Lenice Harumi Ishitani

Desigualdade social e mortalidade precoce por doenças cardiovasculares no Brasil

OBJETIVO: Investigar associacao entre alguns indicadores de nivel socioeconomico e mortalidade de adultos por doencas cardiovasculares no Brasil. METODOS: Foram analisados os obitos de adultos (35 a 64 anos), ocorridos entre 1999 a 2001, por doencas cardiovasculares, e pelos subgrupos das doencas isquemicas do coracao e doencas cerebrovasculares-hipertensivas, obtidos no Sistema de Informacao sobre Mortalidade. Foram selecionados para analise 98 municipios brasileiros, com melhor qualidade de informacao. Para analisar a associacao entre indicadores socioeconomicos e a mortalidade por doencas cardiovasculares, foi utilizada a regressao linear simples e multipla. RESULTADOS: Na analise univariada, verificou-se associacao negativa para a mortalidade por doencas cardiovasculares e o subgrupo das cerebrovasculares-hipertensivas com renda e escolaridade, e associacao direta com taxa de pobreza e condicoes precarias de moradia. Quanto as doencas isquemicas, houve associacao inversa com taxa de pobreza e escolaridade, e direta com condicoes precarias de moradia. A escolaridade, apos ajuste pelo modelo de regressao linear multipla, permaneceu associada a mortalidade pela doenca investigada e seus subgrupos. A cada ponto percentual de aumento na proporcao de adultos com alta escolaridade, a taxa de mortalidade por doencas cardiovasculares diminui em 3,25 por 100.000 habitantes. CONCLUSOES: A analise da mortalidade dos municipios mostrou que a associacao entre doencas cardiovasculares e fatores socioeconomicos e inversa, destacando-se a escolaridade. E provavel que melhor escolaridade possibilite melhores condicoes de vida e, consequentemente, impacto positivo na mortalidade precoce.

[Multiple causes of death due to non-communicable diseases: a multidimensional analysis]

This study approaches multiple causes of death to analyze the associations between causes of death from non-communicable diseases, age, and gender in 3,106 death certificates issued in 1998, comprising individuals who were 20 years old or over and resided in Belo Horizonte, Minas Gerais State, Brazil. The multiple cause of death approach, by considering all the diagnoses mentioned in the death certificate, highlights conditions that are underestimated by the underlying-cause approach that has traditionally been used in mortality statistics. Association of causes of death was analyzed using the multidimensional data analysis method with the multiple correspondence factor analysis technique. The results reinforce the usefulness of the multiple causes approach to improve information on mortality and demonstrate important associations, such as hypertension and cerebrovascular diseases, obesity and diabetes or ischemic heart diseases, allowing to plan, prioritize, and reevaluate health actions.

Ill-defined causes of death in Brazil: a redistribution method based on the investigation of such causes

OBJECTIVE To propose a method of redistributing ill-defined causes of death (IDCD) based on the investigation of such causes. METHODS In 2010, an evaluation of the results of investigating the causes of death classified as IDCD in accordance with chapter 18 of the International Classification of Diseases (ICD-10) by the Mortality Information System was performed. The redistribution coefficients were calculated according to the proportional distribution of ill-defined causes reclassified after investigation in any chapter of the ICD-10, except for chapter 18, and used to redistribute the ill-defined causes not investigated and remaining by sex and age. The IDCD redistribution coefficient was compared with two usual methods of redistribution: a) Total redistribution coefficient, based on the proportional distribution of all the defined causes originally notified and b) Non-external redistribution coefficient, similar to the previous, but excluding external causes. RESULTS Of the 97,314 deaths by ill-defined causes reported in 2010, 30.3% were investigated, and 65.5% of those were reclassified as defined causes after the investigation. Endocrine diseases, mental disorders, and maternal causes had a higher representation among the reclassified ill-defined causes, contrary to infectious diseases, neoplasms, and genitourinary diseases, with higher proportions among the defined causes reported. External causes represented 9.3% of the ill-defined causes reclassified. The correction of mortality rates by the total redistribution coefficient and non-external redistribution coefficient increased the magnitude of the rates by a relatively similar factor for most causes, contrary to the IDCD redistribution coefficient that corrected the different causes of death with differentiated weights. CONCLUSIONS The proportional distribution of causes among the ill-defined causes reclassified after investigation was not similar to the original distribution of defined causes. Therefore, the redistribution of the remaining ill-defined causes based on the investigation allows for more appropriate estimates of the mortality risk due to specific causes.OBJECTIVE To propose a method of redistributing ill-defined causes of death (IDCD) based on the investigation of such causes. METHODS In 2010, an evaluation of the results of investigating the causes of death classified as IDCD in accordance with chapter 18 of the International Classification of Diseases (ICD-10) by the Mortality Information System was performed. The redistribution coefficients were calculated according to the proportional distribution of ill-defined causes reclassified after investigation in any chapter of the ICD-10, except for chapter 18, and used to redistribute the ill-defined causes not investigated and remaining by sex and age. The IDCD redistribution coefficient was compared with two usual methods of redistribution: a) Total redistribution coefficient, based on the proportional distribution of all the defined causes originally notified and b) Non-external redistribution coefficient, similar to the previous, but excluding external causes. RESULTS Of the 97,314 deaths by ill-defined causes reported in 2010, 30.3% were investigated, and 65.5% of those were reclassified as defined causes after the investigation. Endocrine diseases, mental disorders, and maternal causes had a higher representation among the reclassified ill-defined causes, contrary to infectious diseases, neoplasms, and genitourinary diseases, with higher proportions among the defined causes reported. External causes represented 9.3% of the ill-defined causes reclassified. The correction of mortality rates by the total redistribution coefficient and non-external redistribution coefficient increased the magnitude of the rates by a relatively similar factor for most causes, contrary to the IDCD redistribution coefficient that corrected the different causes of death with differentiated weights. CONCLUSIONS The proportional distribution of causes among the ill-defined causes reclassified after investigation was not similar to the original distribution of defined causes. Therefore, the redistribution of the remaining ill-defined causes based on the investigation allows for more appropriate estimates of the mortality risk due to specific causes.

