França Elisabeth, de Abreu Daisy Xavier, Rao Chalapati, Lopez Alan D
Programa de Pós-graduação em Saúde Pública, UFMG, Belo Horizonte, MG, Brazil.
Int J Epidemiol. 2008 Aug;37(4):891-901. doi: 10.1093/ije/dyn121.
Mortality statistics systems with reliable cause-of-death data constitute a major resource for effective health planning; however, many developing countries lack such information systems. Brazil has a long history of registering deaths, and a critical assessment of the quality of current cause-of-death statistics in its five different regions is crucial to identify strengths and weaknesses in the data, and present options for improvement.
Quality of cause-of-death data from 2002 to 2004 was evaluated using an assessment framework based on four main attributes: generalizability, reliability, validity and policy relevance. A set of nine criteria: coverage, completeness, consistency of cause patterns with general mortality levels, consistency of cause specific mortality proportions over time, content validity, proportion of ill-defined causes and non-specific codes, incorrect or improbable age or sex patterns, timeliness, and geographical disaggregation were used to assess the four attributes of data quality.
Completeness of death registration varies from 72 to 80% in the northeast regions, compared with 85-90% in the Southeast and Centre-West regions, and 94-97% in the wealthier South region. The proportion of ill-defined deaths is an important problem in reported causes of death from almost all regions. Lack of adequate evidence limits the assessment of content validity of registered causes of death. Coverage, consistency of causes with general level of mortality, consistency over time, age and sex patterns, timeliness and usability of statistics for subnational purposes were judged to be reasonable and increase confidence in using the statistics.
There is considerable heterogeneity in the quality of cause-of-death statistics across Brazilian regions, especially for criteria such as completeness and ill-defined causes. These factors can influence generalizability and validity of reported causes of death, and must be considered in the interpretation and use of data for secondary descriptive analyses such as burden of disease estimation at regional level, with suitable adjustments to account for bias. The differences identified in this study could be a useful guide for defining measures and investments needed to improve data quality in Brazil.
拥有可靠死因数据的死亡率统计系统是有效卫生规划的主要资源；然而，许多发展中国家缺乏此类信息系统。巴西有着悠久的死亡登记历史，对其五个不同地区当前死因统计数据的质量进行严格评估，对于识别数据的优势和劣势以及提出改进方案至关重要。
使用基于四个主要属性的评估框架对2002年至2004年的死因数据质量进行评估，这四个主要属性为：可推广性、可靠性、有效性和政策相关性。一组九个标准，即覆盖范围、完整性、死因模式与总体死亡率水平的一致性、特定死因死亡率比例随时间的一致性、内容有效性、定义不明确的死因和非特定编码的比例、不正确或不合理的年龄或性别模式、及时性以及地理细分，用于评估数据质量的四个属性。
东北地区的死亡登记完整性在72%至80%之间，而东南部和中西部地区为85% - 90%，较富裕的南部地区为94% - 97%。定义不明确的死亡比例在几乎所有地区报告的死因中都是一个重要问题。缺乏充分证据限制了对登记死因内容有效性的评估。统计数据的覆盖范围、死因与总体死亡率水平的一致性、随时间的一致性、年龄和性别模式、及时性以及用于次国家级目的的可用性被判定为合理，并增强了对使用这些统计数据的信心。
巴西各地区死因统计数据的质量存在相当大的异质性，尤其是在完整性和定义不明确的死因等标准方面。这些因素会影响报告死因的可推广性和有效性，在对数据进行二次描述性分析（如区域层面的疾病负担估计）的解释和使用中必须予以考虑，并进行适当调整以消除偏差。本研究中确定的差异可为确定巴西提高数据质量所需的措施和投资提供有用指导。
