EDITORIAL
Vital statistics: Counting births and deaths
Ruy Laurenti; Maria Helena Prado de Mello Jorge; Maria Lúcia Lebrão; Sabina Léa Davidson Gotlieb; Márcia Furquim de Almeida
Teachers of the area of Health Statistics, Department of Epidemiology of FSP/USP
The Bulletin of the Word Health Organization, volume 83, 2005, presented a very interesting article: "Counting the dead and what they died from: an assessment of the global status of cause of death data" (1). This review sought to assess the current status of global death registration data as supplied to WHO by Member-States. The quantity of nations reporting data went up from 65, in 1970, to 115 countries in 2003.
The article describes data quality indicators like coverage, completeness of registration, the timing of available data, the coding system used for causes of death (ICD-Revisions), and the proportion of deaths coded to various ill-defined categories.
As to quality, these topics permitted the classification of 106 countries as: high quality death data (23 countries), low quality (28 nations), and medium quality data (55 nations).
Brazil was placed in the intermediate quality category, along with Chile, Colombia, Costa Rica, Guatemala and Uruguay, in Latin America. It is surprising that more than 10 European countries (high income areas) were included in this medium classification: Austria, Belgium, Denmark, France, Germany, Italy, Netherlands, Norway, Spain, Sweden, Switzerland, and others. This fact makes one consider the hypothesis that these indicators might not have a good discriminatory power or these countries had problems in producing and reporting procedures of the data on deaths.
FAPESP (São Paulo Financial Support Agency for Research) in its April Bulletin, 2005, published a note called "Vital Statistics" (2), which made some comments about above-mentioned WHO Bulletin review (1), such as: " what was surprising for researchers was the fact that many European countries, like Poland, Portugal and Greece, were classified as low quality in death data, together with many African nations." It closes with " .It is urgent that these countries establish a new Registration System or improve their existing Systems".
It is not necessary to emphasize the importance of mortality statistics and their multiple uses by health authorities. And deaths are not the only relevant data, but also data on live births. Vital Statistics, for the United Nations, is the science that takes care of the "vital events or facts", and live births and deaths are part of them, being the most closely related to health indicators.
And what about vital statistics in Brazil?
Since the late 19th Century, there has been data on Brazilian live births and deaths. Nevertheless, in the past, they were fragmented, and they usually only referred to the Brazilian State Capitals.
The establishment of the National Mortality System, in 1975/1976, carried by the Brazilian Ministry of Health (SIM/MS), with a standardized Death Certificate and a well-defined flow, occurred as the result of the successful effort of members of the Department of Epidemiology of the School of Public Health of the University of São Paulo, Brazil, and of the Ministry of Health. It is necessary to remember the powerful and firm action of Dr. Paulo de Almeida Machado, the Ministry of Health at that time, who played a key role in the creation of the System.
Today, in the way it is structured and behaves, the data System SIM/MS matches the best vital data systems in the world. Coverage is growing. In 1980, 750,000 deaths were covered, and in 2003, there were more than 1,000,000 cases. A coverage of 83% is estimated (3). The quality of the completion of Death Certificates by physicians has improved, mainly in the part of causes of death certification (underlying and associated). The proportion of deaths with an ill-defined underlying cause has been falling from 20% to 13%, in the past 20 years (3).
In this manner, why is not Brazil included among the countries with high quality death data? Such fact is due to coverage, which is not all-inclusive, and to the proportion of ill-defined causes of death, which can be regarded high.
As to live births, an important vital event to health authorities, since 1990, Brazil has had an excellent Official Data System on Live Births (SINASC) that also emerged with the effort of members from the School of Public Health and the Ministry of Health. It collects more than 3,000,000 cases, with very important information for the design of health policies like: mother's age and education, duration of the pregnancy, type of delivery, birth weight, siblings, APGAR index, and other variables.
In this fashion, in relation to vital statistics, particularly deaths, Brazil was classified in the intermediate level, and its completeness and validity should be improved in the future. In our opinion, now a significant effort is necessary for SIM to obtain maximum collection of deaths and better completion quality of the causes of death by physicians of the country.
References
1. Mathers CD, Ma Fat D, Inoue M, Rao C, Lopez AD. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bulletin of the Word Health Organization 83(3), March 2005: 171-9.
2. www.agenciafapesp.br/boletimdentrophp?data[id_materiaboletim]=3535, acessado em 10/04/2005.
3. Rede Interagencial de Informações para a Saúde (RIPSA). Indicadores e Dados Básicos IDB-2004. Brasília; 2005
Publication Dates
-
Publication in this collection
12 June 2007 -
Date of issue
June 2005
