Correction of vital statistics based on a proactive search of deaths and live births: evidence from a study of the North and Northeast regions of Brazil

Abstract

BackgroundIn the last 20 years, Brazil has undergone dramatic changes in terms of socioeconomic development and health care. In the first decade of the 2000s, the Ministry of Health (MoH) developed a series of programs focused on reducing infant mortality, including the Family Health Program as a national policy for primary care. In this paper, we propose a method to correct underreporting of deaths and live births. After vital statistics are corrected, infant mortality trends are analyzed for the period 2000–2010 by macro-geographical region.MethodsA proactive search of live births and deaths was carried out in the Amazon and Northeast regions in 2010 to find vital events that occurred in 2008 and were not reported to the Ministry of Health. The probabilistic sample of 133 municipalities was stratified by adequacy of vital information reporting. For each municipality, the adequacy analysis was based on the reported age-standardized mortality rate per 1,000 population and the ratio between reported and estimated live births. Correction factors were estimated by strata based on additional vital events found in the proactive search. The procedure was generalized to correct municipal vital statistics for the period 2000–2010.ResultsIn the proactive search, 35% of non-reported deaths were found within the health system (hospitals and other health establishments), but 28% were found in non-official sources, like illegal cemeteries. In areas of extreme poverty and unreliable vital information, the estimated completeness of infant death reporting was only 33%. After correction of vital information, the estimated infant mortality rate decreased from 26.1 in 2000 to 16.0 in 2010, with an annual rate of decrease of 4.7%, greater than the required rate to achieve the Millennium Development Goal. Among Brazilian regions, the Northeast showed the largest decrease, from 38.4 to 20.1 per 1,000 live births.ConclusionsThe proactive search for vital events was shown to be a good strategy both in terms of understanding local irregularities and for correcting vital statistics. The methodology could be applied in other countries to routinely assess the pattern and extent of birth and death under-registration in order to improve the utility of these data to inform health policies.

Adequação das informações de mortalidade e correção dos óbitos informados a partir da Pesquisa de Busca Ativa

“…Deaths identified through unofficial sources had the age verified in a second stage of the data collection, allowing for the calculation of correction factors by age group and sex. The estimation of such correction factors permits the calculation of age and sex specific mortality rates, which can then be multiplied by proportional mortality due to specific causes of death, resulting in cause specific mortality rates 16 .…”

“…Otherwise, the correction factor was considered insufficient and the corrected number of infant deaths in the municipality was estimated based on the UF's IMR, which was calculated using only data from municipalities with sufficient correctionas proposed in previous publications 8, [13][14][15][16] .…”

“…Due to a large proportion (45%) of municipalities with less than 10000 inhabitants, we calculated adequacy indicators using the average number of vital events reported in a three-year period 2011-2013, to provide greater stability to municipal estimates 16,17 . SINASC adequacy was assessed by the Live Birth Ratio (LBR), or the ratio between the recorded number of live births (LB) in the SINASC and the estimated number of LB.…”

“…This represented a large shift in the way mortality indicators were calculated in Brazilpreviously indirect demographic methods were used to estimate mortality for all states of the North and Northeast regions as well as for the states of Minas Gerais, Mato Grosso and Goiás 15 . Now, with this new methodology based on data from proactive search of deaths, indicators such as infant mortality rate and maternal mortality ratiocould be calculated annually and used to assess temporal changes 14,16 .…”

“…These gaps hinder the use of information on mortality and live births in several Brazilian municipalities [11][12][13]16,17 . Based on the findings of the Proactive Search of Deaths carried out in 2014, related to events occurred in 2012, the present study aims to create adequacy indicators of the coverage of mortality data, calculate correction factors for indicators produced with data from the SIM by sex and age group, and estimate the Infant Mortality Ratio (IMR) in 19 Brazilian states and in municipalities where the correction was insufficient, seeking to establish priorities for intervention in places where deficiency in the data registry still persist.…”