Bernardo Lanza Queiroz

Evolution of the deaths registry system in Brazil: associations with changes in the mortality profile, under-registration of death counts, and ill-defined causes of death

This paper examines the spatial pattern of ill-defined causes of death across Brazilian regions, and its relationship with the evolution of completeness of the deaths registry and changes in the mortality age profile. We make use of the Brazilian Health Informatics Department mortality database and population censuses from 1980 to 2010. We applied demographic methods to evaluate the quality of mortality data for 137 small areas and correct for under-registration of death counts when necessary. The second part of the analysis uses linear regression models to investigate the relationship between, on the one hand, changes in death counts coverage and age profile of mortality, and on the other, changes in the reporting of ill-defined causes of death. The completeness of death counts coverage increases from about 80% in 1980-1991 to over 95% in 2000-2010 at the same time the percentage of ill-defined causes of deaths reduced about 53% in the country. The analysis suggests that the governments efforts to improve data quality are proving successful, and they will allow for a better understanding of the dynamics of health and the mortality transition.

Estimating pregnancy-related mortality from census data: experience in Latin America

OBJECTIVE To assess the feasibility of measuring maternal mortality in countries lacking accurate birth and death registration through national population censuses by a detailed evaluation of such data for three Latin American countries. METHODS We used established demographic techniques, including the general growth balance method, to evaluate the completeness and coverage of the household death data obtained through population censuses. We also compared parity to cumulative fertility data to evaluate the coverage of recent household births. After evaluating the data and adjusting it as necessary, we calculated pregnancy-related mortality ratios (PRMRs) per 100 000 live births and used them to estimate maternal mortality. FINDINGS The PRMRs for Honduras (2001), Nicaragua (2005) and Paraguay (2002) were 168, 95 and 178 per 100 000 live births, respectively. Surprisingly, evaluation of the data for Nicaragua and Paraguay showed overreporting of adult deaths, so a downward adjustment of 20% to 30% was required. In Honduras, the number of adult female deaths required substantial upward adjustment. The number of live births needed minimal adjustment. The adjusted PRMR estimates are broadly consistent with existing estimates of maternal mortality from various data sources, though the comparison varies by source. CONCLUSION Census data can be used to measure pregnancy-related mortality as a proxy for maternal mortality in countries with poor death registration. However, because our data were obtained from countries with reasonably good statistical systems and literate populations, we cannot be certain the methods employed in the study will be equally useful in more challenging environments. Our data evaluation and adjustment methods worked, but with considerable uncertainty. Ways of quantifying this uncertainty are needed.

The determinants of male retirement in urban Brazil

I use matched and unmatched PME data to study the determinants of males retirement over the past two decades. The PME is a very rich source of data, although not very used. The matched data consists of a series of short panel data constructed by matching individual records across adjacent years of the PME. Some patterns I find are not surprising. For example, probability of being retired increases monotonically with age, and the strong dependence of labor transition on other individual characteristics such as education. Some other patterns are more interesting and surprising. The labor force participation rates of older workers in the main metropolitan areas are lower than what is observed in the rest of the country. The main explanation is that workers in the main metropolitan areas had earlier enrollment into the system and they also have better access to early retirement benefits. I also observed an inverse U-shaped relation between education and retirement. Less and more educated workers have similar retirement patterns during the period studied. Last, I find that more educated workers, and those in the formal sector, have higher retirement probabilities than less educated and those in the informal labor market.

Adjusting the general growth balance method for migration

Death distribution methods proposed for death registration coverage by comparison with census age distributions assume no net migration. This assumption makes it problematic to apply these methods to sub-national and national populations affected by substantial net migration. In this paper, we propose and explore a two-step process in which the Growth Balance Equation is first used to estimate net migration rates, using a model of age-specific migration, and then it is used to compare the observed death rates over successive ages against residual estimates made up by the entry rate plus the net migration rate minus the growth rate. This methodology is predicated on the observation that migration rates have a very different age pattern from death rates; it is only when this condition is true that net migration and deaths can be distinguished. The procedure proposed here works reasonably well in populations that generally have good data and rather high net migration rates. There is no reason to prefer the revised migration model over the original Rogers-Castro formulation.Death distribution methods proposed for death registration coverage by comparison with census age distributions assume no net migration. This assumption makes it problematic to apply these methods to sub-national and national populations affected by substantial net migration. In this paper, we propose and explore a two-step process in which the Growth Balance Equation is first used to estimate net migration rates, using a model of age-specific migration, and then it is used to compare the observed death rates over successive ages against residual estimates made up by the entry rate plus the net migration rate minus the growth rate. This methodology is predicated on the observation that migration rates have a very different age pattern from death rates; it is only when this condition is true that net migration and deaths can be distinguished. The procedure proposed here works reasonably well in populations that generally have good data and rather high net migration rates. There is no reason to prefer the revised migration model over the original Rogers-Castro formulation.

