SUMMARY OBJECTIVE: The ability to cause death is the definitive measure of an infectious disease severity, particularly one caused by a novel pathogen like severe acute respiratory syndrome-CoV-2 (COVID-19). This study describes sickle cell disease-related mortality issues during the COVID-19 pandemic in Brazil. METHODS: The provisional 2020 mortality data originated from the public databases of the Mortality Information System and were investigated using the multiple-cause-of-death methodology. RESULTS: In 2020, 688 sickle cell disease-related deaths occurred, of which 422 (61.3%) had an underlying cause of death and 266 (38.7%) had an associated cause of death. Furthermore, 98 COVID-19-related deaths occurred, of which 78 were underlying cause of death among sickle cell disease associated (non-underlying) cause of death. Sickle cell disease-related deaths occurred mostly among young adults aged 25–49 years. COVID-19 deaths occurred at ages older than among sickle cell disease-related deaths. Majority of deaths happened in the southeast (42.3%) and northeast regions (34.0%), while COVID-19 deaths prevailed in the northeast region (42.9%). Regarding overall deaths, the leading underlying cause of death was sickle cell disease itself, followed by infectious and parasitic diseases (14.8%), owing to COVID-19 deaths, and diseases of the circulatory system (8.9%). Next, in males, diseases of the digestive system (4.8%) occurred, while, in females, maternal deaths succeeded, included in the chapter on pregnancy, childbirth, and the puerperium, accounting for 5.9% of female deaths. The leading overall associated (non-underlying) cause of deaths were septicemias (29.4%), followed by respiratory failure (20.9%), pneumonias (18.3%), and renal failure (14.7%). CONCLUSION: In Brazil, COVID-19 deaths produced trend changes in sickle cell disease-related causes of death, age at death, and regional distribution of deaths in 2020. OBJECTIVE severity syndromeCoV2 syndromeCoV syndrome CoV 2 syndrome-CoV- COVID19. COVID19 COVID 19 . (COVID-19) diseaserelated related COVID-1 Brazil METHODS 202 multiplecauseofdeath multiple methodology RESULTS 68 42 61.3% 613 61 3 (61.3% 26 38.7% 387 38 7 (38.7% Furthermore 9 COVID19related COVIDrelated nonunderlying non (non-underlying 2549 25 49 25–4 years 42.3% 423 (42.3% 34.0%, 340 34.0% , 34 0 (34.0%) 42.9%. 429 42.9% (42.9%) itself 14.8%, 148 14.8% 14 8 (14.8%) 8.9%. 89 8.9% (8.9%) Next males 4.8% 48 4 (4.8% females succeeded pregnancy childbirth puerperium 59 5 5.9 29.4%, 294 29.4% 29 (29.4%) 20.9%, 209 20.9% 20 (20.9%) 18.3%, 183 18.3% 18 (18.3%) 14.7%. 147 14.7% (14.7%) CONCLUSION syndrome-CoV COVID1 1 (COVID-19 COVID- 6 61.3 (61.3 38.7 (38.7 254 25– 42.3 (42.3 34.0 (34.0% 42.9 (42.9% 14.8 (14.8% 8.9 (8.9% 4.8 (4.8 5. 29.4 (29.4% 20.9 (20.9% 18.3 (18.3% 14.7 (14.7% (COVID-1 61. (61. 38. (38. 42. (42. 34. (34.0 (42.9 14. (14.8 8. (8.9 4. (4. 29. (29.4 20. (20.9 18. (18.3 (14.7 (COVID- (61 (38 (42 (34. (14. (8. (4 (29. (20. (18. (COVID (6 (3 (34 (14 (8 ( (29 (20 (18 (1 (2

