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The discrimination of the cause of death is an important part in forensic medicine. With the advantages of simple operation， high test efficiency， and easy sensitivity to the death mechanism of the deceased， postmortem biochemistry analysis has become a significant auxiliary analysis method for discrimination of the cause of death. In this paper， we discuss the development status， advantages and current problems of postmortem biochemical analysis， and then describe the application prospect of postmortem biochemistry in the discrimination of the cause of death by posing feasible solutions， so that to provide an idea for this research.
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Objective To analyze the death status and main causes of death among children under 5 years old in Changsha from 2016 to 2021, and to provide a scientific basis for formulating preventive measures for children's health care. Methods The data of 1 761 deaths of children under 5 years old in Changsha City from 2016 to 2021 were collected, and the mortality trend, the order of causes of death and the utilization of pre-death medical care services were retrospectively analyzed. Results The 7-day neonatal mortality, 28-day neonatal mortality, 0-1-year-old neonatal mortality, and the mortality rate of children under 5 years old (U5MR) in Changsha City from 2016 to 2021 were 0.76‰, 1.28‰, 2.41‰, and 3.86‰, respectively. All the mortality rates showed a decreasing trend (P<0.05). U5MR in males was significantly higher than that in females (P<0.05), and U5MR in rural areas was significantly higher than that in urban areas (P<0.05). The top five causes of U5MR were drowning, premature delivery or low birth weight, pneumonia, other congenital anomalies, and accidental asphyxia, respectively. The death places of children under 5 years old were mainly medical and health institutions, and 81.72% of them were treated in hospitals before death. Conclusion From 2016 to 2021, the mortality rate of children under the age of 5 in Changsha City has gradually decreased. Preventing congenital malformations, reducing preterm birth or low birth weight, improving the treatment level of pneumonia, and preventing accidents such as drowning and accidental suffocation are the key to reducing the mortality rate of children under 5 years old.
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Resumo Objetivo analisar a tendência de mortalidade por causas externas em pessoas idosas no Brasil no intervalo temporal entre os anos 2000 e 2022 e identificar o perfil sociodemográfico de mortalidade. Método estudo ecológico de série temporal utilizando dados secundários, envolvendo a mortalidade em pessoas idosas por causas externas no Brasil, no período de 2000 a 2022. Os dados foram coletados a partir das bases de dados do Departamento de Informática do Sistema Único de Saúde, das estimativas da população residente e de dados populacionais censitários disponibilizados pelo Instituto Brasileiro de Geografia e Estatística. A frequência absoluta e relativa dos dados foi analisada a partir do software Excel 2010. As análises das tendências das taxas de mortalidade e regressão linear segmentada foram realizadas por meio do Joinpoint, com significância estatística avaliada por meio do teste de Monte Carl Resultados No período investigado, foram identificados 572.608 óbitos por causas externas em pessoas idosas com 60 anos ou mais. Em relação ao comportamento da mortalidade por causas externas em pessoas idosas, observou-se tendência de aumento nas taxas de mortalidade na maior parte do período estudado (2000 a 2013) com uma variação percentual anual (VPA: 1,86; IC95%: 1,5-2,2). Conclusão os resultados indicam uma tendência de crescimento da mortalidade de pessoas idosas por causas externas, refletindo a necessidade de priorização de políticas públicas que intervenham sobre esse evento.
Abstract Objective To analyze the trend of mortality due to external causes in older adults in Brazil within the temporal interval spanning from 2000 to 2022 and to identify the sociodemographic profile of mortality. Method Ecological time-series study utilizing secondary data, encompassing mortality in older adults due to external causes in Brazil, spanning the period from 2000 to 2022. The data were collected from the databases of the Department of Informatics of the Unified Health System, population estimates, and census population data provided by the Brazilian Institute of Geography and Statistics. The absolute and relative frequency of the data were analyzed using Microsoft Excel 2010 software. The analysis of trends in mortality rates and segmented linear regression was conducted using Joinpoint, with statistical significance assessed through the Monte Carlo test. Results During the investigated period, 572,608 deaths due to external causes were identified in individuals aged 60 years or older. Regarding the mortality pattern due to external causes in older adults, an increasing trend in mortality rates was observed for the majority of the studied period (2000 to 2013) with an annual percent change (APC) of 1.86 (95% CI: 1.5-2.2). Conclusion The results indicate a growing trend in mortality among older individuals due to external causes, highlighting the need for prioritizing public policies that address this issue.
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Objetivo: examinar la continuidad de vínculos interna y externa en hombres que experiencian duelo por un ser querido. Método: estudio correlacional, descriptivo y transversal. Muestra a conveniencia de 170 hombres dolientes. Las variables fueron mediadores del duelo, continuidad de vínculos y datos sociodemográficos. Se utilizó un cuestionario en línea compuesto por mediadores de duelo, escala de continuidad de vínculos y datos sociodemográficos. Se empleó estadística descriptiva, análisis de varianza y coeficiente de Spearman. El nivel de significancia correspondió a p<0,05. Resultados: la media de edad de los participantes fue de 36,61 años (DE=13,40), y el 80,00% tenía educación superior. Los valores medios de continuidad de vínculos interna y externa fueron 24,85 (DE=7,93) y 7,68 (DE=2,33), respectivamente. Se establecieron diferencias significativas referentes a la continuidad de vínculos interna y externa entre parentesco de la persona fallecida (p<0,001), y ninguna con la causa de muerte o con el tiempo transcurrido desde el fallecimiento. No se precisaron correlaciones significativas entre continuidad de vínculos interna/externa y mediadores del duelo. Conclusión: los hombres dolientes expresan la continuidad de vínculos interna de manera frecuente y la externa en ocasiones, con diferencias respecto a quién era la persona fallecida. La Enfermería podría diseñar estrategias específicas que fortalezcan el afrontamiento del duelo en este grupo.
