Improving the quality of external cause of death data in Brazil: evaluation and validation of a new form to investigate garbage codes.

Garbage codes, such as external causes with no specific information, indicate poor quality cause of death data. Investigation of garbage codes via an effective instrument is necessary to convert them into useful data for public health. This study analyzed the performance and suitability of the new investigation of deaths from external causes (IDEC) form to improve the quality of external cause of death data in Brazil. The performance of the IDEC form on 133 external garbage codes deaths was compared with a stratified matched sample of 992 (16%) investigated deaths that used the standard garbage codes form. Consistency between these two groups was checked. The percentage of garbage codes from external causes reclassified into valid causes with a 95% confidence interval (95%CI) was analyzed. Reclassification for specific causes has been described. Qualitative data on the feasibility of the form were recorded by field investigators. Investigation using the new form reduced all external garbage codes by -92.5% (95%CI: -97.0; -88.0), whereas the existing form decreased garbage codes by -60.5% (95%CI: -63.5; -57.4). The IDEC form presented higher effectivity for external-cause garbage codes of determined intent. Deaths that remained garbage codes mainly lacked information about the circumstances of poisoning and/or vehicle accidents. Despite the fact that field investigators considered the IDEC form feasible, they suggested modifications for further improvement. The new form was more effective than the current standard form in improving the quality of defined external causes.

Improving the quality of external cause of death data in Brazil: evaluation and validation of a new form to investigate garbage codes / Melhorando a qualidade dos dados de causa externa de morte no Brasil: avaliação e validação de um novo formulário para investigar códigos garbage / Mejora en la calidad de los datos de causa externa de muerte en Brasil: evaluación y validación de un nuevo formulario para investigar códigos garbage

Garbage codes, such as external causes with no specific information, indicate poor quality cause of death data. Investigation of garbage codes via an effective instrument is necessary to convert them into useful data for public health. This study analyzed the performance and suitability of the new investigation of deaths from external causes (IDEC) form to improve the quality of external cause of death data in Brazil. The performance of the IDEC form on 133 external garbage codes deaths was compared with a stratified matched sample of 992 (16%) investigated deaths that used the standard garbage codes form. Consistency between these two groups was checked. The percentage of garbage codes from external causes reclassified into valid causes with a 95% confidence interval (95%CI) was analyzed. Reclassification for specific causes has been described. Qualitative data on the feasibility of the form were recorded by field investigators. Investigation using the new form reduced all external garbage codes by -92.5% (95%CI: -97.0; -88.0), whereas the existing form decreased garbage codes by -60.5% (95%CI: -63.5; -57.4). The IDEC form presented higher effectivity for external-cause garbage codes of determined intent. Deaths that remained garbage codes mainly lacked information about the circumstances of poisoning and/or vehicle accidents. Despite the fact that field investigators considered the IDEC form feasible, they suggested modifications for further improvement. The new form was more effective than the current standard form in improving the quality of defined external causes.

Códigos garbage (códigos inespecíficos ou incompletos), como causas externas sem informações específicas, indicam dados de má qualidade sobre a causa da morte. É necessário investigar os códigos garbage com um instrumento efetivo para convertê-los em dados úteis para a saúde pública. Este estudo analisou o desempenho e a adequação do novo formulário de investigação de óbitos por causas externas (IDEC) para melhorar a qualidade dos dados de causa externa de morte no Brasil. O desempenho deste formulário em 133 óbitos com códigos garbage de causas externas foi comparado com uma amostra estratificada e pareada de 992 (16%) óbitos investigados que utilizaram o formulário padrão de códigos garbage existente. A consistência entre esses dois grupos foi verificada. Analisou-se o percentual de códigos garbage de causas externas reclassificados em causas válidas com um intervalo de 95% de confiança (IC95%). A reclassificação para causas específicas foi descrita. Dados qualitativos sobre a viabilidade do formulário foram registrados por pesquisadores de campo. A investigação com o novo formulário reduziu todos os códigos garbage de causas externas em -92,5% (IC95%: -97,0; -88,0) enquanto o formulário existente diminuiu os códigos garbage em -60,5% (IC95%: -63,5; -57,4). O formulário IDEC foi mais eficaz para os códigos garbage de causa externa sem intenção indeterminada. As mortes que permaneceram como códigos garbage careciam principalmente de informações detalhadas sobre as circunstâncias do envenenamento e dos acidentes de trânsito. O formulário IDEC foi considerado viável pelos investigadores de campo, no entanto, eles sugeriram modificações para um maior aperfeiçoamento. O novo formulário foi mais eficaz do que o formulário padrão atual na melhoria da qualidade das causas externas definidas.

Códigos garbage (códigos inespecíficos o incompletos), como causas externas inespecíficas, son los indicadores de datos de mala calidad sobre la causa de muerte. Es necesario investigar los códigos garbage con un instrumento eficaz para convertirlos en datos útiles para la salud pública. Este estudio analizó el desempeño y la adecuación del nuevo formulario de investigación de muertes por causas externas (IDEC) para mejorar la calidad de los datos de causa externa de muerte en Brasil. El desempeño de este formulario en 133 muertes con códigos garbage de causas externas se comparó con una muestra estratificada y emparejada de 992 (16%) muertes investigadas que usaron el formulario estándar de códigos garbage existente. Se comprobó la consistencia entre estos dos grupos. Se analizó el porcentaje de códigos garbage por causas externas reclasificados en causas válidas con un intervalo del 95% de confianza (IC95%). Se procedió a una reclasificación por causas específicas. Los datos cualitativos sobre la viabilidad del formulario fueron registrados por investigadores de campo. La investigación con el nuevo formulario tuvo una reducción de todos los códigos garbage de causas externas en -92,5% (IC95%: -97,0; -88,0), mientras que el formulario existente redujo todos los códigos garbage de causas externas en -60,5% (IC95%: -63,5; -57,4). El formulario IDEC fue el más efectivo para códigos garbage de causa externa sin intención indeterminada. Las muertes que quedaron como códigos garbage carecían principalmente de información detallada sobre las circunstancias de envenenamiento y de accidentes de tránsito. Los investigadores de campo confirmaron la viabilidad del formulario IDEC, además de sugerir modificaciones para mejorarlo. El nuevo formulario fue el más efectivo que el formulario estándar actual en cuanto a la mejora de la calidad de las causas externas definidas.