Abstract Introduction There is a demand to update national mortality trends data related to sickle cell disease (SCD) in Brazil. This study describes causes of death and mortality issues related to SCD using the multiple-cause-of-death methodology. Methods The annual SCD mortality data was extracted from the public databases of the Mortality Information System by researching deaths in rubric D57 “sickle-cell disorders” of the International Classification of Diseases, Tenth Revision and processed by the Multiple Cause Tabulator. Results From 2000 to 2018 in Brazil, a total of 9817 deaths related to SCD occurred during the 19-year period, as the underlying cause in 6924 (70.5%) and as the associated cause of death in 2893 (29.5%). The mean and median ages at death during the entire period were significantly lower for males, 29.4 (±19.6) and 27.5 (15.5-41.5), respectively, than for females, 33.3 (±20.3) and 31.0 (19.5-46.5), respectively. The leading SCD overall associated causes of death were septicemias (32.1%), followed by pneumonias (19.4%) and respiratory failure (18.2%). On certificates with SCD as an associated cause, the underlying causes of death were circulatory system diseases (8.7%), followed, in males, by digestive system and infectious diseases and respiratory system failures, while in females, maternal deaths, included in the chapter on pregnancy, childbirth and the puerperium, accounting for 4.6% of female deaths, were succeeded by digestive system and infectious diseases. Conclusion This study revised mortality data on death rate trends, underlying and associated causes of death, age at death and regional distribution of death in Brazil.

ABSTRACT Introduction Multiple cause of death methodology enhances mortality studies beyond the traditional underlying cause of death approach. Aim: This study aims to describe causes of death and mortality issues related to haemophilia with the use of multiple-cause-of-death methodology. Methods: Annual male haemophilia mortality data was extracted from the public multiple-cause-of-death databases of the Mortality Information System, searching deaths included in rubrics D66 "hereditary factor VIII deficiency" (haemophilia A), and D67 "hereditary factor IX deficiency" (Haemophilia B) of the International Classification of Diseases, Tenth Revision, and processed by the Multiple Cause Tabulator. Results: In Brazil, from 1999 to 2016, a total of 927 male deaths related to haemophilia occurred during the 18 year period, of which 418 (45,1 %) as underlying cause, and 509 (54,9 %) as associated cause of death. The leading associated cause of 418 deaths of haemophilia as underlying cause was hemorrhage (52.6%), half of which intracranial hemorrhage. Infectious and parasitic diseases accounted for 40,5% as the underlying causes of 509 deaths where haemophilia was an associated cause, where human immunodeficiency virus disease prevailed, however falling from 37,0% to 19.7%, and viral hepatitis increased from 6.0% to 7.9%; diseases of the circulatory system, increased from 13.5% to 18.4%, including intracranial hemorrhage from 5.7% to 7.0%, and neoplasms, from 8,5% to 13.2%, respectively from 1999-2007 to 2008-2016, followed as main underlying causes. Conclusion: Hemorrhages, mainly intracranial hemorrhage, human immunodeficiency virus disease, and viral hepatitis are the chief prevention goals aiming at the control of haemophilia mortality.

RESUMO Objetivo: Descrever as causas de morte e dados sobre mortalidade relacionada à fibrose cística (FC) por meio da metodologia de causas múltiplas de morte. Métodos: Dados sobre a mortalidade anual no período de 1999 a 2017 foram extraídos do Sistema de Informações sobre Mortalidade do Ministério da Saúde do Brasil. Foram selecionadas todas as declarações de óbito em que a categoria E84 (FC) da CID-10 foi citada como causa básica ou associada de morte. Foram descritos os dados epidemiológicos e clínicos e calculadas as taxas padronizadas de mortalidade por ano e para o período de 2000 a 2017. Foi realizada a análise de regressão por pontos de inflexão para detectar mudanças nas taxas de mortalidade durante o período estudado. Resultados: No total, foram identificadas 2.854 mortes relacionadas à FC durante o período de estudo: de 68 em 1999 a 289 em 2017. A FC foi a causa básica de morte em 83,5% das declarações de óbito. Observou-se uma tendência contínua de aumento das taxas de mortalidade, com variação percentual anual significativa de 6,84% (5,3-8,4%) nos homens e de 7,50% (6,6-8,4%) nas mulheres. A mediana da idade de óbito aumentou de 7,5 anos em 1999 para 56,5 anos em 2017. As doenças do aparelho respiratório representaram 77% das causas associadas nas declarações de óbito em que a FC foi a causa básica de morte. Conclusões: Observou-se no Brasil um aumento significativo e contínuo das taxas de mortalidade relacionada à FC nos últimos anos, bem como um aumento concomitante da mediana da idade de óbito.

