Uso do sistema de informação sobre mortalidade para identificar subnotificação de casos de tuberculose no Brasil

Abstract

The aim of the study was to analyze the underreporting of deaths from tuberculosis (TB) in Brazil, as well as to assess the impact these cases would cause in the reporting rate and proportion of TB deaths in 2006. We analyzed the deaths recorded in the Mortality Information System (SIM) in 2006 and all reports of TB in Brazil during the 2001 to 2006 period. The variables used for the relationship were: report number, city and State of residence, patient name, date and year of birth, sex, mother's name and address. Six blocking steps were performed. Scores above 12.4 were considered pairs, and those below 9.7, doubtful pairs. After each step, we performed a manual review of doubtful pairs. The Reportable Disease Information System (Sinan) had 547,589 records. The SIM had 6,924 records, 39.3% (n = 2,727) of which were not found in Sinan during the period evaluated. We observed that 64.5% (2,707) of deaths were reported in 2006 and after analyzing the proportion of deaths underreported by region and federal units, we found that the highest percentage was in the Northern region, followed by the Southeast and Northeast. The addition of deaths that had not been reported to the Sinan database increased the reporting rate 3.7%. Regarding the proportion of deaths due to TB, such inclusion was responsible for a 60.7% increase in this indicator. The relationship between both databases seems to be an important strategy for improving the quality of the TB surveillance system.

Mortality related to tuberculosis-HIV/AIDS co-infection in Brazil, 2000-2011: epidemiological patterns and time trends

“…The use of secondary data may have limited the analysis, as many variables of interest are not available with under registering of deaths. On the other hand, we assume that the databases are of acceptable quality, considering the improvement of coverage and quality of SIM records during recent years 9,16,31 . However, there still may exist regional differences in the performance and quality of data, and the number of deaths related to TB-HIV/AIDS co-infections may have been underestimated 31 , especially in the North and Northeast regions.…”

“…On the other hand, we assume that the databases are of acceptable quality, considering the improvement of coverage and quality of SIM records during recent years 9,16,31 . However, there still may exist regional differences in the performance and quality of data, and the number of deaths related to TB-HIV/AIDS co-infections may have been underestimated 31 , especially in the North and Northeast regions. There were a considerable number of data sets with missing information, especially for race/color, education and marriage status, thus the respective analyses and interpretation should be performed with caution 32,33,34 .…”

Do que morrem os pacientes com tuberculose: causas múltiplas de morte de uma coorte de casos notificados e uma proposta de investigação de causas presumíveis

“…Possivelmente, esses eram óbitos diretamente relacionados com a TB, que não foi considerada no momento da internação, talvez por desconhecimento do padrão da doença; ou por se tratar de grupo populacional de difícil diagnóstico, como idosos; ou por falta de acesso a exames para confirmação da doença. Essa hipótese ganha destaque quando se identifica que o padrão de causas de morte é bem diferente quando a TB está registrada como causa associada 12,13,14 .…”

Pulmonary tuberculosis in São Luis, State of Maranhão, Brazil: space and space-time risk clusters for death (2008-2012)

“…This result identifi es a critical area that health services need to investigate in view of the possibility of false positives. The explanatory hypotheses for the research fi ndings include the lack of registries of this information (47) and the nonprioritization of sputum smears in the hospital (48).…”

“…This result identifi es a critical area that health services need to investigate in view of the possibility of false positives. The explanatory hypotheses for the research fi ndings include the lack of registries of this information (47) and the nonprioritization of sputum smears in the hospital (48).Studies analyzing mortality rates by transmissible diseases refl ect the ineffi cacy of prevention and control measures (49) . It should also be remembered that this analysis is restricted whenever a high proportion of deaths occur without medical aid or by poorly defi ned causes 2 .…”