Violence Against LGB+ people in Brazil: analysis of the 2019 National Survey of Health / Violência contra pessoas LGB+ no Brasil: análise da Pesquisa Nacional de Saúde 2019

ABSTRACT Objective: To analyze the association between self-reported sexual orientation and violence in the Brazilian population. Methods: This cross-sectional epidemiological study used the 2019 National Survey of Health database. Total violence and its subtypes (psychological, physical, and sexual) were analyzed in the previous 12 months. Prevalence and odds ratio adjusted for age group were estimated, with their respective 95% confidence intervals, according to the self-reported sexual orientation of the Brazilian population aged 18 years and older. Statistical significance was set at 5%. Results: Most of the Brazilian population self-identified as heterosexual (94.75%) and 1.89% as LGB+. This percentage was lower than that of respondents who refused to answer the question (2.28%). The prevalence of violence in the general population of Brazil was 18.27%, and the most common subtype was psychological violence (17.36%). The LGB+ population was more than twice as likely to experience any type of violence. LGB+ women had the highest prevalence in all violence subtypes, and heterosexual men had the lowest. LGB+ women were over three times more likely to experience physical violence compared to heterosexual ones. Meanwhile, the probability of LGB+ men experiencing sexual violence was almost eight times higher than in heterosexual men. Conclusion: The prevalence of violence against the LGB+ population was high in the country. Public policies aimed at this population are necessary to fight discrimination against sexual diversity and ensure the rights of non-heterosexual people.

RESUMO Objetivo: Analisar a associação entre a orientação sexual autoidentificada e a violência na população brasileira. Métodos: Estudo epidemiológico transversal que utilizou base de dados da Pesquisa Nacional de Saúde 2019. Analisaram-se a violência total e seus subtipos (psicológica, física e sexual) nos 12 meses anteriores. Estimou-se a prevalência e a odds ratio ajustada por faixa etária, com seus respectivos intervalos de confiança de 95%, segundo orientação sexual autoidentificada da população acima de 18 anos no Brasil. Considerou-se a significância estatística de 5%. Resultados: A população brasileira autoidentificou-se majoritariamente como heterossexual (94,75%), e 1,89% identificou-se como LGB+. Esse percentual foi inferior ao de entrevistados que se recusaram a responder à pergunta (2,28%). A prevalência da violência na população geral do Brasil foi de 18,27%, sendo o subtipo mais comum a violência psicológica (17,36%). A população LGB+ apresentou mais que o dobro de chances de sofrer qualquer tipo de violência. As mulheres LGB+ apresentaram as maiores prevalências de todos os subtipos de violência e os homens heterossexuais, as menores. Mulheres LGB+ tiveram mais de três vezes mais chances de sofrer violência física, comparadas às mulheres heterossexuais. Enquanto isso, homens LGB+ mostraram chances quase oito vezes maiores de sofrer violência sexual que os homens heterossexuais. Conclusão: A violência contra a população LGB+ apresentou alta prevalência no país. São necessárias políticas públicas voltadas a essa população para que se enfrente o preconceito contra a diversidade sexual e seja possível garantir os direitos das pessoas não heterossexuais.

COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management.

BACKGROUND: The COVID-19 pandemic brought countless challenges to public health and highlighted the Brazilian health system vulnerabilities in facing the emergency. In this article, we analyze data on COVID-19-related deaths in 2020-21 to show the epidemic consequences in Brazil. METHODS: The Mortality Information System and the Live Birth Information System were the primary information sources. We used population estimates in 2020-21 to calculate COVID-19 specific mortality rates by age, sex, and educational level. Considering the total number of COVID-19 deaths in 2020-21, the COVID-19 proportional mortality (%) was estimated for each age group and sex. A graph of the daily number of deaths from January 2020 to December 2021 by sex was elaborated to show the temporal evolution of COVID-19 deaths in Brazil. In addition, four indicators related to COVID-19 mortality were estimated: infant mortality rate (IMR); maternal mortality ratio (MMR); number and rate of orphans due to mother's COVID-19 death; the average number of years lost. RESULTS: The overall COVID-19 mortality rate was 14.8 (/10,000). The mortality rates increase with age and show a decreasing gradient with higher schooling. The rate among illiterate people was 38.8/10,000, three times higher than a college education. Male mortality was 31% higher than female mortality. COVID-19 deaths represented 19.1% of all deaths, with the highest proportions in the age group of 40-59 years. The average number of years lost due to COVID-19 was 19 years. The MMR due to COVID-19 was 35.7 per 100,000 live births (LB), representing 37.4% of the overall MMR. Regarding the number of orphans due to COVID-19, we estimated that 40,830 children under 18 lost their mothers during the epidemic, with an orphans' rate of 7.5/10,000 children aged 0-17 years. The IMR was 11.7 per 1000 LB, with 0.2 caused by COVID-19. The peak of COVID-19 deaths occurred in March 2021, reaching almost 4000 COVID-19 deaths per day, higher than the average number of deaths per day from all causes in 2019. CONCLUSIONS: The delay in adopting public health measures necessary to control the epidemic has exacerbated the spread of the disease, resulting in several avoidable deaths.

Violence Against LGB+ people in Brazil: analysis of the National Health Survey, 2019 / Violência contra pessoas LGB+ no Brasil: análise da Pesquisa Nacional de Saúde, 2019

Objective: To analyze the association between self-reported sexual orientation and violence in the Brazilian population. Methods: Cross-sectional epidemiological study using the 2019 National Health Survey database. Total violence and its subtypes (psychological, physical, and sexual) in the last 12 months were analyzed. Prevalence and Adjusted Odds Ratio by age group were estimated, with their respective 95% confidence intervals, according to self-reported sexual orientation of the population over 18 years in Brazil. Statistical significance of 5% was considered. Results: The Brazilian population report themselves mostly as heterosexual (94.75%), and 1.89% declaring themselves LGB+. This percentage was lower than that of respondents who refused to answer the question (2.28%). The prevalence of violence in Brazil was 18.27%, the most common subtype being psychological violence (17.36%). The LGB+ population was more than twice as likely to experience any type of violence. LGB+ women had the highest prevalence of all subtypes of violence and heterosexual men the lowest. LGB+ women were more than three times more likely to experience physical violence compared to heterosexual women. Meanwhile, LGB+ men were almost eight times more likely to experience sexual violence than heterosexual men. Conclusions: Violence against the LGB+ population was highly prevalent in the country. Public Policies aimed at this population are necessary so that prejudice against sexual diversity is faced and it is possible to guarantee the rights of non-heterosexual people.

Objetivo: Analisar a associação entre a orientação sexual auto identificada e a violência na população brasileira. Métodos: Estudo epidemiológico transversal utilizando base de dados da Pesquisa Nacional de Saúde 2019. Analisou-se a violência total e seus subtipos (psicológica, física e sexual) nos 12 meses anteriores. Estimou-se a prevalência e a Odds Ratio Ajustada por faixa etária, com seus respectivos intervalos de confiança de 95%, segundo orientação sexual auto identificada da população acima de 18 anos no Brasil. Considerou-se a significância estatística de 5%. Resultados: A população brasileira se auto identificou majoritariamente como heterossexual (94,75%), sendo que 1,89% se identificaram LGB+. Esse percentual foi inferior ao de entrevistados que se recusaram a responder à pergunta (2,28%). A prevalência da violência na população geral do Brasil foi de 18,27%, sendo o subtipo mais comum a violência psicológica (17,36%). A população LGB+ apresentou mais que o dobro de chances de sofrer qualquer tipo de violência. As mulheres LGB+ apresentaram as maiores prevalências de todos os subtipos de violência e os homens heterossexuais, as menores. Mulheres LGB+ tiveram mais de três vezes mais chances de sofrer violência física, comparadas as mulheres heterossexuais. Enquanto isso, homens LGB+ mostraram chances quase oito vezes maiores de sofrer violência sexual que os homens heterossexuais. Conclusões: A violência contra a população LGB+ apresentou alta prevalência no país. São necessárias Políticas Públicas voltadas a essa população para que se enfrente o preconceito contra a diversidade sexual e seja possível garantir os direitos das pessoas não-heterossexuais.