ABSTRACT Objective: To describe causes of death and mortality data related to cystic fibrosis (CF) using a multiple-cause-of-death methodology. Methods: Annual mortality data for the 1999-2017 period were extracted from the Brazilian National Ministry of Health Mortality Database. All death certificates in which category E84 (CF) of the ICD-10, was listed as an underlying or associated cause of death were selected. Epidemiological and clinical data were described, and standardized mortality rates were calculated per year and for the 2000-2017 period. A joinpoint regression analysis was performed to detect changes in the mortality rates during the study period. Results: Overall, 2,854 CF-related deaths were identified during the study period, ranging from 68 in 1999 to 289 in 2017. CF was the underlying cause of death in 83.5% of the death certificates. A continuous upward trend in the death rates was observed, with a significant annual percent change of 6.84% (5.3-8.4%) among males and 7.50% (6.6-8.4%) among females. The median age at death increased from 7.5 years in 1999 to 56.5 years in 2017. Diseases of the respiratory system accounted for 77% of the associated causes in the death certificates that reported CF as the underlying cause of death. Conclusions: A significant and continuous increase in CF-related death rates was found in Brazil in the last years, as well as a concurrent increase in the median age at death.

OBJECTIVES: Remarkable changes in the epidemiology of abdominal aortic aneurysm (AAA) have occurred in many countries during last few decades, which have also affected Brazilian mortality concurrently. This study aimed to investigate mortality trends related to AAA mortality in Brazil from 2000 to 2016. METHODS: Annual AAA mortality data was extracted from the public databases of the Mortality Information System, and processed by the Multiple Cause Tabulator. RESULTS: In Brazil, 2000 through 2016, AAA occurred in 69,513 overall deaths; in 79.6% as underlying and in 20.4% as an associated cause of death, corresponding to rates respectively of 2.45, 1.95 and 0.50 deaths per 100,000 population; 65.4% male and 34.6% female; 60.6% in the Southeast region. The mean ages at death were 71.141 years overall, and 70.385 years and 72.573 years for men and women, respectively. Ruptured AAA occurred in 64.3% of the deaths where AAA was an underlying cause, and in 18.0% of the deaths where AAA was an associated cause. The standardized rates increased during 2000-2008, followed by a decrease during 2008-2016, resulting in an average annual percent change decline of -0.2 (confidence interval [CI], -0.5 to 0.2) for the entire 2000-2016 period. As associated causes, shock (39.2%), hemorrhages (33.0%), and hypertensive diseases (26.7%) prevailed with ruptured aneurysms, while hypertensive diseases (29.4%) were associated with unruptured aneurysms. A significant seasonal variation, highest during autumn and followed by in winter, was observed in the overall ruptured and unruptured AAA deaths. CONCLUSIONS: This study highlights the need to accurately document epidemiologic trends related to AAA in Brazil. We demonstrate the burden of AAA on mortality in older individuals, and our results may assist with effective planning of mortality prevention and control in patients with AAA.