Objective: to examine internalized and externalized continuing bonds in men grieving a loved one. Method: a correlational, descriptive and cross-sectional study. Convenience sample comprised by 170 mourning men. The variables were mediators of mourning, continuing bonds and sociodemographic data. The instrument used was an online questionnaire comprised by mediators of mourning, a continuing bonds scale and sociodemographic data. Descriptive statistics, analysis of variance and Spearman's coefficient were used. The significance level adopted was p<0.05. Results: the participants' mean age was 36.61 years old (SD=13.40), and 80.00% had Higher Education. The mean values corresponding to internalized and externalized continuing bonds were 24.85 (SD=7.93) and 7.68 (SD=2.33), respectively. Significant differences were established referring to internalized and externalized continuing bonds in terms of kinship with the deceased person (p<0.001), and none with the cause of death or with the time elapsed since the event. No significant correlations were defined between internalized/externalized continuing bonds and mediators of mourning. Conclusion: grieving men express internalized and externalized continuing bonds frequently and occasionally, respectively, with differences according to who the deceased person was. The Nursing discipline might devise specific strategies that strengthen coping with grief in this population group.
Objetivo: examinar a manutenção de vínculos interna e externa em homens vivenciando o luto por um ser querido. Método: estudo correlacional, descritivo e de corte transversal. Amostra de conveniência de 170 homens em luto. As variáveis foram: mediadores do luto, manutenção de vínculos e dados sociodemográficos. Utilizou-se um questionário online composto por mediadores de luto, escala de manutenção de vínculos e dados sociodemográficos. Empregou-se estatística descritiva, análise de variância e coeficiente de Spearman. Nível de significância p<0,05. Resultados: os participantes tinham uma média de idade de 36,61 anos (DP=13,40) e 80,00% tinham ensino superior. A média de manutenção interna dos vínculos foi de 24,85 (DP=7,93) e a de manutenção externa foi de 7,68 (DP=2,33). Foram estabelecidas diferenças significativas para a manutenção dos vínculos internos e externos entre os parentes do falecido (p<0,001), nenhuma com a causa da morte ou o tempo decorrido desde a morte. Não foram encontradas correlações significativas entre a manutenção dos vínculos internos e externos e os mediadores do luto. Conclusão: os homens em luto expressaram a manutenção interna dos vínculos com frequência e a manutenção externa dos vínculos ocasionalmente, com diferenças a respeito de quem era a pessoa falecida. A enfermagem poderia criar estratégias específicas para fortalecer o enfrentamento do luto nesse grupo.
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Humans , Male , Adult , Bereavement , Adaptation, Psychological , Grief , Cross-Sectional Studies , Object AttachmentABSTRACT
Objetivo: analizar el patrón temporal y estimar las tasas de mortalidad en las primeras 24 horas de vida y por causas evitables en el estado de Pernambuco en el período de 2000 a 2021. Método: estudio ecológico, teniendo como unidad de análisis el trimestre. La fuente de datos se constituyó por el Sistema de Informaciones sobre Mortalidad y el Sistema de Informaciones sobre Nacidos Vivos. El modelado de series temporales se realizó según el Modelo Autorregresivo Integrado de Promedio Móvil. Resultados: se registraron 14.462 óbitos en las primeras 24 horas de vida, siendo 11.110 (el 76,8%) evitables. Se observa para los pronósticos ( forecasts) que la tasa de mortalidad en las primeras 24 horas de vida registro una variación de 3,3 a 2,4 por 1.000 nacidos vivos, y la tasa de mortalidad por causas evitables de 2,3 a 1,8 por 1.000 nacidos vivos. Conclusión: la predicción sugirió avances en la reducción de la mortalidad en las primeras 24 horas de vida en el estado y por causas evitables. Los modelos ARIMA presentaron estimaciones satisfactorias para las tasas de mortalidad y por causas evitables en las primeras 24 horas de vida.
Objective: to analyze the temporal pattern and estimate mortality rates in the first 24 hours of life and from preventable causes in the state of Pernambuco from 2000 to 2021. Method: an ecological study, using the quarter as the unit of analysis. The data source was made up of the Mortality Information System and the Live Birth Information System. The time series modeling was conducted according to the Autoregressive Integrated Moving Average Model. Results: 14,462 deaths were recorded in the first 24 hours of life, 11,110 (76.8%) of which being preventable. It is observed from the forecasts that the mortality rate in the first 24 hours of life ranged from 3.3 to 2.4 per 1,000 live births, and the mortality rate from preventable causes ranged from 2.3 to 1.8 per 1,000 live births. Conclusion: the prediction suggested progress in reducing mortality in the first 24 hours of life in the state and from preventable causes. The ARIMA models presented satisfactory estimates for mortality rates and preventable causes in the first 24 hours of life.
Objetivo: analisar o padrão temporal e estimar as taxas de mortalidade nas primeiras 24 horas de vida e por causas evitáveis no estado de Pernambuco no período de 2000 a 2021. Método: estudo ecológico, tendo como unidade de análise o trimestre. A fonte de dados foi constituída pelo Sistema de Informações sobre Mortalidade e pelo Sistema de Informações sobre Nascidos Vivos. A modelagem da série temporal foi conduzida segundo o Modelo Autorregressivo Integrado de Médias Móveis. Resultados: foram registrados 14.462 óbitos nas primeiras 24 horas de vida, sendo 11.110 (76,8%) evitáveis. Observa-se para os forecasts que a taxa de mortalidade nas primeiras 24 horas de vida variou de 3,3 a 2,4 por 1.000 nascidos vivos, e a taxa de mortalidade por causas evitáveis variou de 2,3 a 1,8 por 1.000 nascidos vivos. Conclusão: a previsão sugeriu avanços na redução da mortalidade nas primeiras 24 horas de vida no estado e por causas evitáveis. Os modelos ARIMA apresentaram estimativas satisfatórias para as taxas de mortalidade e por causas evitáveis nas primeiras 24 horas de vida.