Mortality surveillance in Brazil: factors associated with certification of unspecified external cause of death.

This article aims to analyze the association between characteristics of death - type of certifier and place of death - and the odds of an external cause death being certified as unspecified in Brazil. Cross-sectional study of deaths due to external causes from the Mortality Information System, 2017. Unspecified external cause (UEC) is the outcome variable in the models. Type of certifier physician, place of death and the interaction of these variables were the explanatory variables. Confounders were controlled by multiple logistic regression. UEC were the initial underlying cause for 22% of the 159,720 deaths from external causes in Brazil and 31% of hospital deaths issued by coroners. After adjustment for confounders, the odds of UEC in a hospital death certified by a coroner was 98% greater (OR=1.98; 95%CI: 1.53; 2.56) than in a home/street death issued by another certifier. This was greater than the odds for certifications by coroners (OR=1.23; 95%CI: 1.14; 1.33) and hospital deaths (OR=1.44; 95%CI: 1.32; 1.58). External causes certified by coroners and/or occurring in hospitals have a higher presence of UEC than other deaths; and indicate the need for coordinated initiatives by the health and public security sectors.

Tripla carga de doenças no Brasil, 1990-2021: mudanças, inflexões e o fator covid-19 / La triple carga de las enfermedades en Brasil, 1990-2021: cambios, inflexiones y el factor covid-19 / Triple burden of diseases in Brazil, 1990-2921; changes, inflection points and the covid-19 factor

RESUMO Objetivo: descrever a evolução temporal pela tripla carga de doenças no Brasil, comparando a mortalidade do Sistema de Informação de Mortalidade (SIM) e do estudo de Carga Global de Doenças (GBD). Método: estudo descritivo e exploratório sobre a evolução temporal das taxas e a distribuição proporcional de óbitos para doenças infecciosas, crônicas não transmissíveis (DCNT) e causas externas, usando duas fontes de dados de 1990 a 2021. As taxas no SIM foram ajustadas pelo método direto por idade e suavizadas por média móvel. As estimativas do GBD corrigem sub registro e causas garbage. Resultados: o Brasil registrou 817.284 óbitos (1990) e 1.349.801 (2019) no SIM, corrigidos em 17,7% e 1,9% no GBD para os respectivos anos. Nesse período, as taxas de mortalidade diminuíram nas duas fontes, respectivamente: DCNT -16,8% (433,7 a 360,7) e -34% (720,5 a 474,6); infeciosas -20,2% (86 para 68,6) e -57,2% (198,5 para 84,9); causas externas -17,3% (77,4 para 64) e -27% (100,9 para 73,7). O SIM mostrou redução -79,2% (138,6 para 28,8) para as taxas de causas mal definidas (CMD). Os fatores de correção do GBD foram maiores nos anos anteriores a 2005. Após 2019, as taxas infeciosas e CMD no SIM aumentaram respectivamente 207% (68,6 para 210,7) e 30,2% (28,8 para 37,5). Conclusão: o avanço da transição epidemiológica da carga de doenças e a melhoria da qualidade do dado de óbito no Brasil foram interrompidos pela covid-19, aumentando a carga das doenças infecciosas.

RESUMEN Objetivo: describir la evolución temporal de la triple carga de las enfermedades en Brasil, comparando la mortalidad del Sistema de Información de Mortalidad (SIM) y del estudio de la Carga Global de las Enfermedades (GBD). Método: estudio descriptivo y exploratorio sobre la evolución temporal de las tasas y la distribución proporcional de las defunciones por enfermedades infecciosas, enfermedades crónicas no transmisibles (ECNT) y causas externas, utilizando dos fuentes de datos, de 1990 a 2021. Las tasas en SIM se ajustaron por el método directo por edad y se suavizaron por media móvil. Las estimaciones de la GBD corregían el subregistro y las causas de la basura. Resultados: Brasil registró 817.284 muertes (1990) y 1.349.801 (2019) en el SIM, corregidas en 17,7% y 1,9% en el GBD para los respectivos años. En este periodo, las tasas de mortalidad disminuyeron en las dos fuentes, respectivamente: ECNT -16,8% (433,7 a 360,7) y -34% (720,5 a 474,6); infecciosas -20,2% (86 a 68,6) y -57,2% (198,5 a 84,9); causas externas -17,3% (77,4 a 64) y -27% (100,9 a 73,7). El SIM mostró una reducción del 79,2% (de 138,6 a 28,8) en las tasas de causas mal definidas (CMD). Los factores de corrección de la GBD fueron mayores en los años anteriores a 2005. Después de 2019, las tasas de infecciosas y de CMD en el SIM aumentaron respectivamente un 207% (68,6 a 210,7) y un 30,2% (28,8 a 37,5). Conclusión: el progreso de la transición epidemiológica de la carga de la enfermedad y la mejora de la calidad de los datos de mortalidad en Brasil fueron interrumpidos por COVID-19, aumentando la carga de las enfermedades infecciosas.

ABSTRACT Objective: to describe the time evolution by the triple burden of diseases in Brazil, comparing the mortality data from the Mortality Information System (Sistema de Informação de Mortalidade, SIM) and from the Global Burden of Disease (GBD) study. Method: a descriptive and exploratory study on the time evolution of the rates and the proportional distribution of deaths for infectious diseases, chronic non-communicable diseases (CNCDs) and external causes, using two data sources and encompassing the period from 1990 to 2021. The SIM rates were adjusted by means of the direct method by age and smoothed by the mobile mean. The GBD estimates correct under-recording and garbage causes. Results: Brazil recorded 817,284 (1990) and 1,349,801 (2019) deaths in the SIM, corrected by 17.7% and 1.9% in the GBD for each year. During this period, the mortality rates decreased in both sources, respectively: CNCDs -16.8% (from 433.7 to 360.7) and -34% (from 720.5 to 474.6); infectious diseases -20.2% (from 86 to 68.6) and -57.2% (from 198.5 to 84.9); external causes -17.3% (from 77.4 to 64) and -27% (from 100.9 to 73.7). The SIM showed a 79.2% reduction (from 138.6 to 28.8) for the ill-defined causes (IDCs). The GBD correction factors were higher in the years before 2015. After 2019, the rates corresponding to infectious diseases and IDCs in the SIM were increased by 207% (from 68.6 to 210.7) and by 30.2% (from 28.8 to 37.5), respectively. Conclusion: the advances in the epidemiological transition of the burden of disease and improvement in the death data in Brazil were interrupted by COVID-19, thus increasing the burden of infectious diseases.

Mortality surveillance in Brazil: factors associated with certification of unspecified external cause of death / Vigilância da mortalidade no Brasil: fatores associados à certificação de causa externa inespecifica de morte

Abstract This article aims to analyze the association between characteristics of death - type of certifier and place of death - and the odds of an external cause death being certified as unspecified in Brazil. Cross-sectional study of deaths due to external causes from the Mortality Information System, 2017. Unspecified external cause (UEC) is the outcome variable in the models. Type of certifier physician, place of death and the interaction of these variables were the explanatory variables. Confounders were controlled by multiple logistic regression. UEC were the initial underlying cause for 22% of the 159,720 deaths from external causes in Brazil and 31% of hospital deaths issued by coroners. After adjustment for confounders, the odds of UEC in a hospital death certified by a coroner was 98% greater (OR=1.98; 95%CI: 1.53; 2.56) than in a home/street death issued by another certifier. This was greater than the odds for certifications by coroners (OR=1.23; 95%CI: 1.14; 1.33) and hospital deaths (OR=1.44; 95%CI: 1.32; 1.58). External causes certified by coroners and/or occurring in hospitals have a higher presence of UEC than other deaths; and indicate the need for coordinated initiatives by the health and public security sectors.

Resumo O objetivo deste artigo é analisar a associação entre características do óbito - tipo de certificador e local do óbito - e a chance de um óbito por causa externa ser certificado como inespecífico no Brasil. Estudo transversal com dados do Sistema de Informações sobre Mortalidade de 2017. Causa externa inespecífica (CEI) é a variável desfecho nos modelos. As exposições de interesse foram tipo de médico certificador, local do óbito e a interação destas variáveis. Variáveis confundidoras foram controladas por regressão logística múltipla. As CEI foram a causa básica inicial de 22% dos 159,7 mil óbitos por causas externas no Brasil e 31% dos óbitos hospitalares emitidos por médicos-legistas. Após ajuste para confundidores, a chance de CEI em um óbito hospitalar certificado por legista foi 98% maior (OR=1,98; IC95%: 1,53; 2,56) do que em um óbito domiciliares/via pública emitido por outro certificador. Esta foi maior do que as chances para certificação por legista (OR=1,23; IC95%: 1,14; 1,33) e óbito hospitalar (OR=1,44; IC95%: 1,32; 1,58). As causas externas certificadas por médicos-legistas e/ou ocorridas em hospitais têm maior presença de CEI do que outras mortes; e indicam a necessidade de iniciativas coordenadas dos setores da saúde e segurança pública.

Primary Health Care in Northern and Northeastern Brazil: mapping team distribution disparities. / Atenção Primária à Saúde no Norte e Nordeste do Brasil: mapeando disparidades na distribuição de equipes.

This study analyzes the spatial pattern of implementation of Primary Health Care (PHC) teams in Northern and Northeastern Brazil. This is an ecological study on the rates of Community Health Workers (ACS), Family Health Team (eSF), Oral Health Team (eSB), and Family Health Extended Center (NASF) based on data from the Ministry of Health (MoH). The analysis of the area data identified patterns of spatial dependence of the municipalities for the rates, using Moran indices and scatterplots to visualize critical areas' clusters (95% confidence). Municipalities of the North (n=450) and Northeast (n=1,794) had 132,174 ACS, 18,405 eSF, 13,017 eSB, and 2,205 NASF. The proportion of municipalities with rates within the recommended by the MoH were: ACS (>1.33), 96% in the North and 98.5% in the Northeast; eSF (>2.9/1,000), 54% and 80% in the respective regions; eSB (>2.9/10,000) 28% and 59% in these respective regions. NASF teams were deployed in 70% of the North and 89% of the Northeast. Except for ACS, the North was a critical team area, mainly in Pará, Rondônia, Amazonas, and Amapá. In the Northeast, these areas were smaller and concentrated mainly in western Bahia and eastern Maranhão. The Northeast showed a better composition of teams and a smaller extent of critical areas.

Objetiva-se analisar o padrão espacial de implantação de equipes da Atenção Primária à Saúde (APS) no Norte e Nordeste do Brasil em 2017. Estudo ecológico das taxas de Agentes Comunitários de Saúde (ACS), equipes Saúde da Família (eSF), equipes Saúde Bucal (eSB) e Núcleo Ampliado de Saúde da Família (NASF), a partir de dados do Ministério da saúde (MS). A análise dos dados de área permitiu a identificação de padrões de dependência espacial dos municípios para as taxas, utilizando os índices e mapas de Moran para visualizar clusters de áreas críticas (95% de confiança). Os municípios do Norte (n=450) e Nordeste (n=1.794) apresentaram 132,2 mil ACS, 18,4 mil eSF, 13 mil eSB e 2,2 mil NASF. A proporção de municípios com taxas dentro do preconizado pelo MS: ACS (>1,33/mil) 96% no Norte e 98,5% no Nordeste; eSF (>2,9/10 mil) 54% e 80% nas respectivas regiões; eSB (>2,9/10 mil) 28% e 59% nestas respectivas regiões. Equipes NASF foram implantadas em 70% do Norte e 89% do Nordeste. Exceto ACS, a região Norte constituiu-se em área crítica de equipes, principalmente no Pará, Rondônia, Amazonas e Amapá. No Nordeste, essas áreas foram menores e concentradas a oeste da Bahia e leste do Maranhão. O Nordeste exibiu melhor composição de equipes e menor extensão de áreas críticas.

Atenção Primária à Saúde no Norte e Nordeste do Brasil: mapeando disparidades na distribuição de equipes / Primary Health Care in Northern and Northeastern Brazil: mapping team distribution disparities

Resumo Objetiva-se analisar o padrão espacial de implantação de equipes da Atenção Primária à Saúde (APS) no Norte e Nordeste do Brasil em 2017. Estudo ecológico das taxas de Agentes Comunitários de Saúde (ACS), equipes Saúde da Família (eSF), equipes Saúde Bucal (eSB) e Núcleo Ampliado de Saúde da Família (NASF), a partir de dados do Ministério da saúde (MS). A análise dos dados de área permitiu a identificação de padrões de dependência espacial dos municípios para as taxas, utilizando os índices e mapas de Moran para visualizar clusters de áreas críticas (95% de confiança). Os municípios do Norte (n=450) e Nordeste (n=1.794) apresentaram 132,2 mil ACS, 18,4 mil eSF, 13 mil eSB e 2,2 mil NASF. A proporção de municípios com taxas dentro do preconizado pelo MS: ACS (>1,33/mil) 96% no Norte e 98,5% no Nordeste; eSF (>2,9/10 mil) 54% e 80% nas respectivas regiões; eSB (>2,9/10 mil) 28% e 59% nestas respectivas regiões. Equipes NASF foram implantadas em 70% do Norte e 89% do Nordeste. Exceto ACS, a região Norte constituiu-se em área crítica de equipes, principalmente no Pará, Rondônia, Amazonas e Amapá. No Nordeste, essas áreas foram menores e concentradas a oeste da Bahia e leste do Maranhão. O Nordeste exibiu melhor composição de equipes e menor extensão de áreas críticas.

Abstract This study analyzes the spatial pattern of implementation of Primary Health Care (PHC) teams in Northern and Northeastern Brazil. This is an ecological study on the rates of Community Health Workers (ACS), Family Health Team (eSF), Oral Health Team (eSB), and Family Health Extended Center (NASF) based on data from the Ministry of Health (MoH). The analysis of the area data identified patterns of spatial dependence of the municipalities for the rates, using Moran indices and scatterplots to visualize critical areas' clusters (95% confidence). Municipalities of the North (n=450) and Northeast (n=1,794) had 132,174 ACS, 18,405 eSF, 13,017 eSB, and 2,205 NASF. The proportion of municipalities with rates within the recommended by the MoH were: ACS (>1.33), 96% in the North and 98.5% in the Northeast; eSF (>2.9/1,000), 54% and 80% in the respective regions; eSB (>2.9/10,000) 28% and 59% in these respective regions. NASF teams were deployed in 70% of the North and 89% of the Northeast. Except for ACS, the North was a critical team area, mainly in Pará, Rondônia, Amazonas, and Amapá. In the Northeast, these areas were smaller and concentrated mainly in western Bahia and eastern Maranhão. The Northeast showed a better composition of teams and a smaller extent of critical areas.

Frequency and factors associated with recording deaths due to unspecified external causes in Brazil: a cross-sectional study, 2017. / Frequência e fatores associados ao registro inespecífico de óbitos por causas externas no Brasil: estudo transversal, 2017.

OBJECTIVE: To analyze the frequency and factors associated with recording deaths due to unspecified external causes in Brazil. METHODS: This was a cross-sectional study of Mortality Information System data for the year 2017. Univariate logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (95%CI) of nonspecific recording according to the explanatory variables - (hospital deaths and deaths certified by coroners). RESULTS: Brazil registered 159,720 deaths from external causes; 38.9% occurred in hospital, 83.4% were certified by coroners and 21.7% were from unspecified causes. Factors associated with the recording of unspecified external causes were hospital death (OR=2.00 - 95%CI 1.96;2.05) and the coroner's certification (OR=1.08 - 95%CI 1.04;1.11). CONCLUSION: The frequency of recording unspecified external causes is greater for hospital deaths than for coroner's certification.

Frequência e fatores associados ao registro inespecífico de óbitos por causas externas no Brasil: estudo transversal, 2017 / Frecuencia y factores asociados al registro inespecífico de óbitos por causas externas en Brasil: estudio transversal, 2017 / Frequency and factors associated with recording deaths due to unspecified external causes in Brazil: a cross-sectional study, 2017

Objetivo: Analisar a frequência e fatores associados ao registro inespecífico de óbitos por causas externas no Brasil. Métodos: Estudo transversal dos dados do Sistema de Informações sobre Mortalidade de 2017. Utilizou-se regressão logística para obter razões de chances (odds ratio [OR]) e intervalo de confiança (IC95%) de registro inespecífico pelas variáveis de explicação (óbitos hospitalares e certificados por legista). Resultados: O Brasil registrou 159.720 óbitos por causas externas; foram 38,9% de ocorrência hospitalar, 83,4% certificados por legistas e 21,7% atribuídos a causas inespecíficas. Revelaram-se fatores associados ao registro de causa externa inespecífica o óbito hospitalar (OR=2,00 - IC95% 1,96;2,05) e a certificação de médico-legista (OR=1,08 - IC95% 1,04;1,11). Conclusão: A frequência de registro de causa externa inespecífica em óbito hospitalar é superior à encontrada em certificação de legistas.

Objetivo: Analizar la frecuencia y factores asociados al registro inespecífico de óbitos por causas externas en Brasil. Métodos: Estudio transversal de datos del Sistema de Informaciones sobre Mortalidad, 2017. Se utilizó la regresión logística para obtener razones de probabilidades (odds ratio [OR]) e intervalo de confianza (IC95%) de registro inespecífico por las variables de explicación (óbitos hospitalarios y certificados por forenses). Resultados: Brasil registró 159.720 óbitos por causas externas; hubo 38,9% en hospitales, 83,4% certificado por forenses y 21,7% por causas inespecíficas. Los factores asociados al registro de causas externas inespecíficas fueron el óbito hospitalario (OR=2,00 - IC95%1,96; 2,05) y la certificación del médico forense (OR=1,08 - IC95% 1,04; 1,11). Conclusión: La causa externa inespecífica en el óbito hospitalario es mayor que la de la certificación de los forenses.

Objective: To analyze the frequency and factors associated with recording deaths due to unspecified external causes in Brazil. Methods: This was a cross-sectional study of Mortality Information System data for the year 2017. Univariate logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (95%CI) of nonspecific recording according to the explanatory variables - (hospital deaths and deaths certified by coroners). Results: Brazil registered 159,720 deaths from external causes; 38.9% occurred in hospital, 83.4% were certified by coroners and 21.7% were from unspecified causes. Factors associated with the recording of unspecified external causes were hospital death (OR=2.00 - 95%CI 1.96;2.05) and the coroner's certification (OR=1.08 - 95%CI 1.04;1.11). Conclusion: The frequency of recording unspecified external causes is greater for hospital deaths than for coroner's certification.

Association between firearms and mortality in Brazil, 1990 to 2017: a global burden of disease Brazil study.

BACKGROUND: Brazil leads the world in number of firearm deaths and ranks sixth by country in rate of firearm deaths per 100,000 people. This study aims to analyze trends in and burden of mortality by firearms, according to age and sex, for Brazil, and the association between these deaths and indicators of possession and carrying of weapons using data from the global burden of diseases, injuries, and risk factors study (GBD) 2017. METHODS: We used GBD 2017 estimates of mortality due to physical violence and self-harm from firearms for Brazil to analyze the association between deaths by firearms and explanatory variables. RESULTS: Deaths from firearms increased in Brazil from 25,819 in 1990 to 48,493 in 2017. Firearm mortality rates were higher among men and in the 20-24 age group; the rate was 20 times higher than for women in the same age group. Homicide rates increased during the study period, while mortality rates for suicides and accidental deaths decreased. The group of Brazilian federation units with the highest firearm collection rate (median = 7.5) showed reductions in the rate of total violent deaths by firearms. In contrast, the group with the lowest firearm collection rate (median = 2.0) showed an increase in firearm deaths from 2000 to 2017. An increase in the rate of voluntary return of firearms was associated with a reduction in mortality rates of unintentional firearm deaths (r = -0.364, p < 0.001). An increase in socio-demographic index (SDI) was associated with a reduction in all firearm death rates (r = -0.266, p = 0.008). An increase in the composite index of firearms seized or collected was associated with a reduction in rates of deaths by firearm in the subgroup of females, children, and the elderly (r = -0.269, p = 0.005). CONCLUSIONS: There was a change in the trend of firearms deaths after the beginning of the collection of weapons in 2004. Federation units that collected more guns have reduced rates of violent firearm deaths.