OBJETIVO: Identificar as causas associadas de morte e o número de causas informadas nas declarações de óbito por doenças cerebrovasculares entre residentes no Estado do Paraná. MATERIAL E MÉTODOS: O banco de dados de mortalidade do ano de 2004 foi obtido do Sistema de Informação de Mortalidade disponível no endereço eletrônico do Datasus. A população escolhida foi separada pelo programa TabWin e as causas múltiplas foram processadas pelo programa Tabulador de Causas Múltiplas de Morte. RESULTADOS: O número médio de causas informadas foi de 2,92 para as mulheres e 2,97 para os homens. A maioria dos óbitos (74,8%) foi de pessoas com 65 anos ou mais de idade. Entre as causas associadas aos óbitos por doenças cerebrovasculares se destacaram as doenças do aparelho respiratório (37,9%), as doenças hipertensivas (37,5%) e os sintomas, sinais e achados anormais de exames clínicos e de laboratório (32,3%). CONSIDERAÇÕES FINAIS: Foi observada relativa melhora na qualidade dos dados de mortalidade em relação ao número de causas citadas. A hipertensão arterial como uma das principais causas associadas sugere a necessidade do seu controle no combate à mortalidade por doenças cerebrovasculares. Incentivos devem ser promovidos para estudos com causas múltiplas, para que se utilizem melhor informações tão importantes, que são desprezadas em estudos de mortalidade feitos somente com a causa básica de morte.

OBJECTIVE: To identify associated causes and the number of causes on death certificates that reported cerebrovascular diseases as the underlying cause among residents of the State of Paraná, in Brazil. METHODS: Mortality data in 2004 were obtained on the Datasus website. The population was selected by the TabWin program and multiple causes were processed by the Multiple Causes of Death Tabulator program. RESULTS: The mean number of causes listed on death certificates was 2.92 for women and 2.97 for men. Most people who died (74.8%) were aged 65 or older. Among the major causes associated with cerebrovascular disease deaths were respiratory diseases (37.9%), hypertensive diseases (37.5%), and symptoms, signs and abnormal clinical and laboratory tests (32.3%). FINAL CONSIDERATIONS: There was a relative improvement in the quality of mortality data regarding the number of causes registered. Hypertension as a major associated cause suggests the need for its control in the fight against mortality caused by cerebrovascular disease. Studies with multiple causes should be encouraged, taking into account all causes listed on death certificates, many of which are overlooked in mortality studies that only use the underlying cause of death.

OBJETIVO: Identificar as causas associadas de morte e o número de causas informadas nas declarações de óbito por doenças cerebrovasculares entre residentes no Estado do Paraná. MATERIAL E MÉTODOS: O banco de dados de mortalidade do ano de 2004 foi obtido do Sistema de Informação de Mortalidade disponível no endereço eletrônico do Datasus. A população escolhida foi separada pelo programa TabWin e as causas múltiplas foram processadas pelo programa Tabulador de Causas Múltiplas de Morte. RESULTADOS: O número médio de causas informadas foi de 2,92 para as mulheres e 2,97 para os homens. A maioria dos óbitos (74,8%) foi de pessoas com 65 anos ou mais de idade. Entre as causas associadas aos óbitos por doenças cerebrovasculares se destacaram as doenças do aparelho respiratório (37,9%), as doenças hipertensivas (37,5%) e os sintomas, sinais e achados anormais de exames clínicos e de laboratório (32,3%). CONSIDERAÇÕES FINAIS: Foi observada relativa melhora na qualidade dos dados de mortalidade em relação ao número de causas citadas. A hipertensão arterial como uma das principais causas associadas sugere a necessidade do seu controle no combate à mortalidade por doenças cerebrovasculares. Incentivos devem ser promovidos para estudos com causas múltiplas, para que se utilizem melhor informações tão importantes, que são desprezadas em estudos de mortalidade feitos somente com a causa básica de morte.

OBJECTIVE: To identify associated causes and the number of causes on death certificates that reported cerebrovascular diseases as the underlying cause among residents of the State of Paraná, in Brazil. METHODS: Mortality data in 2004 were obtained on the Datasus website. The population was selected by the TabWin program and multiple causes were processed by the Multiple Causes of Death Tabulator program. RESULTS: The mean number of causes listed on death certificates was 2.92 for women and 2.97 for men. Most people who died (74.8%) were aged 65 or older. Among the major causes associated with cerebrovascular disease deaths were respiratory diseases (37.9%), hypertensive diseases (37.5%), and symptoms, signs and abnormal clinical and laboratory tests (32.3%). FINAL CONSIDERATIONS: There was a relative improvement in the quality of mortality data regarding the number of causes registered. Hypertension as a major associated cause suggests the need for its control in the fight against mortality caused by cerebrovascular disease. Studies with multiple causes should be encouraged, taking into account all causes listed on death certificates, many of which are overlooked in mortality studies that only use the underlying cause of death.