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

BackgroundReliable 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.MethodsWe describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states.ResultsThere 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.ConclusionsA 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.

O que os dados de mortalidade do Censo de 2010 podem nos dizer

The Brazilian Census of 2010 included in its survey a question on the deaths occurring in the household in the past 12 months. Previously, a similar question was included in the sample of the 1980 census, but has been rarely used. The aim of this paper is to evaluate the quality of mortality data from the Census, especially in regards to mortality age structure. The coverage of deaths went from 40% in 1980 Census to 80% in 2010 Census. The results show that, in Brazil, the quality of information is quite high both in level and in the pattern of mortality curves obtained. A more important restriction exists for groups of more advanced age.

A relação entre parturição e trabalho feminino no Brasil

The objective here is to analyze the effect of having children on women’s share in the economically active population, observing the temporal evolution of this effect during the 1990s. In addition, based on the fact that each child may exert a different effect on a mother’s decision to work or not, the effect of the first, the second and the third (or more) children on this woman’s share in the economically active population were estimated. In general the findings suggest that, regardless of order of birth, children reduce the likelihood of women to participate in the labor market. Also, during the 1990s and the decade of 2000 the negative effect of the first and second children on women’s share in the labor market fell in impact, whereas the effect of a third child took on some importance.

Estimativas do grau de cobertura e da mortalidade adulta (45q15) para as unidades da federação no Brasil entre 1980 e 2010

Objective: Assess the completeness of the DataSUS SIM death-count registry, by sex and Brazilian state, and estimate the probability of adult mortality (45q15), by sex and state, from 1980 to 2010. Methods: The study was based on mortality data obtained in the DataSUS Mortality Information System, from 1980 to 2010, and on population data from the 1980, 1991, 2000, and 2010 demographic censuses. The quality assessment of the registry data was conducted using traditional demographic and death distribution methods, and death probabilities were calculated using life-table concepts. Results: The results show a considerable improvement in the completeness of the death-count coverage in Brazil since 1980. In the southeast and south, we observed the complete coverage of the adult mortality registry, which did not occur in the previous decade. In the northeast and north, there were still places with a low coverage from 2000 to 2010, although there was a clear improvement in the quality of data. For all Brazilian states, there was a decline in the probability of adult mortality; we observed, however, that the death probability for males is much higher than that for females throughout the whole analysis period. Conclusion: The observed improvements seem to be related to investments in the public health care system and administrative procedures to improve the recording of vital events.

Transferências intergeracionais privadas na Amazônia rural brasileira

What motivates family members to share resources? Past research argues for, on the one hand, love and altruism, and on the other, the expectation of reciprocity. Drawing on this literature, this paper examines intergenerational transfers between small farmers and their non-coresident children in the rural area around the city of Altamira, Pará, Brazil. We apply GoM (Grade of Membership) models to create profiles of private transfers, using data collected in 2005 by a team from Indiana University. The results show three profiles: low intergenerational transfers, high levels of transfers of visits and help, and high levels of transfers of visits and money. There is no clear difference in profile by birth order, but we do find sex differences in profile. Men are more likely to send money while women provide time transfers (work and visits). Upward transfers are most common from children with high levels of education or living in urban areas, suggesting a repayment of prior investments made by parents. Thus, our empirical evidence supports theories arguing that transfers are motivated by intertemporal contracts between parents and children, and that altruistic theories of family transfers should be rethought among rural agricultural populations in contexts characterized by many environmental and institutional challenges.

Sustaining ecosystem services : overcoming the dilemma posed by local actions and planetary boundaries

Resolving challenges related to the sustainability of natural capital and ecosystem services is an urgent issue. No roadmap on reaching sustainability exists; and the kind of sustainable land use required in a world that acknowledges both multiple environmental boundaries and local human well-being presents a quandary. In this commentary, we argue that a new globally consistent and expandable systems-analytical framework is needed to guide and facilitate decision making on sustainability from the planetary to the local level, and vice versa. This framework would strive to link a multitude of Earth system processes and targets; it would give preference to systemic insight over data complexity through being highly explicit in spatiotemporal terms. Its strength would lie in its ability to help scientists uncover and explore potential, and even unexpected, interactions between Earths subsystems with planetary environmental boundaries and socioeconomic constraints coming into play. Equally importantly, such a framework would allow countries such as Brazil, a case study in this commentary, to understand domestic or even local sustainability measures within a global perspective and to optimize them accordingly.