Differentials in death count records by databases in Brazil in 2010

ABSTRACT OBJECTIVE To compare the death counts from three sources of information on mortality available in Brazil in 2010, the Mortality Information System (SIM - Sistema de Informações sobre Mortalidade ), Civil Registration Statistic System (RC - Sistema de Estatísticas de Resgistro Civil ), and the 2010 Demographic Census at various geographical levels, and to confirm the association between municipal socioeconomic characteristics and the source which showed the highest death count. METHODS This is a descriptive and comparative study of raw data on deaths in the SIM, RC and 2010 Census databases, the latter held in Brazilian states and municipalities between August 2009 and July 2010. The percentage of municipalities was confirmed by the database showing the highest death count. The association between the source of the highest death count and socioeconomic indicators - the Índice de Privação Brasileiro (IBP - Brazilian Deprivation Index) and Índice de Desenvolvimento Humano Municipal (IHDM - Municipal Human Development Index) - was performed by bivariate choropleth and Moran Local Index of Spatial Association (LISA) cluster maps. RESULTS Confirmed that the SIM is the database with the highest number of deaths counted for all Brazilian macroregions, except the North, in which the highest coverage was from the 2010 Census. Based on the indicators proposed, in general, the Census showed a higher coverage of deaths than the SIM and the RC in the most deprived (highest IBP values) and less developed municipalities (lowest IDHM values) in the country. CONCLUSION The results highlight regional inequalities in how the databases chosen for this study cover death records, and the importance of maintaining the issue of mortality on the basic census questionnaire.

Métodos para avaliação da efetividade de vacinas para COVID-19 com ênfase em abordagens quase-experimentais / Methods to evaluate COVID-19 vaccine effectiveness, with an emphasis on quasi-experimental approaches

Resumo A avalição da efetividade de vacinas é feita com dados do mundo real e é essencial para monitorar o desempenho dos programas de vacinação ao longo do tempo bem como frente a novas variantes. Até o momento, a avaliação da efetividade das vacinas para COVID-19 tem sido baseada em métodos clássicos como estudos de coorte e caso controle teste-negativo, que muitas vezes podem não permitir o adequado controle dos vieses intrínsecos da alocação das campanhas de vacinação. O objetivo dessa revisão foi discutir os desenhos de estudo disponíveis para avaliação de efetividade das vacinas, enfatizando os estudos quase-experimentais, que buscam mimetizar os estudos aleatorizados ao introduzir um componente exógeno para atribuição ao tratamento, bem como suas vantagens, limitações e aplicabilidade no contexto dos dados brasileiros. O emprego de métodos quase-experimentais, incluindo as séries temporais interrompidas, o método de diferença em diferenças, escore de propensão, variáveis instrumentais e regressão descontínua, são relevantes pela possibilidade de gerar estimativas mais acuradas da efetividade de vacinas para COVID-19 em cenários como o brasileiro, que se caracteriza pelo uso de várias vacinas, com respectivos número e intervalos entre doses, aplicadas em diferentes faixas etárias e em diferentes momentos da pandemia.

Abstract The evaluation of vaccine effectiveness is conducted with real-world data. They are essential to monitor the performance of vaccination programmes over time, and in the context of the emergence of new variants. Until now, the effectiveness of COVID-19 vaccines has been assessed based on classic methods, such as cohort and test-negative case-control studies, which may often not allow for adequate control of inherent biases in the assignment of vaccination campaigns. The aim of this review was to discuss the study designs available to evaluate vaccine effectiveness, highlighting quasi-experimental studies, which seek to mimic randomized trials, by introducing an exogenous component to allocate to treatment, in addition to the advantages, limitations, and applicability in the context of Brazilian data. The use of quasi-experimental approaches, such as interrupted time series, difference-in-differences, propensity scores, instrumental variables, and regression discontinuity design, are relevant due to the possibility of providing more accurate estimates of COVID-19 vaccine effectiveness. This is especially important in scenarios such as the Brazilian, which characterized by the use of various vaccines, with the respective numbers and intervals between doses, applied to different age groups, and introduced at different times during the pandemic.

Area deprivation measures used in Brazil: a scoping review

ABSTRACT OBJECTIVE To describe and assess currently used area-based measures of deprivation in Brazil for health research, to the purpose of informing the development of a future small area deprivation index. METHODS We searched five electronic databases and seven websites of Brazilian research institutions and governmental agencies. Inclusion criteria were: studies proposing measures of deprivation for small areas (i.e., finer geography than country-level) in Brazil, published in English, Portuguese or Spanish. After data-extraction, results were tabulated according to the area level the deprivation measure was created for and to the dimensions of deprivation or poverty included in the measures. A narrative synthesis approach was used to summarize the measures available, highlighting their utility for public health research. RESULTS A total of 7,199 records were retrieved, 126 full-text articles were assessed after inclusion criteria and a final list of 30 articles was selected. No small-area deprivation measures that have been applied to the whole of Brazil were found. Existing measures were mainly used to study infectious and parasitic diseases. Few studies used the measures to assess inequalities in mortality and no studies used the deprivation measure to evaluate the impact of social programs. CONCLUSIONS No up-to-date small area-based deprivation measure in Brazil covers the whole country. There is a need to develop such an index for Brazil to measure and monitor inequalities in health and mortality, particularly to assess progress in Brazil against the Sustainable Development Goal targets for different health outcomes, showing progress by socioeconomic groups.

Avaliacao da assistencia a saude do recem-nascido no municipio de Salvador, 1993 / Evaluation of the health care of newborn babies in the municipal district of Salvador, 1993

Os obitos neonatais precoces contribuiram com aproximadamente (trinta por cento) do total de mortes infantis no periodo de 1980 a 1993, representando em torno de (sessenta60 a setenta por cento) das mortes neonatais em Salvador. As causas mais frequentes naquele periodo foram as hipoxias, asfixia ao nascer e outras afeccoes respiratorias, o crescimento fetal retardado e a prematuridade, as quais sao tecnicamente evitaveis e estao relacionadas as deficiencias na atencao ao pre-natal, ao parto e ao recem-nascido. A ausencia de estudos sobre a magnitude das mortes neonatais precoces e a sua relacao com a qualidade do cuidado prestado ao recem-nascido tem dificultado a reorganizacao da assistencia neonatal em Salvador. Assim, o presente estudo teve como objetivo avaliar a existencia de associacao entre a qualidade da assistencia a saude do recem-nascido e as mortes neonaatais precoces nessa cidade em 1993, utilizando o metodo epidemiologico.