A contribuição do linkage entre o SIM e SINASC para a melhoria das informações da mortalidade infantil em cinco cidades brasileiras

Record Linkage for Malaria Deaths Data Recovery and Surveillance in Brazil

OBJECTIVE

The objective is to describe the results and the methodological processes of record linkage for matching deaths and malaria cases.

METHODS

A descriptive cross-sectional study was conducted with probabilistic record linkage of death and malaria cases data in Brazil from 2011 to 2020 using death records from the Mortality Information System (SIM) and epidemiological data from the Notifiable Diseases Information System (Sinan) and Epidemiological Surveillance Information Systems for malaria (Sivep-Malaria). Three matching keys were used: patient's name, date of birth, and mother's name, with an analysis of cosine and Levenshtein dissimilarity measures.

RESULTS

A total of 490 malaria deaths were recorded in Brazil between 2011 and 2020. The record linkage resulted in the pairing of 216 deaths (44.0%). Pairings where all three matching keys were identical accounted for 30.1% of the total matched deaths, 39.4% of the matched deaths had two identical variables, and 30.5% had only one of the three key variables identical. The distribution of the variables of the matched deaths (216) was similar to the distribution of all recorded deaths (490). Out of the 216 matched deaths, 80 (37.0%) had poorly specified causes of death in the SIM.

CONCLUSIONS

The record linkage allowed for the detailing of the data with additional information from other epidemiological systems. Record linkage enables data linkage between information systems that lack interoperability and is an extremely useful tool for refining health situation analyses and improving malaria death surveillance in Brazil.

Procedures for health data linkage: applications in health surveillance

OBJECTIVE

To present a standardized methodology for linking different public health databases.

METHODS

This was a methodological review article specifically describing data processing procedures for deterministic linkage between structured databases. It instructs on how to: treat data, select linkage keys, and link databases using two databases simulated in R software.

RESULTS

The commands used for the deterministic linkage of the inner_join type were presented. The linkage process resulted in a database with 40,108 pairs using only the "Name" key. Adding the second key, "Name of mother", the resulted dropped to 112 pairs. By adding the third key, "Date of birth", only two pairs were identified.

CONCLUSION

Database linkage and its analysis are valid and valuable tools for health services in supporting health surveillance actions.

Use of linkage to analyze completeness and concordance of deaths from congenital syphilis in the Metropolitan Region of São Paulo, Brazil, 2010-2017: a descriptive study

OBJECTIVE

To evaluate the completeness and concordance of infant deaths from congenital syphilis in the Metropolitan Region of Sao Paulo, Brazil, between 2010 and 2017.

METHODS

This was a descriptive study based on linkage between the Mortality Information System (SIM) and the Live Birth Information System (SINASC). Deaths with mention of congenital syphilis in multiple causes of death were analyzed. The completeness of 11 SIM variables was analyzed and SINASC was adopted as the reference. The Kappa statistic was used to analyze concordance.

RESULTS

There were 134 recorded congenital syphilis deaths, 132 of which were linked. 67 had congenital syphilis as the underlying cause, while 65 involved multiple causes of death, indicating underestimated congenital syphilis mortality. After linkage, the number of variables with excellent completeness increased from two to ten.

CONCLUSION

Linking SIM with SINASC data improved completeness. The magnitude of congenital syphilis mortality was found to be underestimated, and the use of multiple causes improved its measurement.

[Avoidability of fetal deaths: reflections on the Brazilian List of Avoidable Causes of Deaths through interventions by the Brazilian Unified National Health System]

Although the Brazilian List of Avoidable Causes of Deaths (LBE in Portuguese), in its version for children under 5 years of age (LBE < 5), does not include stillbirths, some studies have used the list with or without adaptations. We present a proposal for adaptation of the LBE for stillbirths (LBE-OF in Portuguese) and the results of its application to stillbirths in the State of Rio de Janeiro, Brazil, in 2018, compared to the results with LBE < 5. We reviewed the categories from the 10th revision of the International Classification of Diseases (ICD-10) in the LBE < 5 and reassigned them in the avoidability groups, according to time of death in relation to delivery and the causes consistent with stillbirths. Conditions that did not elucidate the determinants of death were allocated as ill-defined causes. Stillbirths in the State of Rio de Janeiro, selected from the databases of the Mortality Information System (SIM in Portuguese), were classified according to LBE-OF and LBE < 5. When classifying the 2,585 stillbirths that occurred in the State of Rio de Janeiro in 2018, we found that according to LBE < 5, there were predominantly causes "reducible by adequate care in labor and delivery" (42.9%), while according to LBE-OF, the most frequent causes were "reducible by adequate care for during pregnancy" (43.6%). Ill-defined causes ranked second according to the LBE-OF (35.4%) and third according to LBE < 5. Some 30% of stillbirths changed groups and subgroups of avoidability, showing greater consistency with the profile of obstetric care. Although identifying a higher percentage of ill-defined causes, the LBE-OF is more consistent with the pathophysiology of fetal deaths. The inclusion of stillbirths in the SIM would be a positive step in monitoring and upgrading the investigation of causes of fetal death.

Quality of children's death records for regionalized spaces: a methodological route

OBJECTIVES

To propose a methodological path to investigate the coverage and information filling of maternal-infant deaths recorded in the Ministry of Health's Mortality Information System for regional spaces.

METHODS

Four steps were proposed: 1) Assessment of the completeness of the maternal and child variables, which was measured using the deterministic linkage technique between the Mortality Information System (Sistema de Informações sobre Mortalidade - SIM) and the Live Birth Information System (Sistema de Informações sobre Nascidos Vivos - SINASC); 2) Application of the multiple imputation technique to achieve the total filling of the missing information of the variables; 3) Estimation of death coverage; 4) The Unknown Variable Information Index (Índice de Informação Desconhecida da Variável - IIDV) was measured, which represents the combined effect of data completeness and coverage of deaths. The proposal of the methodological path was exemplified for neonatal deaths in the municipalities of Paraíba that are part of the new classification proposed by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE), as adjacent rural areas, in three triennium periods from 2009 to 2017.

RESULTS

The percentage of matching records was 45%. Most of the variables had a percentage of non-completion below 10% and around 17% for the mother's education. Coverages ranged from 75 to 83%. The IIDV for all variables was between 21 and 36% after the linkage.

CONCLUSION

The path of the methodological proposal proved to be effective, which can be replicated to other regions, and can be extended to other categories of deaths such as post-neonatal. The combination of the proposed procedures demands low operating costs and their uses are relatively simple to be applied by the managers and technicians of the vital statistics information systems.

Life-threatening conditions at birth: an analysis of causes of death and survival estimate for under-five children in live birth cohorts

Despite the reduction in under-five mortality, the causes are still mostly avoidable, and survival may be compromised by life-threatening conditions at birth. The study estimated the burden of life-threatening conditions at birth, neonatal near miss, and mortality, with an emphasis on avoidable causes, as well as under-five survival in live birth cohorts. This was a retrospective cohort study of live birth in the city of Rio de Janeiro, Brazil (2012-2016). The databases from the Brazilian Information System on Live Births and the Brazilian Mortality Information System were linked. Pragmatic criteria were used to define life-threatening conditions and near miss. Deaths were classified according to the Brazilian list of causes of avoidable deaths. Morbidity and mortality and survival indicators were estimated (Kaplan-Meier). Of the 425,505 live birth , 2.2% presented life-threatening conditions at birth. The under-five, infant and neonatal mortality rates were 0.01, 0.06, and 14.97 per 1,000 person-days, respectively. Avoidable, unclearly avoidable, and ill-defined causes accounted respectively for 61%, 35%, and 4% of the deaths. The risk of death from avoidable causes attributable to life-threatening conditions at birth was 97.6%. Survival was lower in newborns with life-threatening conditions compared to those without life-threatening conditions. The pragmatic criteria for life-threatening conditions determined the profile of proportional mortality by causes of death according to the three groups of causes in the Brazilian list of causes of avoidable deaths. Life-threatening conditions at birth increases the risk of morbidity and mortality in under-five children and raises the discussion on vulnerability and the need for care for these children and social support for their families.

Qualidade dos sistemas de informações sobre nascidos vivos e sobre mortalidade no Rio Grande do Sul, Brasil, 2000 a 2014

Resumo O estudo avalia a qualidade do SIM e do SINASC nos aspectos cobertura, incompletitude e consistência, bem como a contribuição do “linkage” para a recuperação de dados. Foram analisados nascimentos e óbitos de menores de um ano ocorridos no Rio Grande do Sul entre 2000 e 2014. Os registros foram pareados por “linkage” determinístico através do número da DNV e, na ausência deste, por “linkage” probabilístico. A cobertura do SINASC aumentou 37%, passando de 72,2% em 2000 para 98,9%. O grau de incompletitude do SINASC foi excelente para todas as variáveis, exceto quantidade de filhos mortos e ocupação materna. No SIM, até 2003 a maioria das variáveis apresentou preenchimento ruim ou muito ruim. Apesar da melhoria, seis delas ainda possuíam preenchimento regular ou ruim em 2014. Após o “linkage”, a incompletitude reduziu-se para grande parte das variáveis. Houve alta variabilidade quanto à consistência: sexo apresentou percentual superior a 97% em todo período, enquanto para outras cinco variáveis essa fração segue inferior a 75% em 2014. Destaca-se a alta cobertura e a excelente incompletitude do SINASC. Persistem problemas relacionados à consistência de informações. Evidencia-se a relevância do “linkage” como método para recuperar informações.

Simulação e comparação de técnicas de correção de dados incompletos de idade para o cálculo de taxas de incidência

O objetivo foi comparar duas técnicas para estimar idade em bancos de dados com registros incompletos e analisar sua aplicação no cálculo da incidência de câncer. Utilizou-se a base de dados do Registro de Câncer de Base Populacional do Município de São Paulo, Brasil, contendo casos diagnosticados por câncer do trato urinário, entre 1997 e 2013. Foram aplicadas duas técnicas para estimativa de idade: fator de correção e imputação múltipla. Foram simuladas, usando a distribuição binomial, seis bases de dados com diferentes proporções de dados incompletos para idade de 5% até 50%. A razão entre as incidências foi calculada tendo, como referência, a base completa, cuja incidência padronizada foi de 11,83/100 mil; as demais incidências nas bases com 5% ou mais de dados incompletos para idade apresentaram-se subestimadas. Ao aplicar o fator de correção, as taxas corrigidas não apresentaram diferenças em comparação com as padronizadas, entretanto, essa técnica não permite corrigir taxas específicas. A imputação múltipla foi útil na correção das taxas padronizadas e específicas em bancos com até 30% de dados incompletos, entretanto, as taxas específicas para indivíduos com menos de 50 anos apresentaram-se subestimadas. Bases com 5% ou mais de dados incompletos necessitam de aplicação de correção. A imputação múltipla, apesar de complexa em sua execução, mostrou-se superior ao fator de correção. Todavia, deve ser utilizada com parcimônia, pois taxas específicas por idade podem manter-se subestimadas.

The absence of birthweight paradox as a marker of disadvantages faced by low maternal education children

Background

This study tested the hypothesis that the birthweight paradox would not be observed when assessing the effect of maternal education on neonatal mortality in the presence of socioeconomic inequality in access to health care.

Methods

Non-concurrent cohort study. Passive follow-up of live-born infants using probabilistic record linkage of birth and death records for Rio de Janeiro (2004-2010; n = 1 445 367). Maternal age, birthweight and neonatal death were evaluated according to maternal educational level strata (<4, 4-11 and ≥12 years of study). We estimated the association between maternal educational level and neonatal mortality using logistical regression models adjusted for maternal age and birthweight (<2500 g and ≥2500 g).

Results

Neonatal mortality was 1.8 times higher in low educational level group compared with high educational level. We did not find birthweight-specific mortality curves crossing over in the stratum under 2500 g (birthweight paradox). The odds of a low birthweight child being born in facilities without neonatal intensive care units was about 70% higher in the group of low education when compared with mothers with high education.

Conclusions

The absence of crossing birthweight-specific mortality curves may be a reason for concern about the severity of the disadvantages faced by low maternal education women.