Mapping disparities in homicide trends across Brazil: 2000-2014.

BACKGROUND: Homicides are a major problem in Brazil. Drugs and arms trafficking, and land conflicts are three of the many factors driving homicide rates in Brazil. Understanding long-term spatiotemporal trends and social structural factors associated with homicides in Brazil would be useful for designing policies aimed at reducing homicide rates. METHODS: We obtained data from 2000 to 2014 from the Brazil Ministry of Health (MOH) Mortality Information System and sociodemographic data from the Brazil Institute of Geography and Statistics (IBGE). First, we quantified the rate of change in homicides at the municipality and state levels. Second, we used principal component regression and k-medoids clustering to examine differences in temporal trends across municipalities. Lastly, we used Bayesian hierarchical space-time models to describe spatio-temporal patterns and to assess the contribution of structural factors. RESULTS: There were significant variations in homicide rates across states and municipalities. We noted the largest decrease in homicide rates in the western and southeastern states of Sao Paulo, Rio de Janeiro and Espirito Santo, which coincided with an increase in homicide rates in the northeastern states of Ceará, Alagoas, Paraiba, Rio Grande Norte, Sergipe and Bahia during the fifteen-year period. The decrease in homicides in municipalities with populations of at least 250,000 coincided with an increase in municipalities with 25,000 people or less. Structural factors that predicted municipality-level homicide rates included crude domestic product, urbanization, border with neighboring countries and proportion of population aged fifteen to twenty-nine. CONCLUSIONS: Our findings support both a dissemination hypothesis and an interiorization hypothesis. These findings should be considered when designing interventions to curb homicide rates.

[Expansion, displacement and interiorization of homicides in Brazil, between 2000 and 2015: a spatial analysis]. / Expansão, deslocamento e interiorização do homicídio no Brasil, entre 2000 e 2015: uma análise espacial.

The scope of this paper is to analyze the variation of the spatial pattern of the homicide rate in Brazil between 2000 and 2015. It is an ecological study by micro-regions of homicides taken from the Mortality Information System, using Moran indexes, and critical area clusters (95% CI). The rate increased by 6% (to 29.1/100,000 inhabitants (95% CI 28.9, 29.4), and in 80% of the micro regions between 2000 and 2015. The areas with high rates (> 38.2/100,000) increased 2.7-fold. In 2000, the highest rates were concentrated in areas in Pernambuco, São Paulo, Mato Grosso and Rio de Janeiro; by 2015, it will affect most states in the North and Northeast. The coastal regions of the Northeast and borders of Pará and Maranhão in the Amazon are critical areas. The lowest rate (19.1/100,000) is in São Paulo and Santa Catarina micro regions, with less critical clusters in the Southeast and South regions. Homicides have expanded into the interior of Brazil, with displacement between regions, mainly gravitating towards the poorest, which exhibit more critical areas in several scenarios, such as state borders and the coast. Conversely, there is marked contraction of homicides in states of highly developed regions with the presence of less critical areas. Key words Homicide.

O objetivo do estudo é analisar a mudança do padrão espacial da taxa de mortalidade por homicídios (TMH) no Brasil, entre 2000 e 2015. Trata-se de estudo ecológico por microrregiões das TMH do Sistema de Informações sobre Mortalidade, utilizando os índices de Moran e clusters de áreas críticas (95% de confiança). A TMH cresceu 6% (para 29,1/100 mil hab.; IC95% 28,9; 29,4), e em 80% das microrregiões entre 2000 e 2015. O número de áreas com altas TMH (> 38,2/100 mil) aumentou 2,7 vezes. Em 2000, as áreas com TMH mais altas concentravam-se em Pernambuco, São Paulo, Mato Grosso e Rio de Janeiro; em 2015, passam a ocupar estados das regiões Norte e Nordeste. As áreas mais críticas estão no litoral do Nordeste e nas fronteiras do Pará e Maranhão na Amazônia Legal. As menores TMH (até 19,1/100 mil) estão mais presentes nas microrregiões de São Paulo e Santa Catarina, com aglomerados menos críticos nas regiões Sudeste e Sul. O homicídio se expandiu para dentro do território nacional, com deslocamento entre regiões, em direção principalmente às mais pobres, que mostram áreas mais críticas em cenários distintos, como fronteiras de estados e litoral. Inversamente, há contração expressiva do homicídio em estados de regiões de desenvolvimento alto, com presença de áreas menos críticas.

[Trend and distribution of the homicide mortality rate in accordance with the size of the population of Brazilian municipalities - 2000 and 2015]. / Tendência e distribuição da taxa de mortalidade por homicídios segundo porte populacional dos municípios do Brasil, 2000 e 2015.

The scope of this study is to analyze the trends and distribution of homicide mortality rates (HMR) according to the population size of Brazilian municipalities between 2000 and 2015. It is an ecological study of deaths recorded in the Mortality Information System, with HMR standardized by the direct method and 95% confidence interval. HMR in Brazil grew 6% (to 29.1/100,000) in the period, with an increase in small municipalities (83%; 12.7 to 23.2/100,000) and mediumsized cities (52%; 19.7% to 30.1/100,000); which is true for both sexes, different ages, regions and firearm-related events. HMR decreased in major cities (19%; 40.6% to 32.9/100,000) and the Southeast region (55%; 45.6% to 20.6/100,000). The relative risk (RR) of small and medium-sized cities in relation to large cities is already greater than or close to 1 among women (RR 0.99; 1.03), people aged 60 years or older (RR 1.43; 1.36) and homicides by other means (RR 1.16; 1.18). The cities of São Paulo and Rio de Janeiro contributed the most to the reduction of HMR, especially in large cities (-37.6 and -22.3 homicides/100,000 inhabitants). Small and medium-sized municipalities have consistent trends of an increase in HMR even considering population subgroups.

