Mortality information and situation in the americas

Mortality Information System

Fatima Marinho, MD, MPH, PhDHealth and Analysis (HSD/HA)

Pan American Health Organization (PAHO/WHO)

Topics

• Sources and data base

• Quality of death information in The Americas % under-registration, % ill defined,

% garbage codes

• Distribution major causes of death

• Examples of data quality problems

• Challenges

Sources

• National Offices of Statistics• Mexico, Ecuador, El Salvador, Peru

• Civil Registration offices• Costa Rica, Argentina, Chile

• Ministry of Health• Republica Dominicana, Brazil, Colombia

Main Variables/Annual data request to the countries *

•Deaths: Individual data on each death, with the following specifications:•Sex•Underlying cause of death•Age (in hours for the first day, in days for the first month, in months for the first year, and complete years after one year of age)•Other available causes

*Since 2009 this extensive set has been requested

Major civil division of residence of the decedent•Certification of the cause (s) of death: physician or nonmedical•Educational attainment of decedent (instruction or education level) •Ethnicity of the decedent•Place of occurrence of the death (hospital, residence, public thoroughfare, etc)•Date of death

Seasonality of Respiratory Deaths

Why evaluate data quality?Why evaluate data quality?

• Accuracy of the information for policy• Availability of the data doesn’t guarantee

quality• The source per se is not a guarantee of

quality, for example, hospital statistics • Poor quality of the data poor decision

lost of opportunity to identify problems and intervention in order to improve the population health

Challenges for using mortality data

• Incomplete series of data registries• Poor certification of cause of death• Poor availability and opportunity of the data• Poor use of the data• Poor value of cause of death codification • There is a tendency to codify the cause of death

according what is expected to be more frequent• Late registration of death

Total defunciones

• En 2007 hubo un total de 5 736 164* defunciones en los 32 países de la Región de las Américas con datos para ese año (53,1% hombres y 46,9% mujeres).

• La tasa de mortalidad ajustada por edad para la población total fue 5,8 por 1 000 habitantes (7,1 por 1 000 en hombres y 4,7 por 1 000 en mujeres).

*Dato corregido para subregistro

La mortalidad captada fue de 5 085 260

USA responde por mitad de las defunciones captadas

Percentage of years

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

CanadaUnited States of America

ChileMexico

Trinidad and TobagoCosta Rica

BarbadosPuerto Rico

VenezuelaColombia

PanamaEcuador

El SalvadorGuatemala

UruguayDominica

Dominican RepublicParaguay

Saint Kitts and NevisCuba

BelizeBermudaSurinameArgentina

Antigua and BarbudaSaint LuciaNicaragua

PeruBritish Virgin Islands

BrazilBahamas

Saint Vincent andTurks and Caicos Islands

Cayman IslandsGuyana

JamaicaMontserrat

AnguillaGrenada

HondurasFrench Guiana

GuadeloupeVirgin Islands (USA)

MartiniqueNetherlands Antilles

ArubaHaiti

Bolivia

Source: PAHO/WHO. Mortality Information System; Washington DC:2011

0

5

10

15

20

25

30

35

40

45

50

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

CIE-7 CIE-8

CIE-9 CIE-10

Timeliness1950-2010

Number of countries in The Region with mortality data by cause, 1950-2010

Under- registration %completeness


45/48 Countries and Territories in the

Americas have a Vital Statistics System working

% ill-defined causes of death Subregion


circa 2009

% ill-defined causes of death by country

circa 2009


% ill-defined causes of death Selected countries, 2000-2009

0.0

5.0

10.0

15.0

20.0

25.0

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Cuba

Estados Unidos de América

México

Colombia

Chile

Nicaragua

Panamá

Brasil

Paraguay

El Salvador


2005 2006 2007 2008 2009

% % % % %

Other ill-defined and unspecified causes of mortality (R99)

40.4 41.6 42.5 45.3 46.5

Unattended death (R98) 26.5 20.7 17.9 21.8 20.3

Senility (R54) 9.3 10.7 10.3 9.6 8.5

Other symptoms and signs involving the circulatory and respiratory systems (R09)

8.2 7.1 7.1 6.9 7.6

Other sudden death, cause unknown(R96)