Uso das causas múltiplas de morte em saúde pública

Informe Epidemiologico do SUS 2001; 10(4) : 163 175. Resumo As estatisticas de mortalidade tem empregado, tradicionalmente, o conceito de causa basica de morte. Atualmente, entretanto, com o aumento da expectativa de vida e importância das doencas cronico-degenerativas como causas de obito, um maior numero de diagnosticos tem sido informados nas declaracoes de obito. Para evitar a perda de informacoes relativas as afeccoes que nao sao selecionadas como causa basica de morte, uma proposta alternativa e a utilizacao do enfoque de causas multiplas. Este enfoque retrataria melhor a magnitude de patologias frequentemente mencionadas como causas associadas de morte, contribuindo para o melhor conhecimento de importantes problemas de saude publica e oferecendo subsidios para o planejamento e a avaliacao dos programas de saude. Dessa forma, algumas vantagens e limitacoes relacionadas a utilizacao do enfoque de causas multiplas de morte sao apresentadas.

Mortality of malnourished elderly in Belo Horizonte, Minas Gerais State, Brazil: a multidimensional analysis focusing on multiple causes of death

This study aimed to identify the mortality profiles of elderly individuals with malnutrition, based on associations between multiple causes of death and other variables recorded on the death certificate. We studied the deaths of elderly (> 60 years) living in Belo Horizonte, Minas Gerais State, Brazil, with malnutrition recorded as one of the causes. Data were used from the mortality information system. Multiple correspondence analysis was used to investigate these associations. The study showed excess mortality among women, whites, widowers, and individuals with low schooling. Ten mortality profiles were studied, and malnutrition was five times more frequent according to the multiple-causes technique. The results showed both the importance of multiple causes of death not detected by focusing on the underlying cause and the adequacy of multiple correspondence analysis for identifying the associations between causes and other variables listed on the death certificate.

Principais causas de óbitos infantis pós-neonatais em Belo Horizonte, Minas Gerais, Brasil, 1996 a 2004

OBJECTIVES: to analyze the evolution of the leading causes of post-neonatal mortality by underlying cause of death in the city of Belo Horizonte, Minas Gerais Brazil, between 1996 and 2004. METHODS: causes of death were grouped according to the chapters of the International Statistical Classification of Diseases and Related Health Problems, 10th review (ICD-10) and an abbreviated ICD-10 list. Diarrhea, pneumonia, malnutrition and septicemia were analyzed in a specific group for avoidable causes. Rates and proportional mortality by cause were calculated for three-year periods. RESULTS: 2,010 post-neonatal deaths were registered in the period, and the tendency was for the number to decrease. Infant mortality rate dropped from 26.6 to 13.3/1000 live births (LB), and post-neonatal from 8.6 to 4.3/1000 LB between 1996 and 2004. Mortality rates from both respiratory and infectious diseases were down 60%. However, the diarrhea-pneumonia-malnutrition-septicemia group was still responsible for a quarter of all deaths in 2002-2004. Congenital malformations have become the leading post-neonatal cause of death, along with perinatal conditions, responsible for 34% of deaths. In addition, an increase in the proportion of mortality accounted for by injuries and ill-defined causes was observed. CONCLUSIONS: a change was observed in the profile of the causes of post-neonatal mortality in Belo Horizonte, with an increase in the risk of death from congenital anomalies and perinatal conditions. This increase may be a consequence of displacement of neonatal deaths to the postneonatal component.

