Redistributing deaths by ill-defined and unspecified causes on cancer mortality in Brazil

Bigoni, Alessandro; Cunha, Amanda Ramos da; Antunes, José Leopoldo Ferreira

doi:10.11606/s1518-8787.2021055003319

Brasil

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055003319 linkcopy

Redistributing deaths by ill-defined and unspecified causes on cancer mortality in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE to discuss the impact four different redistribution strategies have on the quantitative and temporal trends of cancer mortality assessment in Brazil.

METHODOLOGY This study used anonymized and georeferenced data provided by the Brazilian Ministry of Health (BMoH). Four different approaches were used to conduct the redistribution of ill-defined deaths and garbage codes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed the calculation of region, sex, and cancer type trends.

RESULTS Death rates increased considerably in all regions after redistribution. Overall, Elisabeth B. França’s and the World Health Organization methods had a milder impact on trends and rate magnitudes when compared to the Global Burden of Disease (GBD) 2010 method. This study also observed that, when the BMoH dealt with the problem of redistributing ill-defined deaths, results were similar to those obtained by the GBD method. The redistribution methods also influenced the assessment of trends; however, differences were less pronounced.

CONCLUSIONS Since developing a comparative gold standard is impossible, matching global techniques to local realities may be an alternative for methodological selection. In our study, the compatibility of the findings suggests how valid the GBD method is to the Brazilian context. However, caution is needed. Future studies should assess the impact of these methods as applied to the redistribution of deaths to type-specific neoplasms.

Neoplasms, mortality; Data Accuracy; Vital Statistics; Cause of Death

Targets

C00-C139, C15-C259, C30-C349, C37-C388, C40-C419, C43-C459, C47-C549, C56-C578, C58-C580, C60-C638, C64-C679, C680-C688, C69-C758, C81-C866, C88-C969, D001-D002, D010-D013, D020-D023, D03-D069, D070-D072, D074-D075, D090, D092-D093, D098, D100-D107, D11-D129, D130-D137, D140-D143, D15-D169, D22-D249, D260-D279, D280-D281, D287, D290-D298, D300-D308, D31-D36, D361-D367, D371-D375, D380-D385, D391-D392, D398, D400-D408, D410-D418, D42-D439, D440-D448, D45-D479, D480-D486, D492-D494, D496, K620-K621, K635, N60-N609, N840-N841, N87-N879.

	North	Northeast	Southeast	South	Center-West
Initial magnitude
Certified	48.32	40.80	100.91	116.40	76.93
EF redistributed	58.94	51.63	107.07	122.15	82.82
WHO redistributed	69.55	62.47	113.23	127.91	88.71
GBD redistributed	89.56	87.83	137.81	149.87	111.23
BMoH redistributed^a	108.94	96.88	129.42	141.18	116.50
Final magnitude
Certified	76.77	75.35	92.13	110.99	87.79
EF redistributed	80.54	78.47	95.14	113.27	89.31
WHO redistributed	84.31	81.59	98.15	115.55	90.82
GBD redistributed	97.20	96.77	115.37	130.12	103.64
BMoH redistributed^a	104.85	97.75	117.12	131.72	105.43
APC
Certified	2.51 [2.30; 2.72] ↑	3.27 [2.30; 4.25] ↑	-0.48 [-0.54; -0.41] ↓	-0.24 [-0.44; -0.03] ↓	0.68 [0.46; 0.90] ↑
EF redistributed	1.62 [1.46; 1.78] ↑	2.23 [1.70; 2.76] ↑	-0.64 [-0.71; -0.57] ↓	-0.38 [-0.57; -0.19] ↓	0.37 [0.23; 0.50] ↑
WHO redistributed	0.92 [0.72; 1.12] ↑	1.40 [1.09; 1.71] ↑	-0.78 [-0.87; -0.69] ↓	-0.52 [-0.70; -0.34] ↓	0.09 [-0.01; 0.19] ↔
GBD redistributed	0.32 [0.05; 0.60] ↑	0.43 [0.10; 0.76] ↑	-0.93 [-0.96; -0.90] ↓	-0.71 [-0.81; -0.62] ↓	-0.40 [-0.51; -0.29] ↓
BMoH redistributed^a	-0.43 [-0.75; -0.11] ↓	0.09 [-0.17; 0.35] ↔	-0.84 [-0.98; -0.69] ↓	-0.60 [-0.72; -0.48] ↓	-0.49 [-0.60; -0.38] ↓

	North	Northeast	Southeast	South	Center-West
RR of initial magnitude
Certified	1.00	1.00	1.00	1.00	1.00
EF redistributed	1.22	1.27	1.06	1.05	1.08
WHO redistributed	1.44	1.53	1.12	1.10	1.15
GBD redistributed	1.85	2.15	1.37	1.29	1.45
BMoH redistributed^a	2.03	2.04	1.30	1.19	1.37
RR of final magnitude
Certified	1.00	1.00	1.00	1.00	1.00
EF redistributed	1.05	1.04	1.03	1.02	1.02
WHO redistributed	1.10	1.08	1.07	1.04	1.03
GBD redistributed	1.27	1.28	1.25	1.17	1.18
BMoH redistributed^a	1.72	1.61	1.27	1.18	1.27
APC of RR of all years
EF redistributed	-0.77 [-0.97; -0.57] ↓	-1.02 [-1.50; -0.54] ↓	-0.14 [-0.18; -0.09] ↓	-0.14 [-0.16; -0.12] ↓	-0.29 [-0.41; -0.17] ↓
WHO redistributed	-1.38 [-1.72; -1.03] ↓	-1.80 [-2.64; -0.95] ↓	-0.26 [-0.35; -0.17] ↓	-0.27 [-0.32; -0.23] ↓	-0.55 [-0.78; -0.32] ↓
GBD redistributed	-2.07 [-2.45; -1.68] ↓	-2.73 [-3.83; -1.61] ↓	-0.46 [-0.54; -0.39] ↓	-0.49 [-0.64; -0.35] ↓	-1.07 [-1.37; -0.77] ↓
BMoH redistributed^a	-2.89 [-3.17; -2.61] ↓	-3.53 [-4.60; -2.44] ↓	-0.39 [-0.54; -0.23] ↓	-0.28 [-0.39; -0.17] ↓	-1.13 [-1.40; -0.85] ↓

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Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
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[TFN1] ^a It refers to the period from 2000 to 2013.

[TFN2] ↑ Increasing trend; ↓ Decreasing trend; ↔ Stationary trend; EF: redistribution method proposed by França et al. (2014)⁹; GBD: redistribution method proposed by Lozano et al.¹⁴ (GBD 2010); APC: annual percentage change.