O estudo tem como objetivo analisar tendências e distribuição das taxas de mortalidade por homicídios (TMH) segundo porte populacional dos municípios brasileiros entre 2000 e 2015. Trata-se de estudo ecológico dos óbitos do Sistema de Informações sobre Mortalidade, com TMH padronizada pelo método direto e intervalo de 95% de confiança. A TMH no Brasil cresceu 6% (para 29,1/100 mil) no período, com aumento em municípios de pequeno (83%; 12,7 para 23,2/100 mil) e médio porte (52%; 19,7 para 30,1/100 mil); o que se verifica para ambos os sexos, diferentes idades, regiões e em eventos por arma de fogo. A TMH decresceu em municípios de grande porte metropolitanos (19%; 40,6 para 32,9/100 mil) e da região Sudeste (55%; 45,6 para 20,6/100 mil). O risco relativo-RR de cidades pequenas e médias em relação a grandes já é maior ou próximo de 1 em mulheres (RR 0,99; 1,03), pessoas com 60 ou mais anos (RR 1,43; 1,36) e homicídios por outros meios (RR 1,16; 1,18). As cidades de São Paulo e Rio de Janeiro foram as que mais contribuíram para a redução das TMH, em especial nas cidades grandes (-37,6 e -22,3 homicídios/100 mil hab.). Municípios de porte pequeno e médio apresentam tendências consistentes de incremento de TMH mesmo considerando subgrupos populacionais.

Tendência e distribuição da taxa de mortalidade por homicídios segundo porte populacional dos municípios do Brasil, 2000 e 2015 / Trend and distribution of the homicide mortality rate in accordance with the size of the population of Brazilian municipalities - 2000 and 2015

Resumo O estudo tem como objetivo analisar tendências e distribuição das taxas de mortalidade por homicídios (TMH) segundo porte populacional dos municípios brasileiros entre 2000 e 2015. Trata-se de estudo ecológico dos óbitos do Sistema de Informações sobre Mortalidade, com TMH padronizada pelo método direto e intervalo de 95% de confiança. A TMH no Brasil cresceu 6% (para 29,1/100 mil) no período, com aumento em municípios de pequeno (83%; 12,7 para 23,2/100 mil) e médio porte (52%; 19,7 para 30,1/100 mil); o que se verifica para ambos os sexos, diferentes idades, regiões e em eventos por arma de fogo. A TMH decresceu em municípios de grande porte metropolitanos (19%; 40,6 para 32,9/100 mil) e da região Sudeste (55%; 45,6 para 20,6/100 mil). O risco relativo-RR de cidades pequenas e médias em relação a grandes já é maior ou próximo de 1 em mulheres (RR 0,99; 1,03), pessoas com 60 ou mais anos (RR 1,43; 1,36) e homicídios por outros meios (RR 1,16; 1,18). As cidades de São Paulo e Rio de Janeiro foram as que mais contribuíram para a redução das TMH, em especial nas cidades grandes (-37,6 e -22,3 homicídios/100 mil hab.). Municípios de porte pequeno e médio apresentam tendências consistentes de incremento de TMH mesmo considerando subgrupos populacionais.

Abstract The scope of this study is to analyze the trends and distribution of homicide mortality rates (HMR) according to the population size of Brazilian municipalities between 2000 and 2015. It is an ecological study of deaths recorded in the Mortality Information System, with HMR standardized by the direct method and 95% confidence interval. HMR in Brazil grew 6% (to 29.1/100,000) in the period, with an increase in small municipalities (83%; 12.7 to 23.2/100,000) and mediumsized cities (52%; 19.7% to 30.1/100,000); which is true for both sexes, different ages, regions and firearm-related events. HMR decreased in major cities (19%; 40.6% to 32.9/100,000) and the Southeast region (55%; 45.6% to 20.6/100,000). The relative risk (RR) of small and medium-sized cities in relation to large cities is already greater than or close to 1 among women (RR 0.99; 1.03), people aged 60 years or older (RR 1.43; 1.36) and homicides by other means (RR 1.16; 1.18). The cities of São Paulo and Rio de Janeiro contributed the most to the reduction of HMR, especially in large cities (-37.6 and -22.3 homicides/100,000 inhabitants). Small and medium-sized municipalities have consistent trends of an increase in HMR even considering population subgroups.

Improvement of the unspecified external causes classification based on the investigation of death in Brazil in 2017. / Melhoria da classificação das causas externas inespecíficas de mortalidade baseada na investigação do óbito no Brasil em 2017.

BACKGROUND: Unspecified causes of death are among the traditional indicators of quality of information. OBJECTIVE: To verify the performance of the 60 cities in the Data for Health Initiative project and to analyze the reclassification of unspecified external causes of death (UEC). METHODS: Using the 2017 records from the Mortality Information System, the proportion and percent change in UEC were compared after investigation between project cities and other cities, and the percent of reclassification to specific external causes was calculated. RESULTS: The project cities comprised 52% (n = 11,759) of the total UEC in Brazil, of which 64.5% were reclassified after investigation, whereas the other cities reclassified 31% of UEC. Results were similar for men, youth, blacks, metropolitan cities, the Southeast region, and deaths attested by forensic institutes. In the project cities, pedestrian traffic accidents were external causes with greater reclassification. In men, the UEC was reclassified to homicides (23.8%) and accident of terrestrial transportation (ATT) (11.1%), with motorcyclists (4.4%) and pedestrians (4.3%) being the most prominent. In women, these causes were changed to other accident causes (20.8%), ATT (10.6%) and homicides (7.9%). UEC changed to ATT (18.3%) in the age groups of 0-14 years old and to homicides (32.5%) in the age groups of 15-44 years. CONCLUSION: The project cities obtained better results after investigation of UEC, enabling analysis of the reclassification to specific causes by sex and age groups.

INTRODUÇÃO: Causas inespecíficas de mortalidade estão entre os indicadores tradicionais de qualidade da informação. OBJETIVO: Verificar o desempenho das 60 cidades do projeto Dados para a Saúde e analisar a reclassificação das causas externas inespecíficas de mortalidade (CEI). MÉTODOS: A partir de registros de 2017 do Sistema de Informações sobre Mortalidade, comparou-se proporções e variações percentuais após investigação das CEI, entre cidades do projeto e demais cidades, e calculou-se percentual de reclassificação para causas específicas. RESULTADOS: As cidades do projeto concentraram 52% (n = 11.759) das CEI do Brasil, das quais 64,5% foram reclassificadas após investigação, enquanto as demais cidades reclassificaram 31%. Resultados foram semelhantes para homens, jovens, negros, cidades metropolitanas, região Sudeste, e em eventos atestados por institutos forenses. Nas cidades do projeto, acidentes de pedestres foram causas com maior reclassificação. Em homens, as CEI migraram para homicídios (23,8%) e acidentes de transporte terrestre (ATT) (11,1%), com destaque para motociclistas (4,4%) e pedestres (4,3%). Em mulheres, essas causas foram alteradas para outras causas acidentais (20,8%), ATT (10,6%) e homicídios (7,9%). CEI migraram para ATT (18,3%) no grupo de idade de 0 a 14 anos, e homicídios (32,5%) no grupo de 15 a 44 anos. CONCLUSÃO: As cidades do projeto obtiveram melhores resultados após investigação de CEI, possibilitando analisar a reclassificação para causas específicas, por sexo e faixas etárias.