2.7 2.6 3.3 3.8 4.2

Remainder 11.2 15.3 16.9 12.6 12.3

Number of deaths 196919

175695

179553

143577

137622

% ill-defined causes of deathAmericas 2005-2009


% ill-defined causes of deathBrazil 2005-2009

2005 2006 2007 2008 2009

% % % % %


35.9 41.6 42.0 44.1 43.8



9.4 8.7 8.8 7.5 8.9

Senility (R54) 2.6 4.1 4.3 4.3 4.7

Other general symptoms and signs(R68)

1.7 3.3 3.7 3.3 3.3

Remainder 2.2 3.3 3.5 3.5 3.6

Number of deaths 104455

85543 80244 79784 78994


% ill-defined causes of deathCuba 2005-2009

2005 2006 2007 2008 2009

% % % % %


45.8 54.0 49.8 44.2 40.6

Senility (R54) 18.2 17.6 19.3 24.1 23.1

Other sudden death, cause unknown(R96)

19.2 15.2 14.2 13.5 16.8


Other general symptoms and signs(R68)

4.6 4.7 3.9 3.5 3.0

Remainder 6.4 4.7 4.7 5.9 8.1

Number of deaths 637 635 643 764 794


% ill-defined causes of deathPeru 2003-2007

2005 2006 2007 2008 2009

% % % % %


27.6 44.6 77.8 78.1 74.6

Senility (R54) 18.3 8.9 0.0 0.0 0.0


11.4 19.5 0.0 0.0 0.0

Shock, not elsewhere classified (R57) 10.8 5.1 0.0 0.0 1.6


Remainder 27.5 14.0 22.2 13.7 12.2

Number of deaths 2149 1814 18 630 189


% under-registration and % ill-defined causes of death Americas, 2007-2009

Source: Health situation in the Americas – Basic Indicators 2011

Nicaragua

JamaicaCayman Islands

Americas

In the Second Annual Report of the Registrar General of Great Britain in 1840, William Farr presented the statistics of causes of death (CoD), defined as:

“diseases, which terminate in the extinction of existence,” but Farr highlighted the concern that “…the attention of the observer was less attracted to this class of facts, and overlooking the proximate cause, that is, the internal morbid process…”

In that report, he also criticized the use of vague categories like “sudden death,” “natural death,” “visitation of God,” and “old age,” but he admitted that in some cases, no particular cause of death could be identified

All these criticisms remain relevant today

Causes of death?

Even with a physician-completed death certificate, assignment of the underlying cause of death can be problematic

Underlying cause of death (ICD)a) the disease or injury which initiated the train of morbid

events leading directly to death or

a) b) the circumstances of the accident or violence which produced the fatal injury”

The most effective public health objective is to prevent the precipitating from operating

From the stand point of prevention of death is necessary to break the chain of events or to effect a cure at some point

many deaths assigned to causes that cannot or should not be considered underlying causes of death

“often called garbage codes (GCs)”

In 1996, Murray and Lopez introduced the term “garbage coding” for the practice of assigning deaths to causes that are not useful for public health analysis of cause-of-deathdata as part of the assessment of the Global Burden of Disease (GBD)

Typology of Garbage Codes

Four categories were identified:

1.Causes that cannot or should not be considered as underlying causes of death (Type 1)

chapter 18 of ICD-10 or R codes essential primary hypertension and atherosclerosis. causes that are described as the long-term sequelae of disease, such as paraplegia and tetraplegia

2. Intermediate causes of death (Type 2): heart failure, septicemia, peritonitis, osteomyelitis, or pulmonary embolism.

3. Immediate causes of death (Type 3): final steps in a disease pathway leading to death. disseminated intravascular coagulation or defibrination syndrome . Cardiac arrest and respiratory failure

4. Unspecified causes (Type 4): injuries are coded to unspecified factors or intent

Source: Algorithms for enhancing public health utility of nationalcauses of death data IHME

•the likelihood that a condition can be an underlying cause of death

•the need for codes that provide a location for unspecified or ambiguous causes of death

•the need for codes that represent causes that are not underlying but intermediate or final events in the chain leading to death

This typology has been developed taking into consideration the following:


