing data, under-registration and causes of garbage redistribution (CG). The trienniums and Bayesian method were used to estimate mortality rates by improving the fluctuation caused by small numbers at the municipal level. Results: The CG redistribution stage showed greater weight in the corrections, about 40% in 2000 and about 20% from 2007, with stabilization from this year.. Throughout the historical series, the quality of information on causes of death has improved in Brazil, with heterogeneous results being observed among the municipalities. Conclusions: methodological studies that propose the correction and improvement of the SIM are essential for monitoring the mortality rates due to NCDs at regional levels. The methodological proposal applied, for the first time in real data from Brazilian municipalities, is challenging and deserves further improvements. Despite the improvement in the data, the use of rates with raw data is not recommended, as the treatment in the data, the method used in this study for the treatment of raw data showed a great impact on the final estimates.Objetivo: propor método para melhoria das estimativas de mortalidade por doenças crônicas não transmissíveis (DCNT), incluindo a redistribuição de causas garbage nos municípios Brasileiros. Métodos: foram utilizados os dados do Sistema de Informações sobre Mortalidade (SIM) nos triênios de 2010-2012 e 2015-2017, comparadas com as taxas padronizadas por idade, antes e após correção das DCNT (cardiovasculares, respiratória crônicas, diabetes e neoplasias). O tratamento para correção dos dados abordou dados faltantes, sub-registro e redistribuição de causas garbage (CG). Foram utilizados triênios e método bayesiano para estimar as taxas de mortalidade diminuindo o efeito da flutuação provocada pelos pequenos números no nível municipal. Resultados: a etapa de redistribuição CG mostrou maior peso nas correções, cerca de 40% em 2000 e cerca de 20% a  partir de 2007, com estabilização a partir deste ano. Ao longo da série histórica a qualidade da informação sobre causas de morte melhorou no Brasil, sendo observados resultados heterogêneos nos municípios. Observou-se clusters com as maiores proporções de correção nas regiões Nordeste e Norte. O diabetes foi a causa com maior proporção de acréscimo (mais de 40% em 2000). Conclusões: estudos metodológicos que propõem correção e melhoria do SIM são essenciais para o monitoramento das taxas de mortalidade por DCNT em níveis regionais. A proposta metodológica aplicada, pela primeira vez em dados reais de municípios brasileiros, é desafiadora e merece maiores aprimoramentos. Apesar da melhora nos dados, o método utilizado neste estudo para o tratamento dos dados brutos mostrou um grande impacto nas estimativas finais

A importância da vigilância de casos e óbitos e a epidemia da COVID-19 em Belo Horizonte, 2020

Objectives: This study aims to describe the actions carried out by the epidemiological surveillance system in Belo Horizonte to address the COVID-19 epidemic and the timeless of the data for detecting transmission in 2020. Methods: The sources of information used by the epidemiological surveillance of the municipality for COVID-19 were identified and the temporal distribution and interval for detection of confirmed cases of the disease were analyzed. Results: The city's epidemiological surveillance uses outpatient, hospital, public and private laboratory notifications as data sources. For reporting COVID-19 cases in official information systems, there is also an active search of laboratory results linked to suspected deaths investigated. From January to April 2020, 1,449 hospitalized cases of COVID-19 were reported, the first case being detected in late February 2020. Of the total 1,025 laboratory samples of cases hospitalized after the 8th epidemiological week, 87 (8.5%) of COVID-19 cases were confirmed. The median time between the onset of symptoms and the release of laboratory results was 12 days for the analyzed period. Conclusion: Epidemiological surveillance uses several data sources to monitor and analyze the transmission of COVID-19. The timeliness of this system to detect cases of the disease is compromised by the delay in the release of laboratory results, which has been a considerable challenge for adequate surveillance.Objetivos: Descrever as ações realizadas pela vigilância epidemiológica da Secretaria Municipal de Saúde de Belo Horizonte para enfrentamento da epidemia de COVID-19 e avaliar a oportunidade para detecção precoce da transmissão da doença durante o período compreendido entre 1 de janeiro a 24 de abril de 2020. Métodos: Foram identificadas as fontes de informação utilizadas pela vigilância epidemiológica do município para a COVID-19 e analisadas a distribuição temporal e oportunidade para detecção dos casos confirmados da doença. Resultados: A vigilância epidemiológica do município utiliza fontes de notificações ambulatoriais, hospitalares, de laboratórios públicos e privados, além de busca ativa com cruzamento de dados laboratoriais na investigação de óbitos suspeitos, sendo os casos confirmados de COVID-19 informados em sistemas de informação oficiais. Foram notificados 1.449 casos internados, sendo o primeiro caso detectado no final de fevereiro de 2020. Do total de 1.025 amostras laboratoriais de casos internados após a semana epidemiológica 8, foram confirmados 87 casos (8,5%) por COVID-19. A mediana de tempo entre o início dos sintomas e liberação dos resultados laboratoriais foi de 12 dias. Conclusão: A vigilância epidemiológica utiliza várias fontes de dados para monitoramento e análise da transmissão da COVID-19. A oportunidade para detecção de casos da doença está comprometida pela demora na liberação dos resultados laboratoriais, sendo um desafio para a vigilância