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Humans , Infant, Newborn , Brazil , Information Systems , Mortality , Cause of DeathABSTRACT
Objetivo: Determinar el riesgo de muerte por insuficiencia cardiaca congestiva subyacente en pacientes anémicos de la población peruana. Materiales y métodos: Estudio observacional, descriptivo, de casos y controles y retrospectivo basado en datos del Sistema Informático Nacional de Defunciones (Sinadef) del Ministerio de Salud (Minsa) peruano entre enero de 2021 y agosto de 2022. El muestreo fue no probabilístico, intencional por conveniencia según los criterios de inclusión y exclusión. Se incluyó a todos los pacientes con y sin anemia que fallecieron por insuficiencia cardiaca congestiva u otras comorbilidades, que sumaron un total de 35 724 personas. Las variables fueron anemia, definida como un trastorno del tamaño o número de hematíes, de la hemoglobina, así como de la absorción y disponibilidad del hierro, e insuficiencia cardiaca congestiva, definida como la incapacidad del miocardio para bombear sangre de forma competente. Se realizó la prueba de chi al cuadrado y de los coeficientes Phi y V de Cramer para determinar la existencia y grado de asociación de las variables y la razón de probabilidades para la estimación del riesgo. Se consideró un valor de p significativo menor del 0,05, con un intervalo de confianza al 95 %. Resultados: La anemia estuvo moderadamente asociada a la insuficiencia cardiaca congestiva: fallecieron 62,80 % de personas con anemia. Las variables están estadísticamente relacionadas y, según los coeficientes Phi y V de Cramer, se trata de una relación moderada. Se halló que los anémicos tuvieron 11,14 veces mayor riesgo de morir por insuficiencia cardiaca congestiva que las personas con otras comorbilidades. Conclusiones: La anemia se asocia a un alto riesgo de muerte por insuficiencia cardiaca subyacente en la población peruana. Es necesario el seguimiento de los niveles de hierro, hemoglobina y hematíes en pacientes con insuficiencia cardiaca, así como tratar las causas de estas deficiencias, con el objetivo de reducir la morbimortalidad en este grupo de pacientes.
Objective: To determine the risk of death from underlying congestive heart failure among Peruvian patients with anemia. Materials and methods: An observational, descriptive, case-control and retrospective study based on data from the Sistema Informático Nacional de Defunciones (SINADEF National Death Computer System) of the Ministry of Health of Peru (MINSA) and conducted between January 2021 and August 2022. A non-probability purposive convenience sampling was used considering the inclusion and exclusion criteria. All patients with and without anemia who died from congestive heart failure or other comorbidities were included in the research, totaling 35,724 people. The variables were anemia, defined as a condition related to the amount or number of red blood cells and hemoglobin, as well as to iron absorption and availability, and congestive heart failure, defined as the inability of the myocardium to pump blood efficiently. Chi-square test and phi and Cramer's V coefficients were used to determine the presence and degree of association of the variables and the odds ratio for risk estimation. A significant p value less than 0.05 with a 95 % confidence interval was considered. Results: Anemia was moderately associated with congestive heart failure: 62.80 % of people with anemia died from this disease. The variables were statistically related and, according to phi and Cramer's V coefficients, there was a moderate relationship. People with anemia had 11.14 times higher risk of dying from congestive heart failure than people with other comorbidities. Conclusions: Anemia is associated with high risk of death from underlying heart failure in the Peruvian population. It is necessary to monitor iron, hemoglobin and red blood cell levels among patients with heart failure, as well as to identify the causes of these deficiencies in order to reduce morbidity and mortality in this group of patients.
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Fundamento: los accidentes constituyen cadenas de eventos y circunstancias que llevan a la ocurrencia de lesiones no intencionales. Son responsables de numerosas muertes cada año en el mundo. En el año 2019, los accidentes del tránsito y las caídas estuvieron entre las primeras 20 causas de muerte. En Cuba se erigieron como la quinta causa de mortalidad por todas las causas y edades en el decenio 2010-2019. Objetivo: caracterizar la mortalidad por accidentes en Cuba en el decenio 2010- 2019. Métodos: se realizó un estudio ecológico, longitudinal, descriptivo, de la mortalidad anual por accidentes en Cuba, a lo largo del decenio que comprende los años 2010 al 2019. Los anuarios estadísticos, publicados desde el año 2012 al 2022, por la Dirección de Registros Médicos y Estadísticas de Salud, del Ministerio de Salud Pública de Cuba, constituyeron la principal fuente de información. Para su procesamiento estadístico, los datos obtenidos fueron incluidos en una hoja de cálculo en Microsoft Excel y los resultados se expresaron en figuras y tablas. Resultados: las tasas brutas de mortalidad por accidentes en Cuba en el decenio 2010- 2019 se incrementaron de 43 a 49,9 por 100 000 habitantes, las más elevadas fueron por caídas: 23,7 en el año 2018 y 23,4 por 100 000 habitantes en el 2019. Los años de vida potencialmente perdidos por accidentes disminuyeron de 5,4 a 4,7 por 1 000 habitantes de 1 a 74 años. Conclusiones: en Cuba, en el decenio 2010- 2019, se observó un aumento en la mortalidad por accidentes a expensas de las caídas accidentales, estas con mayor frecuencia en el sexo femenino.
Background: accidents constitute chains of events and circumstances that lead to the occurrence of unintentional injuries. They are responsible for numerous deaths every year in the world. In 2019, traffic accidents and falls were among the top 20 causes of death. In Cuba, they stood as the fifth cause of mortality from all causes and ages in the decade 2010-2019. Objective: to characterize mortality from accidents in Cuba in the 2010-2019 decade. Methods: an ecological, longitudinal, descriptive study of annual mortality due to accidents in Cuba was carried out, throughout the decade from 2010 to 2019. The statistical yearbooks, published from 2012 to 2022, by the Directorate of Medical Records and Health Statistics, from the Ministry of Public Health of Cuba, constituted the main source of information. For its statistical processing, the data obtained were included in a spreadsheet in Microsoft Excel and the results were expressed in figures and tables. Results: the gross mortality rates due to accidents in Cuba in the 2010-2019 decade increased from 43 to 49.9 per 100,000 inhabitants, the highest being due to falls: 23.7 in 2018 and 23.4 per 100 000 inhabitants in 2019. The years of potential life lost due to accidents decreased from 5.4 to 4.7 per 1,000 inhabitants between 1 and 74 years of age. Conclusions: in Cuba, in the 2010-2019 decade, an increase in mortality from accidents was observed at the expense of accidental falls, these more frequently in the female sex.