Melhoria da classificação das causas externas inespecíficas de mortalidade baseada na investigação do óbito no Brasil em 2017 / Improvement of the unspecified external causes classification based on the investigation of death in Brazil in 2017

RESUMO Introdução: Causas inespecíficas de mortalidade estão entre os indicadores tradicionais de qualidade da informação. Objetivo: Verificar o desempenho das 60 cidades do projeto Dados para a Saúde e analisar a reclassificação das causas externas inespecíficas de mortalidade (CEI). Métodos: A partir de registros de 2017 do Sistema de Informações sobre Mortalidade, comparou-se proporções e variações percentuais após investigação das CEI, entre cidades do projeto e demais cidades, e calculou-se percentual de reclassificação para causas específicas. Resultados: As cidades do projeto concentraram 52% (n = 11.759) das CEI do Brasil, das quais 64,5% foram reclassificadas após investigação, enquanto as demais cidades reclassificaram 31%. Resultados foram semelhantes para homens, jovens, negros, cidades metropolitanas, região Sudeste, e em eventos atestados por institutos forenses. Nas cidades do projeto, acidentes de pedestres foram causas com maior reclassificação. Em homens, as CEI migraram para homicídios (23,8%) e acidentes de transporte terrestre (ATT) (11,1%), com destaque para motociclistas (4,4%) e pedestres (4,3%). Em mulheres, essas causas foram alteradas para outras causas acidentais (20,8%), ATT (10,6%) e homicídios (7,9%). CEI migraram para ATT (18,3%) no grupo de idade de 0 a 14 anos, e homicídios (32,5%) no grupo de 15 a 44 anos. Conclusão: As cidades do projeto obtiveram melhores resultados após investigação de CEI, possibilitando analisar a reclassificação para causas específicas, por sexo e faixas etárias.

ABSTRACT Background: Unspecified causes of death are among the traditional indicators of quality of information. Objective: To verify the performance of the 60 cities in the Data for Health Initiative project and to analyze the reclassification of unspecified external causes of death (UEC). Methods: Using the 2017 records from the Mortality Information System, the proportion and percent change in UEC were compared after investigation between project cities and other cities, and the percent of reclassification to specific external causes was calculated. Results: The project cities comprised 52% (n = 11,759) of the total UEC in Brazil, of which 64.5% were reclassified after investigation, whereas the other cities reclassified 31% of UEC. Results were similar for men, youth, blacks, metropolitan cities, the Southeast region, and deaths attested by forensic institutes. In the project cities, pedestrian traffic accidents were external causes with greater reclassification. In men, the UEC was reclassified to homicides (23.8%) and accident of terrestrial transportation (ATT) (11.1%), with motorcyclists (4.4%) and pedestrians (4.3%) being the most prominent. In women, these causes were changed to other accident causes (20.8%), ATT (10.6%) and homicides (7.9%). UEC changed to ATT (18.3%) in the age groups of 0-14 years old and to homicides (32.5%) in the age groups of 15-44 years. Conclusion: The project cities obtained better results after investigation of UEC, enabling analysis of the reclassification to specific causes by sex and age groups.

Mortalidade e anos de vida perdidos por violências interpessoais e autoprovocadas no Brasil e Estados: análise das estimativas do Estudo Carga Global de Doença, 1990 e 2015 / Mortality and years of life lost by interpersonal violence and self-harm: in Brazil and Brazilian states: analysis of the estimates of the Global Burden of Disease Study, 1990 and 2015

RESUMO: Objetivo: Analisar a mortalidade e os anos de vida perdidos por morte ou incapacidade (Disability-Adjusted Life Years - DALYs) por violências interpessoais e autoprovocadas, comparando 1990 e 2015, no Brasil e nas Unidades Federadas, utilizando estimativas produzidas pelo estudo Carga Global de Doença 2015 (GBD 2015). Métodos: Análise de dados secundários das estimativas do GBD 2015, com produção de taxas padronizadas de mortes e DALYs. A principal fonte de dados de óbitos foi o Sistema de Informações sobre Mortalidade, submetido à correção do sub-registro de óbitos e redistribuição de códigos garbage. Resultados: De 1990 a 2015, observou-se estabilidade das taxas de mortalidade por homicídios, com variação percentual de -0,9%, passando de 28,3/100 mil habitantes (II 95% 26,9-32,1), em 1990, para 27,8/100 mil (II 95% 24,3-29,8), em 2015. As taxas de homicídio foram mais altas em Alagoas e Pernambuco, e ocorreu redução em São Paulo (-40,9%). As taxas de suicídio variaram em -19%, saindo de 8,1/100 mil (II 95% 7,5-8,6), em 1990, para 6,6/100 mil (II 95% 6,1-7,9), em 2015. Taxas mais elevadas ocorreram no Rio Grande do Sul. No ranking de causas externas por Disability-Adjusted Life Years (DALYs), predominaram as agressões por arma de fogo, seguidas de acidentes de transporte e em sexto lugar lesões autoprovocadas. Conclusões: O estudo aponta a importância das causas externas entre jovens e homens na morte prematura e em incapacidades, constituindo um problema prioritário no país. O estudo Carga Global de Doença poderá apoiar políticas públicas de prevenção de violência.

ABSTRACT: Objective: To analyze mortality and years of life lost due to death or disability (disability-adjusted life years - DALYs) for interpersonal violence and self-harm, comparing 1990 and 2015, in Brazil and Federated Units, using estimates produced by the Global Burden of Disease 2015 (GBD 2015). Methods: Secondary data analysis of estimates from the GBD 2015, producing standardized death rates and years of life lost due to death or disability. The main source of death data was the Mortality Information System, submitted to correction of underreporting of deaths and redistribution of garbage codes. Results: From 1990 to 2015, homicide mortality rates were stable, with a percentage variation of -0.9%, from 28.3/100 thousand inhabitants (95% UI 26.9-32.1) in 1990 to 27.8/100,000 (95% UI 24.3-29.8) in 2015. Homicide rates were higher in Alagoas and Pernambuco, and there was a reduction in São Paulo (-40.9%). Suicide rates decreased by 19%, from 8.1/100,000 (95% UI 7.5-8.6) in 1990 to 6.6/100,000 (95% UI 6.1-7,9) in 2015. Higher rates were found in Rio Grande do Sul. In the ranking of external causes for years of life lost due to death or disability (DALYs), firearm aggression predominated, followed by transportation accidents; self-inflicted injuries were in sixth place. Conclusions: The study shows the importance of external causes among young people and men as a cause of premature death and disabilities, which is a priority problem in the country. The Global Burden of Disease study may support public policies for violence prevention.