A carga de doença devido ao diabetes e à hiperglicemia no Brasil e seus estados : achados do Global Burden of Disease Study 2015

Introduction and objective: The global burden of disease (GBD) 2015 project, extends GBD analyses to include Brazilian federative units separately. We take advantage of GBD methodological advances to describe the current burden of diabetes and hyperglycemia in Brazil. Methods: Using standard GBD 2015 methods, we analyzed the burden of diabetes, chronic kidney disease due to diabetes and high fasting plasma glucose in Brazil and its states. Results: The age-standardized rate of disability-adjusted life years (DALYs) which was lost to high fasting plasma glucose, a category which encompasses burdens of diabetes and of lesser hyperglycemia, were 2448.85 (95% UI 2165.96-2778.69) /100000 for males, and 1863.90 (95% UI 1648.18- 2123.47) /100000 for females in 2015. This rate was more than twice as great in states with highest burden, these being overwhelmingly in the northeast and north, compared with those with lowest rates. The rate of crude DALYs for high fasting plasma glucose, increased by 35% since 1990, while DALYs due to all noncommunicable diseases increased only by 12.7%, and DALYs from all causes declined by 20.5%. Discussion: The worldwide pandemic of diabetes and hyperglycemia now causes a major and growing disease burden in Brazil, especially in states with greater poverty and a lesser educational level. Conclusion: Diabetes and chronic kidney disease due to diabetes, as well as high fasting plasma glucose in general, currently constitute a major and growing public health problem in Brazil. Actions to date for their prevention and control have been slow considering the magnitude of this burden.Introdução e objetivo: O projeto Global Burden of Disease (GBD) 2015 estendeu suas análises para incluir unidades federativas brasileiras de maneira separada. Aproveitamos os avanços metodológicos do GBD para descrever a carga atual de diabetes e hiperglicemia no Brasil. Métodos: Utilizando os métodos padrão GBD 2015, analisamos a carga de diabetes, de doença renal crônica por diabetes e de glicemia de jejum elevada no Brasil e seus estados. Resultados: A taxa padronizada por idade de anos de vida ajustados por morte ou incapacidade (DALYs) perdidos devido à glicemia de jejum elevadafoi de 2448,85 (95% IU 2165,96-2778,69)/100000 para homens e 1863,90 (95% IU 1648,18-2123,47)/100.000 para as mulheres em 2015. Esta taxa foi mais do que o dobro em estados com maior carga, quase sempre no Nordeste e Norte, em comparação com aqueles com as taxas mais baixas. A taxa bruta de DALYs devido à glicose de jejum elevada aumentou 35% desde 1990, enquanto que a dos DALYs devido a todas as doenças não transmissíveis aumentou apenas 12,7% e a taxa dos DALYs devido a todas as causas diminuiu 20,5%. Discussão: A pandemia mundial de diabetes e hiperglicemia atualmente causa uma grande e crescente carga de doenças no Brasil, especialmente em estados com maior pobreza e menor escolaridade. Conclusão: O diabetes e a doença renal crônica por diabetes, bem como a glicemia de jejum elevada constituem atualmente um grande e crescente problema de saúde pública no Brasil. As ações até o momento para sua prevenção e controle tem sido tímidas considerando a magnitude dessa carga

Improvement of the unspecified external causes classification based on the investigation of death in Brazil in 2017

