Uso do diagnóstico principal das internações do Sistema Único de Saúde para qualificar a informação sobre causa básica de mortes naturais em idosos

Abstract

Introduction: Ill-defined causes of death are common among the elderly owing to the high frequency of comorbidities and, consequently, to the difficulty in defining the underlying cause of death. Objective: To analyze the validity and reliability of the "primary diagnosis" in hospitalization to recover the information on the underlying cause of death in natural deaths among the elderly whose deaths were originally assigned to "ill-defined cause" in their Death Certificate. The hospitalizations occurred in the state of Rio de Janeiro, in 2006. Methods: The databases obtained in the Information Systems on Mortality and Hospitalization were probabilistically linked. The following data were calculated for hospitalizations of the elderly that evolved into deaths with a natural cause: concordance percentages, Kappa coefficient, sensitivity, specificity, and the positive predictive value of the primary diagnosis. Deaths related to "ill-defined causes" were assigned to a new cause, which was defined based on the primary diagnosis. Results: The reliability of the primary diagnosis was good, according to the total percentage of consistency (50.2%), and fair, according to the Kappa coefficient (k = 0.4; p < 0.0001). Diseases related to the circulatory system and neoplasia occurred with the highest frequency among the deaths and the hospitalizations and presented a higher consistency of positive predictive values per chapter and grouping of the International Classification of Diseases. The recovery of the information on the primary cause occurred in 22.6% of the deaths with ill-defined causes (n = 14). Conclusion:The methodology developed and applied for the recovery of the information on the natural cause of death among the elderly in this study had the advantage of effectiveness and the reduction of costs compared to an investigation of the death that is recommended in situations of non-linked and low positive predictive values. Monitoring the mortality profile by the cause of death is necessary to periodically update the predictive values.

Fatores associados à mortalidade por causas inespecíficas e mal definidas no estado do Amazonas, Brasil, de 2006 a 2012

“…The association between ill-defined mortality and socioeconomic factors, such as non-white skin color and low schooling was also reported by different authors 21,31,35 , reflecting situations of exclusion and restricted access to health services. Differently from what was observed in AM, these studies also evidenced high mortality with undetermined cause in women, but not in relation to the marital status.…”

“…The relationship between mortality by defined causes and age is in agreement with that reported from different studies conducted in the country. Among the possible explanations is the difficulty of establishing an underlying cause in concomitant multiple morbidities, a common situation among the elderly 30,31 . Lower odds of nonspecific causes in the 10-49 years age range and in males may be associated with the occurrence of deaths due to non-natural causes, which is known to be higher among young male adults 32 .…”

Análise de confiabilidade da causa básica e associadas de morte

“…Hospital Luxemburgo, Belo Horizonte, 2017. (8,6) 60 (9,4) 10 0,004** desse estudo, foram por causa dos quadros infecciosos terminais e refletem dificuldades de acesso e tratamento ainda existentes. Escolas médicas, serviços de saúde e conselhos de medicina são fundamentais a conscientização sobre a importância, individual e coletiva, do preenchimento correto e completo da DO, especialmente no que se refere às menções das causas de morte.…”

“…4 Diferentes formas de aferição da confiabilidade das causas de morte (naturais ou não naturais) indicaram que ainda há problemas relacionados ao preenchimento incorreto ou incompleto das causas de óbitos. [5][6][7] Investigações em prontuários médicos, autópsias e a ligação entre os dados com outros sistemas de informação têm sido utilizados desde as últimas décadas dos anos 1900 nos casos de mortes por câncer no mundo e no Brasil. 8,9 O objetivo deste estudo foi avaliar a confiabilidade do registro de neoplasias malignas como CB de morte no SIM por meio de investigação em prontuário.…”

Mortality in community-dwelling elderly: coefficient and associated factors

“…In the context of elderly health, most studies are developed in hospitals or long-stay institutions (6)(7)(8)(9)(10) , where the characteristics of the population tend to be distinct and with profiles of greater frailty. Thus, there is a need for global assessment studies of the elderly, in the community's context, with longitudinal methodology and analysis of death's leading causes.…”