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Background: Neonatal deaths are deaths of live born babies occurring before 28 completed days. The vast majority occur in low-income countries like Nigeria with a high neonatal mortality rate. There is paucity of autopsy studies due to refusal of family to give consent for such procedures. Aim: To identify the commonest causes of neonatal death in 53 neonatal autopsies in Calabar, Nigeria. Materials and Methods: Detailed postmortem was carried out using lettules techniques and bits taken for histological analysis to ascertain the cause of death. Other relevant contributory factors such as the gestational age, mode of delivery, place of birth, antemortem cause of deaths and maternal obstetric history were obtained from the medical records and autopsy request forms. Results: In the one-year retrospective study of 53 neonatal autopsies, male: female ratio was 1: 0.83 and mean age at death was 6.5 + 7.3 days, ranging from 1 to 28 days. The commonest cause of neonatal death was severe birth asphyxia seen in 10 cases (18.9%), followed by kernicterus in 6 cases (11.3%), birth trauma seen in 6 cases (11.3%), congenital heart disease seen in 5 cases (9.4%), and prematurity seen in 5 cases (9.4%). Conclusion: The study confirms the usefulness of neonatal autopsy in ascertaining the definitive cause of death. Severe birth Asphyxia was identified as the commonest cause of death in the neonatal period followed by birth trauma, kernicterus and congenital heart diseases.
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Background: Sepsis currently represents a challenge for health systems, this fact may be related to the spread of bacterial resistance, the increase in the population of elderly, immunosuppressed individuals, and the improvement of emergency care, favoring the survival of critically ill patients. This article aimed to evaluate the accuracy of mortality indicators due to sepsis in 2018. Method: Validation study of death certificates that occurred in the Federal District in 2018. Declarations whose basic causes of death identified were classified as garbage codes were identified, which were investigated by a multidisciplinary team, capable of reclassifying them with codes that allow for the improvement of health data. In order to assess accuracy, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios of death certificates from sepsis were calculated, with 95% confidence intervals. Results: A total of 6.244 statements were evaluated, of which 233 (3.74%) presented sepsis as the underlying cause before being investigated and only 35 (0.56%) maintained it after the investigation. The filling of statements with sepsis as the underlying cause by physicians showed a sensitivity of 0.9% (95%CI: 0.6 to 1.3) and a specificity of 92.0% (95%CI: 90.9 to 93.1). Conclusion: The low accuracy of the declarations demonstrates the non-reliability of the underlying cause of death from sepsis, especially the completion of death certificates that occurred in the Federal District in 2018.(AU)
Justificativa: A sepse, atualmente, representa um desafio para os sistemas de saúde, tal fato pode estar relacionado com a disseminação da resistência bacteriana, o aumento da população de idosos, os indivíduos imunossuprimidos, e a melhoria do atendimento de emergência, favorecendo a sobrevivência de pacientes críticos. Este artigo teve por objetivo avaliar a acurácia dos indicadores de mortalidade devido à sepse em 2018. Método: Estudo de validação da causa básica dos óbitos ocorridos no Distrito Federal em 2018. Foram identificadas as declarações de óbito cujas causas básicas de morte apontadas foram classificadas como garbage code sepse, as quais foram investigadas por uma equipe multidisciplinar, capacitada para reclassificá-las com códigos que permitem o aprimoramento dos dados em saúde. A fim de avaliar a acurácia, foram calculados os valores de sensibilidade, especificidade, valores preditivos positivo e negativo, razões de verossimilhança positiva e negativa das declarações dos óbitos por sepse, com intervalos de confiança de 95%. Resultados: Um total de 6.244 declarações foram avaliadas, das quais 233 (3,74%) apresentavam a sepse como causa básica antes de serem investigadas e apenas 35 (0,56%) mantiveram-na após a investigação. O preenchimento das declarações com a sepse enquanto causa básica pelos médicos apresentou sensibilidade de 0,9% (IC95%: 0,6 a 1,3) e especificidade de 92,0% (IC95%: 90,9 a 93,1). Conclusão: A baixa acurácia das declarações demonstra a não fidedignidade da causa básica de óbito por sepse, sobretudo, do preenchimento das declarações dos óbitos ocorridos no Distrito Federal em 2018.(AU)
Justificación: Sepsis representa en la actualidad un desafío para los sistemas de salud, este hecho puede estar relacionado con propagación de resistencias bacterianas, aumento de la población de ancianos, inmunodeprimidos, y mejora de la atención de urgencias, favoreciendo la supervivencia de los pacientes críticos. Este artículo tuvo como objetivo evaluar la precisión de los indicadores de mortalidad por sepsis en 2018. Método: Estudio de validación de causa básica de muertes ocurridas en Distrito Federal en 2018. Se identificaron actas de defunción cuyas causas básicas de muerte fueron clasificadas como sepsis código basura y fueron investigadas por un equipo multidisciplinario capacitado para reclasificarlas con códigos que permitan la mejora de datos de salud. Para evaluar la precisión, se calcularon sensibilidad, especificidad, valores predictivos positivo y negativo y razones de verosimilitud positiva y negativa de certificados de defunción por sepsis, con intervalos de confianza del 95%. Resultados: se evaluaron 6.244 declaraciones, de las cuales 233 (3,74%) tenían como causa básica la sepsis antes de ser investigadas y solo 35 (0,56%) mantuvieron después de investigación. Realización de declaraciones con sepsis como causa subyacente por parte de los médicos mostró sensibilidad del 0,9% (95%IC: 0,6 a 1,3) y especificidad del 92,0% (95%IC: 90,9 a 93,1). Conclusión: Baja precisión de las declaraciones demuestra la poca confiabilidad de la causa subyacente de muerte por sepsis, especialmente la finalización de los certificados de defunción ocurridos en Distrito Federal en 2018.(AU)
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Humans , Indicators of Morbidity and Mortality , Sepsis/mortality , Data Accuracy , Cause of DeathABSTRACT
Resumo Objetivou-se investigar a magnitude e a tendência da mortalidade de crianças de 5 a 14 anos por causas, no estado do Rio de Janeiro, de 2000 a 2019. Estudo ecológico de tendência temporal utilizando dados do Sistema de Informações sobre Mortalidade (SIM). Calcularam-se taxas de mortalidade por 100 mil crianças, por capítulos, grupos e categorias (CID-10). Estimou-se a série temporal por regressão joinpoint. As taxas de mortalidade de 10 a 14 anos foram superiores às da faixa de 5 a 9 anos. As cinco principais causas foram as mesmas de 5 a 14 anos, com diferente ordem de importância. As duas principais foram causas externas e neoplasias (31% e 15% para 5 a 9 anos; 45% e 11% para 10 a 14 anos). De 5 a 9 anos, a tendência da mortalidade teve declínio anual (8%) entre 2011 e 2015. De 10 a 14 anos, o declínio anual foi 1,3%, de 2000 a 2019. A mortalidade por causas externas decresceu em ambas as faixas, menos para a categoria "Agressão por arma de fogo" (meninos,10-14 anos) e "Afogamento" (meninos, 5-9 anos). A mortalidade por neoplasias ficou estável para todos. Doenças infecciosas e respiratórias decresceram de forma diferenciada entre os grupos. A maioria das causas de morte é evitável ou tratável, apontando necessidade de investimentos em saúde e intersetoriais.