Introdução: Causas inespecíficas de mortalidade estão entre os indicadores tradicionais de qualidade da informação. Objetivo: Verificar o desempenho das 60 cidades do projeto Dados para a Saúde e analisar a reclassificação das causas externas inespecíficas de mortalidade (CEI). Métodos: A partir de registros de 2017 do Sistema de Informações sobre Mortalidade, comparou-se proporções e variações percentuais após investigação das CEI, entre cidades do projeto e demais cidades, e calculou-se percentual de reclassificação para causas específicas. Resultados: As cidades do projeto concentraram 52% (n = 11.759) das CEI do Brasil, das quais 64,5% foram reclassificadas após investigação, enquanto as demais cidades reclassificaram 31%. Resultados foram semelhantes para homens, jovens, negros, cidades metropolitanas, região Sudeste, e em eventos atestados por institutos forenses. Nas cidades do projeto, acidentes de pedestres foram causas com maior reclassificação. Em homens, as CEI migraram para homicídios (23,8%) e acidentes de transporte terrestre (ATT) (11,1%), com destaque para motociclistas (4,4%) e pedestres (4,3%). Em mulheres, essas causas foram alteradas para outras causas acidentais (20,8%), ATT (10,6%) e homicídios (7,9%). CEI migraram para ATT (18,3%) no grupo de idade de 0 a 14 anos, e homicídios (32,5%) no grupo de 15 a 44 anos. Conclusão: As cidades do projeto obtiveram melhores resultados após investigação de CEI, possibilitando analisar a reclassificação para causas específicas, por sexo e faixas etárias.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

Óbitos por COVID-19 no Brasil : quantos e quais estamos identificando?

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Variations and particularities in cardiovascular disease mortality in Brazil and Brazilian states in 1990 and 2015 : estimates from the Global Burden of Disease

Objetivo: Analisar as variações e os diferenciais da mortalidade por doenças cardiovasculares (DCV) no Brasil e em seus estados, em 1990 e 2015. Métodos: Foram utilizados os dados de mortalidade compilados pelo Global Burden of Disease (GBD) 2015, obtidos da base de dados do Sistema de Informação sobre Mortalidade do Ministério da Saúde. Foram realizadas a correção do sub-registro de óbitos e a reclassificação dos códigos garbage por meio de algoritmos específicos. As causas cardiovasculares foram subdivididas em 10 causas específicas. As taxas de mortalidade — dos anos 1990 e 2015 — foram padronizadas pela idade, de acordo com o sexo e o estado brasileiro. Resultados: A taxa de mortalidade por DCV padronizada por idade caiu de 429,5 (1990) para 256,0 (2015) a cada 100 mil habitantes (40,4%). A redução proporcional foi semelhante em ambos os sexos, mas as taxas em homens são substancialmente mais altas do que nas mulheres. A redução da taxa padronizada por idade foi mais acentuada para a doença cardíaca reumática (44,5%), cardiopatia isquêmica (43,9%) e doença cerebrovascular (46,0%). A queda na mortalidade diferiu marcadamente entre os estados, sendo mais acentuada nos estados das regiões Sudeste e Sul do país e no Distrito Federal, e atenuada nos estados do Norte e Nordeste. Conclusão: A mortalidade por DCV padronizada por idade reduziu no Brasil nas últimas décadas, porém de forma heterogênea entre os estados e para diferentes causas específicas. Considerando a magnitude da carga de doença e o envelhecimento da população brasileira, as políticas de enfrentamento das DCV devem ser priorizadas.Objective: To analyze variations and particularities in mortality due to cardiovascular disease (CVD) in Brazil and in Brazilian states, in 1990 and 2015. Methods: We used data compiled from the Global Burden of Disease (GBD) 2015, obtained from the database of the Mortality Information System (SIM) of the Brazilian Ministry of Health. Correction of the sub-registry of deaths and reclassification of the garbage codes were performed using specific algorithms. The cardiovascular causes were subdivided into 10 specific causes. Age-standardized CVD mortality rates — in 1990 and 2015 — were analyzed according to sex and Brazilian state. Results: Age-standardized CVD mortality rate decreased from 429.5 (1990) to 256.0 (2015) per 100,000 inhabitants (40.4%). The proportional decrease was similar in both sexes, but death rates in males were substantially higher. The reduction of age-standardized mortality rate was more significant for rheumatic heart disease (44.5%), ischemic cardiopathy (43.9%), and cerebrovascular disease (46.0%). The decline in mortality was markedly different across states, being more pronounced in those of the southeastern and southern regions and the Federal District, and more modest in most states in the north and northeast regions. Conclusion: Agestandardized CVD mortality has declined in Brazil in recent decades, but in a heterogeneous way across states and for different specific causes. Considering the burden magnitude and the Brazilian population aging, policies to prevent and manage CVD should continue to be prioritized

Cause-specific mortality for 249 causes in Brazil and states during 1990–2015 : a systematic analysis for the global burden of disease study 2015

Background: Reliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015. Methods: We describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states. Results: There was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country’s Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI. Conclusions: A widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly