Universidade de São Paulo - USP, School of Public Health, Department of Epidemiology, São Paulo, SP, Brazil.
Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Preventive and Social Dentistry, Porto Alegre, RS, Brazil.
Braz Oral Res. 2022 Oct 10;36:e0117. doi: 10.1590/1807-3107bor-2022.vol36.0117. eCollection 2022.
Less-than-optimal reliability of mortality information systems regarding the underlying cause of death can mask the reality of oral (OC) and oropharyngeal cancer (OPC) mortality. This study aimed to assess the impact on the magnitude and temporal trends of OC and OPC mortality in Brazil of two statistical approaches to redistribute deaths with ill-defined underlying causes. We analyzed deaths with ill-defined causes in Brazil by macro-region, between 1996-2018. The Mortality Information System provided official information on deaths. Two correction methods were applied: the EF method, which proportionally reallocates deaths classified as R00-R99 in the ICD-10 to the remaining specific causes of death according to the proportion of deaths with certified causes; and the GBD method, which considers the concept of garbage codes, redistributing deaths from several ICD-10 chapters according to previously established coefficients. For the trend analysis of mortality (certified and redistributed), the Prais-Winsten method was carried out. The OC and OPC death rates had an evident increase after the redistribution by the two techniques in all regions of the country; the increase was higher using the GBD method. In the Northeast and North regions, this method more than doubled the certified death rates. The redistribution methods also changed time series trends. In epidemiological studies of mortality from OC and OPC, it is necessary to redistribute deaths from ill-defined causes when analyzing data from less-than-optimal information systems. The choice of the correction method is critical; epidemiological studies must manage it as a methodological decision that has significant impacts on results.
死亡率信息系统关于根本死因的可靠性不理想，可能掩盖了口腔（OC）和口咽（OPC）癌症死亡率的真实情况。本研究旨在评估两种重新分配死因不明的死亡人数的统计方法对巴西 OC 和 OPC 死亡率的幅度和时间趋势的影响。我们分析了 1996 年至 2018 年巴西各地区死因不明的死亡人数。死亡率信息系统提供了官方的死亡信息。应用了两种校正方法：EF 方法，根据死因明确的死亡人数比例，将 ICD-10 中分类为 R00-R99 的死亡人数按比例重新分配到其余特定死因；GBD 方法，考虑到垃圾码的概念，根据事先确定的系数重新分配来自 ICD-10 多个章节的死亡人数。对于死亡率（认证和重新分配）的趋势分析，采用了 Prais-Winsten 方法。在两种技术重新分配后，OC 和 OPC 的死亡率在该国所有地区都明显增加；使用 GBD 方法增加幅度更高。在东北和北部地区，该方法使认证死亡率增加了一倍以上。重新分配方法也改变了时间序列趋势。在 OC 和 OPC 死亡率的流行病学研究中，当分析信息系统不理想的数据时，有必要重新分配死因不明的死亡人数。校正方法的选择至关重要；流行病学研究必须将其作为对结果有重大影响的方法学决策进行管理。