Abstract This study investigated the magnitude and trends of cause-specific mortality among children 5 to 14 years of age in the state of Rio de Janeiro (RJ) from 2000 to 2019. We performed an ecological study, using data from the Mortality Information System (MIS). We calculated mortality rates per 100,000 children by chapters, groups, and categories of causes of death (ICD-10). Trends were estimated by joinpoint regression. Mortality rates among children aged 10 to 14 years were higher than those among children 5 to 9. The five leading causes of death were the same in both age groups, but they ranked differently. The two leading ones were external causes and neoplasms (31% and 15% among children aged 5 to 9 years; 45% and 11% among children aged 10 to 14 years). Among children 5 to 9 years, the mortality trend showed an annual decline (8%) from 2011 to 2015. Among children aged 10 to 14 years, the annual decline was 1.3% from 2000 to 2019. Mortality due to external causes decreased in both age groups, except for the category "Assault by unspecified firearm" (boys, 10 to 14 years) and "Unspecified drowning and submersion" (boys, 5 to 9 years). Mortality caused by neoplasms remained steady in both age groups. Infectious and respiratory diseases decreased differently between the two groups. Most causes of death are preventable or treatable, indicating the need for health and intersectoral investments.
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Resumo O objetivo deste artigo é avaliar a magnitude e o perfil dos óbitos por condições posteriores à COVID-19 no Brasil. Estudo descritivo com base nos dados preliminares de registro de óbitos do Sistema de Informação sobre Mortalidade ocorridos em 2021. Foram considerados os registros com código CID B94.8 como causa básica e com código U09 em alguma linha da parte I ou II da declaração de óbito. Foi avaliada a distribuição dos óbitos por região geográfica, semestre de ocorrência, sexo, faixa etária, raça/cor, escolaridade e local de ocorrência. Foram registrados 2.948 óbitos por condições posteriores à COVID-19, variando de 0,5 óbito por 1.000 registros na região Nordeste a 3,6/1.000 na região Centro-Oeste. Mais da metade ocorreu entre o sexo masculino (58,0%), aqueles com 60 anos ou mais de idade (66,9%) e de cor da pele branca (51,8%). Os óbitos por condições posteriores à COVID-19 apresentaram características sociodemográficas distintas entre as regiões.
Abstract This paper aims to assess the magnitude and profile of deaths from post-COVID conditions in Brazil. Descriptive study based on preliminary data from the 2021 Mortality Information System. Records with ICD code B94.8 as the Basic Cause and with code U09 in some lines of part I or II of the declaration were considered for analysis. The distribution of deaths by geographic region, semester of occurrence, sex, age group, ethnicity/skin color, schooling, and place of occurrence was evaluated. We identified 2,948 deaths from conditions subsequent to COVID-19 were recorded, ranging from 0.5 deaths per 1,000 records in the Northeast Region to 3.6/1,000 in the Midwest Region. More than half occurred among males (58.0%), those aged 60 years or older (66.9%), and whites (51.8%). Conclusion: Deaths from post-COVID conditions had distinct sociodemographic characteristics between regions.
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Resumo Objetivou-se analisar a mortalidade dos imigrantes bolivianos residentes no município de São Paulo comparada à dos brasileiros, com ênfase na análise das mortes evitáveis. Estudo descritivo dos óbitos do município de São Paulo entre 2007 e 2018 registrados no Sistema de Informações sobre Mortalidade. Foram analisados os óbitos de pessoas de 5 a 74 anos, conforme a lista de causas de mortes evitáveis por intervenções do Sistema Único de Saúde, segundo grupos e sexo; o teste de qui-quadrado foi utilizado na comparação das nacionalidades. A tendência temporal foi avaliada pela regressão de Prais-Winsten. Houve 1.123 óbitos de bolivianos e 883.116 de brasileiros, com predomínio de óbitos masculinos, com idade média ao morrer menor (-13,6 anos) para bolivianos. A proporção de óbitos por causas evitáveis foi semelhante entre bolivianos (71,0%) e brasileiros (72,8%) e a tendência não apresentou variação anual proporcional significante para ambas as nacionalidades. Para bolivianos, houve maior frequência de causas externas (27,6%) e de causas reduzíveis por ações de promoção, prevenção, controle e atenção às doenças infecciosas (20,8%). Os bolivianos exibiram mortalidade mais jovem, sem redução na proporção de causas evitáveis, o que pode indicar acesso desigual aos serviços de saúde.
Abstract The objective was to analyze the mortality of Bolivian immigrants compared to the Brazilian population, living in the city of São Paulo, with an emphasis on the analysis of avoidable deaths. Descriptive study of deaths in the city of São Paulo, between 2007 and 2018, registered in the Mortality Information System. Deaths of people aged 5 to 74 years were analyzed, according to "Brazilian List of Causes of Preventable Deaths", according to groups and sex; Pearson's chi-square test was used to compare nationalities. The temporal trend of avoidable deaths was evaluated by Prais-Winsten regression. There were 1.123 Bolivians deaths and 883.116 among Brazilians, with a predominance of male deaths and the Bolivians died on average 13.6 years younger. The proportion of deaths from preventable causes was similar between Bolivians (71.0%) and Brazilians (72.8%) and the trend did not show significant proportional annual variation for both nationalities. There is a higher frequency, among Bolivians, of external causes (27.6%) and of causes reducible by actions to health promotion, prevention, control, and care for infectious diseases (20.8%) than to Brazilians. Conclusion: Bolivians died younger and showed no reduction in the proportion of potentially avoidable causes, which may indicate unequal access to health services.
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Objective:To analyze the changing trends in maternal mortality ratios (MMRs) and the main cause-specific MMRs in China from 2010 to 2020, evaluate the association between MMRs and pregnancy healthcare and predict the MMRs for the next five years.Methods:Data on MMRs, the main cause-specific MMRs, and maternal healthcare in China from 2010 to 2020 were collected from China Health Statistical Yearbook. Estimated annual percent changes (EAPCs) were used to analyze the trends in MMRs and the main cause-specific MMRs in China. Average growth rate was used to describe the trend of perinatal healthcare indicators, and spearman rank correlation was used to analyze the correlation between MMRs and perinatal healthcare indicators. GM (1,1) model was established to predict the MMRs for the following five years. Results:(1) From 2010 to 2020, the EAPCs were－5.16%,－6.24%, and－4.28%, respectively, indicating downward trends in MMRs in the whole nation, urban and rural areas ( t=－0.98,－12.42 and－8.96, all P<0.001). (2) From 2010 to 2020, the main cause-specific MMRs in China from obstetric hemorrhage, hypertension during pregnancy, amniotic fluid embolism, and liver disease were all in downward trends ( t=－12.42,－5.44,－3.98 and－3.63, all P<0.001). Except for the MMR from hypertension during pregnancy in urban areas (average growth rate =0.51%), all main cause-specific MMRs in both urban and rural areas decreased significantly, especially the MMRs from hepatopathy in urban and rural areas (average growth rate=－10.40% and－13.96%). (3) The nation wide MMR was negatively correlated with maternal system management rate ( r s=－0.80, P=0.003), prenatal examination rate ( r s=－0.97, P<0.001), postpartum visit rate ( r s=－0.82, P=0.002) and hospital delivery rate ( r s=－0.98, P<0.001). Negative correlations were also found between the MMR and hospital delivery rate in both urban ( r s=－0.82, P=0.002) and rural areas ( r s=－0.95, P<0.001). (4) The GM (1, 1) models for forecasting MMRs in the whole nation, urban and rural areas were established with an accuracy of level 1. The MMR was predicted to show a downward trend in the following five years. The MMRs in China were 15.86/100 000 in 2021 and 15.13/100 000 in 2022 through prediction, similar to the 16.1/100 000 and 15.7/100 000 as announced by the government. Conclusions:The overall MMR in China shows a downward trend, and it dropped faster in urban areas than the rural areas. In addition, it is predicted that the MMR will continue to decline in the following five years, but the gap between urban and rural areas will remain.
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Objective:To investigate the current status of hospitalized neonatal death of different gestational ages in Shaanxi Province.Methods:All neonatal deaths in six hospitals in Shaanxi Province from 2016 to 2020 were retrospectively analyzed, and the differences in perinatal complications, the causes of death, and the age at death were compared using Chi-square (or Fisher's exact ) test. Results:(1) Totally, 220 488 neonates were delivered in the obstetric department of the six hospitals during the study period; 71 782 out of them were admitted to the neonatal department. While 424 neonatal death was reported, giving the total hospitalized neonates mortality rate of 5.5‰ (394/71 782), which included 152 deaths of transferred patients ( n=9 103, 16.7‰), 226 premature (53.3%), 196 term (46.2%), and two post-term infants (0.5%). (2) Among mothers of dead neonates, 73.6% were found to have at least one perinatal complication. The most common one was fetal distress (146 cases, 34.4%), followed by gestational diabetes mellitus (113 cases, 26.7%), amniotic fluid abnormalities ( n=73, 17.2%), maternal infectious diseases ( n=71, 16.8%), and hypertensive disorders in pregnancy (HDP) ( n=52, 12.3%). The lower the gestational age, the higher the proportion of multiple pregnancies and assisted reproduction technology applied (Fisher exact test, P<0.05). On the contrary, the higher the gestational age, the higher the cesarean section rate ( χ 2=26.69, P<0.001). HDP was more likely to occur in the gestational age of 28-31 +6 and 32-34 +6 weeks ( χ 2=37.16, P<0.001), and amniotic fluid abnormalities were more likely to occur in those over 37 weeks ( χ 2=27.47, P<0.001). (3) The five leading causes of neonatal death were neonatal respiratory distress syndrome (NRDS, n=100, 23.6%), neonatal asphyxia ( n=88, 20.8%), maternal infectious diseases ( n=80, 18.9%), and birth defects ( n=54, 12.7%), and pulmonary hemorrhage ( n=22, 5.2%). The first three causes of death in term and post-term infants were neonatal asphyxia ( n=65, 32.8%), birth defects ( n=42, 21.2%), and infectious diseases ( n=26, 13.1%). NRDS ( n=83, 36.7%), infectious diseases ( n=54, 23.9%), and neonatal asphyxia ( n=23, 10.2%) were the three leading causes of death of premature babies. (4) Out of the 326 (76.9%) neonatal deaths within seven days after birth, 162 (38.2%) died within 24 h after birth and 164 cases (38.7%) between one to seven days after birth. Conclusions:Most neonatal deaths occurred among preterm ones and within seven days after birth, whose mothers suffered perinatal complications. The causes of neonatal death vary among different gestational age groups.
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To study of premature/early death of autistic patients from the perspective of life course can help families, medical institutions and policy makers better deal with the adverse effects of autism. Several studies have shown that autistic patients have a high risk of death, however, the results are still inconsistent. To assess the risk of mortality among the autistic patients, we undertook a comprehensive search of MEDLINE, Web of Science and EMBASE databases. This paper reviewed the studies on the negative disease outcomes of autism spectrum disorders, including the risk of death, causes of death and several research hotspots in this field. Strict inclusion/exclusion criteria were used. Information was extracted from selected papers, tabulated and synthesized. In the study, 15 studies were included, with a total of 216 045 individuals. The main outcome was all-cause mortality in association with autism and the secondary outcome was cause-specific mortality. The results showed that all-cause mortality was higher for the autistic patients (RR=2.32, 95%CI: 1.98-2.72, I2=87.1%, P < 0.001). Risk ratio showed a greater inequality for female than male (male: RR=2.00, 95%CI: 1.57-2.55, I2=93.2%, P < 0.001; female: RR=4.66, 95%CI: 3.30-6.58, I2=92.0%, P < 0.001). Compared with the unnatural death, the risk of natural death was higher (RR=3.44, 95%CI: 1.27-9.26, I2=80.2%, P=0.025). As autism had many comorbidities, which would bring more health risks and natural deaths possibilities. There were some structural differences in unnatural death. Accidental injury death and suicide were two kinds of causes. Lacking social skills would weaken the ability to ask for help when encountering injuries. This paper put forward some suggestions for futures. First, to well study the comorbidity can reduce the risk of death from a medical point of view. Second, the scientists and policymakers should pay attention to the social environment and provide a safer environment for the autistic patients. Third, for women and for adolescents without cognitive impairment, due to their high risk of suicide, the society should provide them with more supportive social networks and improve their life satisfaction. Fourth, it is necessary to balance the rehabilitation resources in various regions in China and provide more high-quality lifelong rehabilitation monitoring and care services.
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Adolescent , Humans , Male , Female , Autism Spectrum Disorder , Cause of Death , Comorbidity , Autistic Disorder , ChinaABSTRACT
ObjectiveTo determine the trend in diabetes-related death and probability of premature mortality among residents in Yangpu District of Shanghai and provide evidence for the formulation of relevant intervention strategies. MethodsMortality and demographic data were collected among residents in Yangpu District of Shanghai from 2002 to 2020. Statistical analysis was conducted using chi-square test with SPSS 21.0 and Excel 2010. Joinpoint regression was used to determine annual percent change （APC）. The mortality was standardized by utilizing the world standard population in 2000. ResultsA total of 25 091 cases of diabetes-related deaths were reported in Yangpu District， Shanghai from 2002 to 2020. The average annual crude mortality of diabetes-related diseases was 122.10/105， which was 116.13/105 in males and 128.23/105 in females. The difference between males and females in crude mortality was statistically significant （P<0.05）. Moreover， primary causes of diabetes-related deaths were diabetes， cardiovascular and cerebrovascular diseases， and tumors. Among diabetic deaths， peripheral circulatory complications accounted for 50.79%， followed by renal complications （16.05%）. The crude mortality in males， females， and total of diabetes-related diseases showed an upward trend， while the standardized mortality remained stable with an upward trend in male and a downward trend in female. Furthermore， the crude mortality in males， females， and total of diabetes complicated with cardiovascular and cerebrovascular diseases showed an increasing trend. In contrast， both the standardized mortality in males and in total showed an increasing trend， while that in females remained stable. The overall crude mortality of diabetes was on the rise， which was increasing in males and stable in females. The overall standard mortality of diabetes was on the decline， which was increasing in males while declining in females. In addition， the probability of premature mortality caused by diabetes-related diseases， cardiovascular and cerebrovascular diseases complicated with diabetes， and diabetes decreased from 2002 to 2020 with no statistical significance. Males showed an upward trend while females showed a downward trend. ConclusionThe mortality of diabetes-related diseases， cardiovascular and cerebrovascular diseases complicated with diabetes， and diabetes among residents in Yangpu District of Shanghai is on the rise. Similarly， standardized mortality and probability of premature mortality in males for all three diseases are also on the rise. It warrants more attention to the health of male diabetes patients and targeted measures to reduce the disease burden.
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Objective@# To analyze the death among children under 5 years of age in Huzhou City, Zhejiang Province from 2012 and 2021, so as to provide insights into reduction of mortality among children. @*Methods@#The mortality surveillance data among children under 5 years of age in Huzhou City from 2012 to 2021 were collected from Children Death Report Cards and Surveillance Report among Children under 5 Years of Age, including gender, place of residence, date of death and death diagnosis. The trends in mortality and cause of death were analyzed among children under 5 years of age in Huzhou City from 2012 to 2021.@*Results@#A total of 1 262 deaths occurred among children under 5 years of age in Huzhou City from 2012 to 2021, with mean annual mortality of 4.39‰, and the mortality appeared a tendency towards a decline (χ2trend=132.695, P<0.001). A total of 899 infants died, with mean annual mortality of 3.13‰, and 363 children at ages of 1 to <5 years died, with mean annual mortality of 1.26‰. The mortality appeared a tendency towards a decline among both infants (χ2trend=117.778, P<0.001) and children at ages of 1 to <5 years (χ2trend=19.201, P<0.001). A total of 724 local children died, with mean annual mortality of 3.33‰, and there were 538 deaths among floating children, with mean annual mortality of 7.65‰. The mortality appeared a tendency towards a decline among both local (χ2trend=43.728, P<0.001) and floating children (χ2trend=94.038, P<0.001). The five most common causes of death included preterm birth or low birth weight (207 deaths, 16.40%), drowning (155 deaths, 12.28%), accidental asphyxia (138 deaths, 10.94%), other congenital abnormalities (126 deaths, 9.98%), and congenital heart diseases (113 deaths, 8.95%). @*Conclusions @#The mortality appeared a tendency towards a decline among children under 5 years of age in Huzhou City from 2012 to 2021, and preterm birth or low birth weight was the predominant cause of death.
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@#Abstract: Objective To further investigate the underreporting of mortality surveillance data among permanent residents in Hainan Province in 2020, and to explore the application of Application of the Analysis of National Causes of Death for Action (ANACONDA) in the quality analysis of mortality surveillance. Methods The data were collected from the Death Information Monitoring and Management System of Hainan Center for Disease Control and Prevention, and mainly included 33 418 deaths reported from 19 cities and counties in Hainan Province from January 1, 2020 to December 31, 2020. All the data were analyzed by the application of ANACONDA, and the causes of death were classified by the International Classification of Diseases, 10th Revision (ICD-10). Results A total of 33 418 deaths were reported in Hainan Province in 2020, with a crude mortality rate of 3.6‰. The proportion of deaths in males under 85 years old was higher than that in females, while the proportion of deaths in 85 years old and above was opposite. The quality analysis of cause of death surveillance showed that there was under-reporting of death surveillance in Hainan Province in 2020, with an under-reporting rate of 30.1%. There were differences in the age composition and GBD regional composition ratio of deaths of the three major categories of diseases, and the misreporting of causes of death in the middle and high age groups was more significant. The Vital Statistics Performance Index (VSPI) score of death data in Hainan Province in 2020 was 52.8, the score of cause of death reporting quality was 85.5, and the score of specific cause of death level that could be used was 88.4. The completeness of death reports in the priority action areas for improving cause of death data quality accounted for the largest share, followed by the quality of cause of death reports. There was a difference in the proportion of specific causes of death between males and females after the survey, but the change in order was not obvious. Conclusions The data integrity of cause-of-death surveillance is low in Hainan Province in 2020. It is suggested to improve the completeness of reporting data, strengthen the training of cause-of-death surveillance system, and regularly evaluate and supervise the system.
