Matos Sonia Gesteira E, Proietti Fernando A, Barata Rita de Cássia Barradas
Secretaria Municipal de Saude de Belo Horizonte, Belo Horizonte, MG, Brasil.
Rev Saude Publica. 2007 Feb;41(1):76-84. doi: 10.1590/s0034-89102007000100011.
To determine reliability of data encoding for death due to violence; to assess the agreement between cause of death in the Mortality Information System and cause selected from the Forensic Medicine Institute database; and to assess the impact of adding information of non-specified injuries and undetermined death events subsequently obtained from Forensic Medicine Institute in the mortality statistics due to violence.
A random sample of 411 death certificates due to violence was obtained in Belo Horizonte, Southeastern Brazil, between 1998 and 2000. Based on data from death certificates and Forensic Medicine Institute database, causes of death were coded and the agreement between this information and that from Mortality Information System was assessed. Also, in all certificates including "non-specified injury" and "undetermined death events," the impact of adding information from Forensic Medicine Institute was assessed in the classification of cause of death.
Coding agreement was significant (Kappa=0.782; 95% CI: 0.744; 0.819) and of the underlying cause was moderate to significant (Kappa=0.602; 95% CI: 0.563; 0.641). There were 12.9% and 5.7% misclassification of suicides and murders, respectively, for those causes classified as "non-specified injury" and "undetermined death events," which were overall reduced to 47.3% and 59.8% respectively.
There is a need for further improving the process of underlying cause coding and selection. Also medical examiners need to provide more complete death certificates and medical and police information provided with bodies for Forensic Medicine Institute autopsy should be more complete, especially in those cases of road traffic injuries and falls.
确定暴力致死数据编码的可靠性；评估死亡信息系统中的死因与法医学研究所数据库中所选死因之间的一致性；评估在暴力致死的死亡率统计中加入随后从法医学研究所获得的非特定损伤信息和死因不明事件信息的影响。
1998年至2000年期间，在巴西东南部的贝洛奥里藏特随机抽取了411份暴力致死的死亡证明。根据死亡证明和法医学研究所数据库的数据，对死因进行编码，并评估该信息与死亡信息系统信息之间的一致性。此外，在所有包含“非特定损伤”和“死因不明事件”的证明中，评估加入法医学研究所信息对死因分类的影响。
编码一致性显著（Kappa=0.782；95%置信区间：0.744；0.819），根本死因的一致性为中度到显著（Kappa=0.602；95%置信区间：0.563；0.641）。对于那些被归类为“非特定损伤”和“死因不明事件”的死因，自杀和谋杀的错误分类分别为12.9%和5.7%，总体上分别降至47.3%和59.8%。
需要进一步改进根本死因编码和选择过程。此外，法医需要提供更完整的死亡证明，并且提供给法医学研究所进行尸检的尸体的医疗和警方信息应该更完整，特别是在道路交通伤害和跌倒的案件中。