Garbage Codes Subregion and country



0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0%

VIRCUBCRI

COLCHLSURTTOJAMMEXBMUVENUSAKNABRABLZNICTCABHSPRYPANGUY

AIAECUPRI

DOMURYCYMATGBRBABWLCA

GRDSLV

MSRVCTGTMVGBARG


circa 2009

12%

6%

59%

23%

Type 1 Causes that cannot or should not be considered as ucd

Type 3 Immediate

Type 2 Intermediate

Type 4 Unspecified causes

Causes %

Heart failure (I50) 19.0

Other sepsis (A41) 9.6

Essential (primary) hypertension (I10)

6.7

Chronic kidney disease (N18)

6.0

Malignant neoplasm, without specification of site (C80)

5.7

Exposure to unspecified factor (X59)

3.7

Unspecified kidney failure (N19)

3.5

Pneumonitis due to solids and liquids (J69)

3.1

Other diseases of digestive system (K92)

2.9

Cardiac arrest (I46) 2.7

Remainder 39.3

• Intermediate causes are the most important gc (60%)


Type 1 Causes that cannot or should not be considered as ucd

%

Essential (primary) hypertension (I10)

57.7

Atherosclerosis (I70) 15.9

Cerebral palsy (G80) 5.3

Hyperplasia of prostate (N40)

2.8

Remainder 18.3

Type 2 Intermediate causes

%

Heart failure (I50) 31.9

Other sepsis (A41) 16.1

Chronic kidney disease (N18)

10.1

Unspecified kidney failure (N19)

5.8

Remainder 36.1


Type 3 Immediate causes of death

%

Respiratory failure, not elsewhere classified (J96)

50.1

Cardiac arrest (I46) 45.1

Disseminated intravascular coagulation [defibrination syndrome] (D65)

2.8

Remainder 1.9

Type 4 Unspecified causes %

Malignant neoplasm, without specification of site (C80)

24.9

Exposure to unspecified factor (X59)

16.2

Complications and ill-defined descriptions of heart disease (I51)

12.8

Unspecified event, undetermined intent (Y34)

6.9

Remainder 39.3


Cause of death and Epidemiologic transition in the

Region

Estados Unidos

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

1950

1952

1954

1956

1958

1960

1962

1964

1966

1968

1970

1972

1974

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

Group I Communicable Group II Non communicable Group III Injuries Ill defined

Transición Epidemiológica en EU

Fuente: Sistema de inforamción de Mortaldiad HA/HSD/OPS

0

10

20

30

40

50

60

70

80

90

100

1930 1940 1950 1960 1970 1980 1990 2000 2009

Group I Communicable Group II No Communicable Group III Injuries Group IV Ill Defined