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ObjectiveTo analyze the mortality data of children under 5 years in Chongming District， Shanghai， and to analyze the main causes of death of children under 5 years， so as to provide scientific basis for reducing the mortality of children under 5 years in Chongming District. MethodsData of children under 5 years in Chongming District from 2011 to 2020 were collected from the Maternal and Child Health Information System of Chongming District， Shanghai. The mortality rate and main causes of death of children under 5 years in Chongming District were analyzed retrospectively. ResultsFrom 2011 to 2020， the average mortality rate of children under 5 years in Chongming District was 6.51‰， and the overall trend was stable. The mortality rate of children under 5 years with non-local household registration （11.44‰） was significantly higher than that of children under 5 years of age with local household registration （4.88‰） （P<0.05）. The main causes of death for children under 5 years were accidental deaths （drowning， accidental asphyxia， traffic accidents）， while the main causes of death for infants were congenital heart disease， premature birth or low birth weight， congenital abnormalities， birth asphyxia and pneumonia. ConclusionIt is necessary to strengthen safety education for children and their guardians and strengthen safety management for children who are not registered in this city. Departments of obstetrics and gynecology and the departments of pediatrics should be expanded， and prenatal examination should be strenthened for high risk or elderly parturient women to further reduce the death rate of children under 5 years old.
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Resumo O objetivo deste estudo é analisar a tendência das principais causas de óbito de mulheres em idade fértil (MIF) no Brasil, por faixa etária, no período de 2006 a 2019. Utilizaram-se dados do Sistema de Informações sobre Mortalidade (SIM) e do Instituto Brasileiro de Geografia e Estatística (IBGE). As principais causas de morte de MIF (10 a 49 anos) foram classificadas por capítulos da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10). Posteriormente realizou-se análise de tendência temporal por meio de modelos de regressão polinomial das principais causas de morte de MIF segundo faixa etária. No Brasil, as maiores taxas de mortalidade por causas p/100 mil MIF deveram-se a neoplasias (25,34), doenças do aparelho circulatório (20,15), causas externas (18,69), doenças infecciosas e parasitárias (8,79) e doenças do aparelho respiratório (6,37). Para o período analisado, após padronização, as taxas de mortalidade por doenças do aparelho circulatório, do aparelho respiratório e infecciosas e parasitárias apresentaram tendência decrescente, com uma queda expressiva de 26,6% para as doenças do aparelho circulatório; já as taxas de mortalidade por causas externas e neoplasias registraram tendência crescente de 2006 a 2012 e decrescente de 2013 em diante. As causas externas e as neoplasias foram as principais causas de óbito, especialmente entre as mulheres mais jovens e com tendência crescente. Sendo este um importante problema de saúde pública, faz-se necessário planejar ações que otimizem os recursos e melhorem a qualidade de vida e saúde das mulheres.
Abstract The aim of this study is to analyze the trend of the main causes of death of women of reproductive age (WRA) in Brazil by age group from 2006 to 2019. Data used are from the Mortality Information System (SIM) and the Brazilian Institute of Geography and Statistics (IBGE) of Brazil. The main causes of death of WRA (10 to 49 years) were divided by chapters as per the International Statistical Classification of Diseases and Related Health Problems (ICD-10). Subsequently, a temporal trend analysis was performed using polynomial regression models for the main causes of death in WRA. In Brazil, the highest mortality rates by cause by 100,000 WRA occurred due to: neoplasms (25.34), diseases of the circulatory system (20.15), external causes (18.69), infectious and parasitic diseases (8.79) and respiratory system diseases (6.37). For the analyzed period, after standardization, the mortality rate due to diseases of the circulatory and respiratory systems, and infectious and parasitic conditions showed a decreasing trend, with a significant drop of 26.6% for diseases of the circulatory system; while external causes and neoplasms showed an increasing trend from 2006 to 2012 and decreasing from 2013 onwards. Identifying the main causes of death of WRA in each age group is required to guide the planning of actions to optimize resources and obtain better results in women's health.
Resumen El objetivo de este estudio es analizar la tendencia de las principales causas de muerte de mujeres en edad fértil (MEF) en Brasil por grupo de edad desde 2006 hasta 2019. Con datos del Sistema de Información de Mortalidad (SIM) y del Instituto Brasileiro de Geografía y Estadísticas (IBGE) de Brasil, las principales causas de muerte de MEF (10 a 49 años) fueron divididas por capítulos de la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud (CIE-10). Luego se hizo un análisis de tendencia temporal mediante modelos de regresión polinomial de las principales causas de muerte en MEF. En Brasil, las mayores tasas de mortalidad por causa en MEF/100.000 mujeres ocurrieron por neoplasias (25,34), enfermedades del aparato circulatorio (20,15), causas externas (18,69), enfermedades infecciosas y parasitarias (8,79) y enfermedades del sistema respiratorio (6,37). Para el período analizado, después de la estandarización, la tasa de mortalidad por neoplasias y por enfermedades de los sistemas circulatorio, respiratorio e infeccioso y parasitario mostró una tendencia decreciente, con una caída significativa del 26,6 % para enfermedades del sistema circulatorio, mientras que las causas externas y neoplasias mostraron una tendencia creciente entre 2006 y 2012 y decreciente desde 2013 en adelante. Identificar las principales causas de muerte en MEF en cada grupo de edad orienta la planificación de acciones para optimizar recursos y obtener mejores resultados en la salud de la mujer.