Utilização da imprensa escrita na qualificação das causas externas de morte

OBJETIVO: Complementar a informacao sobre a causa basica de morte em obitos por causas externas com uso de noticias veiculadas em jornais. METODOS: Estudo de investigacao de 153 obitos por causas externas ocorridas em residentes de Belo Horizonte, MG, em 2008. Construiu-se o banco de dados denominado imprensa, com informacoes de jornais de grande circulacao nacional e estadual, o qual foi relacionado ao banco de dados do Sistema de Informacoes de Mortalidade. Os dados foram analisados nos programas EpiInfo e o Link-plus. A concordância dos resultados foi avaliada pelo coeficiente kappa. RESULTADOS: Foram localizadas 1.530 noticias sobre acidentes e violencias, 201 das quais foram pareadas as declaracoes de obito do banco do Sistema de Informacoes de Mortalidade e 153 noticias eram de residentes de Belo Horizonte. As principais causas de morte identificadas nos bancos foram agressoes e acidentes de transporte. No banco imprensa, agressoes e acidentes de transporte corresponderam a 86,3%, outros acidentes 7,8%, eventos de intencao indeterminada 4,6%, e casos de intervencao legal 1,3%. Apos a complementacao com o banco imprensa houve aumento nos obitos por acidentes de automoveis (220,0%) e motos (100,0%), o que resultou em diminuicao do numero de obitos por causa indeterminada e por acidentes de transporte nao especificados notificados no Sistema de Informacoes de Mortalidade. CONCLUSOES: Noticias de jornais tem grande potencial para qualificar e complementar a causa basica de morte em obitos por causas externas no Sistema de Informacoes de Mortalidade, principalmente daqueles por acidentes de transporte.

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.

Fatores de risco relacionados à carga global de doença do Brasil e Unidades Federadas, 2015

Objective: To analyze the global burden of disease related to disability adjusted life years (DALYs) attributed to selected risk factors in Brazil and its 27 Federated Units. Methods: Databases from the Global Burden of Disease study in Brazil and its Federated Units were used, estimating the summary exposure value (SEV) for selected environmental, behavioral, and metabolic risk factors (RFs), and their combinations. The DALYs were used as the main metric. The ranking of major RFs between 1990 and 2015 was compiled, comparing data by sex and states. Results: The analyzed RFs account for 38.8% of the loss of DALYs in the country. Dietary risks was the main cause of DALYs in 2015. In men, dietary risks contributed to 12.2% of DALYs and in women, to 11.1%. Other RFs were high systolic blood pressure, high body mass index, smoking, high fasting plasma glucose and, among men, alcohol and drug use. The main RFs were metabolic and behavioral. In most states, dietary risks was the main RF, followed by high blood pressure. Conclusion: Dietary risks leads the RF ranking for Brazil and its Federated Units. Men are more exposed to behavioral risk factors, and women are more exposed to metabolic ones.RESUMO: Objetivo: Analisar a carga global de doenca, quanto aos anos de vida ajustados por incapacidade (disability adjusted life years - DALYs) atribuidos a fatores de risco (FRs) selecionados, para Brasil e 27 Unidades Federadas (UFs). Metodos: Foram utilizadas bases de dados do estudo Carga Global de Doenca (Global Burden of Disease - GBD) para Brasil e UFs estimando a sintese de exposicao de risco (summary exposure value - SEV) para FRs selecionados, incluindo os ambientais, comportamentais, metabolicos e suas combinacoes. Os DALYs foram usados como metrica principal do estudo. Construiu-se o ranking dos principais FRs entre 1990 e 2015, com comparacoes por sexo e UF. Resultados: Os FRs analisados explicariam 38,8% da perda de DALYs no pais. A dieta inadequada foi a principal causa de DALYs em 2015. Em homens, a dieta inadequada contribuiu com 12,2% dos DALYs, e, em mulheres, com 11,1% deles. Outros FRs importantes foram: pressao arterial sistolica elevada, indice de massa corporal (IMC) elevado, tabagismo, glicose serica elevada; entre homens, destaca-se o uso de alcool e drogas. Os principais FRs foram metabolicos e comportamentais. Na maioria das UFs, predominou a dieta inadequada, seguida da pressao arterial elevada. Conclusao: A dieta inadequada lidera o ranking de FRs para Brasil e UF. Os homens estao mais expostos aos FRs comportamentais, e as mulheres, aos metabolicos.

Óbitos infantis evitáveis em Belo Horizonte: análise de concordância da causa básica, 2010-2011

Objectives: to examine the profile of avoidable infant deaths investigated and produce a concordance between the basic cause declared on the original death certificate (DO) and the one produced after investigation. Methods: a population-based study examining infant deaths and avoidable deaths investigated by the Belo Horizonte Death Prevention Committee (CMPOFI), in 2010 and 2011. The death certificate issued after investigation was based on analysis of data from outpatient centers, hospitals and households conducted by the CMPOFI. The causes of death were codified according to the 10th edition of the International Statistical Classification of Diseases and Problems Related to Health and the basic cause selected. The concordance between the basic cause of death on the original death certificate and on the one produced after investigation, analyzed according to the reduced list tabulating the causes of infant mortality (LIR-MI), was determined using the Kappa index. Results: the Kappa index was weak (K=0.389; CI95%: 0.192-5.76) when evaluated using the LIR-MI groups. There were significant changes in the cause of death after investigation, with an increase in the proportion of deaths from asphyxia, maternal factors, child infections, perinatal infections, external causes and sudden infant death syndrome. Conclusions: the investigation of deaths shed greater light on the circumstances of avoidable infant deaths and the classification of the basic cause, which are fundamental steps in guiding action to prevent such deaths.