Transición Epidemiológica en Brasil


México

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

1955

1957

1959

1961

1963

1965

1967

1969

1971

1973

1975

1977

1979

1981

1983

1985

1987

1989

1991

1993

1995

1997

1999

2001

2003

2005

2007


Transición Epidemiológica en México


Guatemala

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

1963

1965

1967

1969

1971

1975

1977

1979

1981

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006


Transición Epidemiológica en Guatemala


Rango 1 2 3 Países Año Argentina 2009

Influenza y neumonía Enfermedades isquémicas

del corazón Enfermedades

cerebrovasculares Belice 2008

Diabetes mellitus Enfermedades isquémicas

del corazón Eventos de intención no

determinada Brasil 2009 Enfermedades

cerebrovasculares Enfermedades isquémicas

del corazón Influenza y neumonía Canadá 2007

Enfermedades isquémicas del corazón

Neoplasia maligna de la tráquea, de los bronquios

y del pulmón Demencia y enfermedad

de Alzheimer Chile 2008 Enfermedades


del corazón Cirrosis y otras

enfermedades del hígado Colombia 2008 Enfermedades

isquémicas del corazón Agresiones/homicidios Enfermedades

cerebrovasculares Costa Rica 2009 Enfermedades

isquémicas del corazón Enfermedades

cerebrovasculares Enfermedades hipertensivas

Cuba

2009 Enfermedades


cerebrovasculares


y del pulmón Ecuador 2009

Diabetes mellitus Enfermedades

cerebrovasculares Influenza y neumonía El Salvador 2008

Agresiones/homicidios Enfermedades del sistema

urinario Enfermedades isquémicas

del corazón Estados Unidos de América

2007 Enfermedades

isquémicas del corazón


y del pulmón Demencia y enfermedad

de Alzheimer Guatemala 2008

Influenza y neumonía Agresiones/homicidios

Ciertas afecciones originadas en el período

perinatal

Américas 2007 Enfermedades


cerebrovasculares Diabetes mellitus

The three leading causes of death in the Americas

Source: Mortality Information System - PAHO

Rango 1 2 3 Países Año Guyana 2006 Enfermedades


cerebrovasculares Diabetes mellitus Islas del Caribe No-Latino

2008 Enfermedades


cerebrovasculares Diabetes mellitus México 2009


del corazón Cirrosis y otras enfermedades del

hígado Nicaragua 2009


del corazón Cirrosis y otras enfermedades del

hígado Panamá 2009 Enfermedades


cerebrovasculares Diabetes mellitus Paraguay 2009 Enfermedades


del corazón Ciertas afecciones originadas en el

período perinatal Perú 2007

Influenza y neumonía Enfermedades isquémicas

del corazón Enfermedades cerebrovasculares Puerto Rico 2007 Enfermedades

isquémicas del corazón Diabetes mellitus Demencia y enfermedad de

Alzheimer República Dominicana

2004 Enfermedades isquémicas del corazón

Enfermedades cerebrovasculares

Ciertas afecciones originadas en el período perinatal

Suriname 2007 Enfermedades cerebrovasculares

Enfermedades isquémicas del corazón Diabetes mellitus

Territorios franceses

2005 Enfermedades cerebrovasculares Diabetes mellitus Neoplasia maligna de la próstata

Trinidad y Tobago

2007 Enfermedades isquémicas del corazón Diabetes mellitus Enfermedades cerebrovasculares

Uruguay 2004 Enfermedades cerebrovasculares

Enfermedades isquémicas del corazón

Neoplasia maligna de la tráquea, de los bronquios y del pulmón

Venezuela 2007 Enfermedades isquémicas del corazón

Enfermedades cerebrovasculares Agresiones/homicidios

Américas 2007 Enfermedades


cerebrovasculares Diabetes mellitus

The three leading cause of death in the Americas

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

%

Insulin-dependent diabetes mellitus E10 Non-insulin-dependent diabetes mellitus E11

Malnutrition-related diabetes mellitus E12 Other specified diabetes mellitus E13

Unspecified diabetes mellitus E14

Diabetes MellitusAmericas, 2000-2009


Diabetes MellitusBrazil, 2000-2009


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

%




Diabetes MellitusMexico, 2000-2009


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

%




Diabetes MellitusCuba, 2000-2009


0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

2001 2002 2003 2004 2005 2006 2007 2008 2009

%


Malnutrition-related diabetes mellitus E12 Unspecified diabetes mellitus E14

Adjusted mortality rates due to CVD dropped 43.7% from 2000 to 2007, very higher than the average of the Region. The CVD mortality trend for Belize wasn’t showed individually in the Americas profile.


Mortality total and due to cardiovascular diseases Belize, 2000-2007

Mortality due to cardiovascular diseases by major group of causes

Limitations to compare Argentina mortality rates due to Ischaemic heart disease to other countries


35

57

27

42

43

35

21

44

22

22

10

3

37

29

9

53

7

26

52

12

31

19

17

10

14

0% 20% 40% 60% 80% 100%

Argentina

Canada

Ecuador

Guatemala

Americas

Ischaemic (I20-I25) Cerebrovascular (I60-I69)

Hypertensive (I10-I15) Cardiac Arrest (I46)+Heart faillure (I50)

Other

Mortality due to cardiovascular diseases by major group of causes


Cardiovascular diseases mortalitySelected countries


Diabetes mellitus mortality Selected countries


What do we need?

• Unify criteria for measuring quality (definitions, standards)

• Encourage the development and consolidation of a critical

mass of research on causes of death …..

Evaluation in The Region

• Policy focused on countries with major needs

• Promote the use of standards to improve the quality of

information

• Use and dissemination of statistics locally corrected

Mortality information and situation in the americas

Health & Medicine

Transcript of Mortality information and situation in the americas