OBJETIVO: Estudar a tendência da mortalidade relacionada à doença de Chagas informada em qualquer linha ou parte do atestado médico da declaração de óbito. MÉTODOS: Os dados provieram dos bancos de causas múltiplas de morte da Fundação Sistema Estadual de Análise de Dados de São Paulo (SEADE) entre 1985 e 2006. As causas de morte foram caracterizadas como básicas, associadas (não-básicas) e total de suas menções. RESULTADOS: No período de 22 anos, ocorreram 40 002 óbitos relacionados à doença de Chagas, dos quais 34 917 (87,29%) como causa básica e 5 085 (12,71%) como causa associada. Foi observado um declínio de 56,07% do coeficiente de mortalidade pela causa básica e estabilidade pela causa associada. O número de óbitos foi 44,5% maior entre os homens em relação às mulheres. O fato de 83,5% dos óbitos terem ocorrido a partir dos 45 anos de idade revela um efeito de coorte. As principais causas associadas da doença de Chagas como causa básica foram as complicações diretas do comprometimento cardíaco, como transtornos da condução, arritmias e insuficiência cardíaca. Para a doença de Chagas como causa associada, foram identificadas como causas básicas as doenças isquêmicas do coração, as doenças cerebrovasculares e as neoplasias. CONCLUSÕES: Para o total de suas menções, verificou-se uma queda do coeficiente de mortalidade de 51,34%, ao passo que a queda no número de óbitos foi de apenas 5,91%, tendo sido menor entre as mulheres, com um deslocamento das mortes para as idades mais avançadas. A metodologia das causas múltiplas de morte contribuiu para ampliar o conhecimento da história natural da doença de Chagas.

OBJECTIVES: To study mortality trends related to Chagas disease taking into account all mentions of this cause listed on any line or part of the death certificate. METHODS: Mortality data for 1985-2006 were obtained from the multiple cause-of-death database maintained by the São Paulo State Data Analysis System (SEADE). Chagas disease was classified as the underlying cause-of-death or as an associated cause-of-death (non-underlying). The total number of times Chagas disease was mentioned on the death certificates was also considered. RESULTS: During this 22-year period, there were 40 002 deaths related to Chagas disease: 34 917 (87.29%) classified as the underlying cause-of-death and 5 085 (12.71%) as an associated cause-of-death. The results show a 56.07% decline in the death rate due to Chagas disease as the underlying cause and a stabilized rate as associated cause. The number of deaths was 44.5% higher among men. The fact that 83.5% of the deaths occurred after 45 years of age reflects a cohort effect. The main causes associated with Chagas disease as the underlying cause-of-death were direct complications due to cardiac involvement, such as conduction disorders, arrhythmias and heart failure. Ischemic heart disease, cerebrovascular disorders and neoplasms were the main underlying causes when Chagas was an associated cause-of-death. CONCLUSIONS: For the total mentions to Chagas disease, a 51.34% decline in the death rate was observed, whereas the decline in the number of deaths was only 5.91%, being lower among women and showing a shift of deaths to older age brackets. Using the multiple cause-of-death method contributed to the understanding of the natural history of Chagas disease.

OBJETIVO: Estudar a mortalidade relacionada à paracoccidioidomicose informada em qualquer linha ou parte do atestado médico da declaração de óbito. MÉTODOS: Os dados provieram dos bancos de causas múltiplas de morte da Fundação Sistema Estadual de Análise de Dados (SEADE) de São Paulo entre 1985 e 2005. Foram calculados os coeficientes padronizados de mortalidade relacionada à paracoccidioidomicose como causa básica, como causa associada e pelo total de suas menções. RESULTADOS: No período de 21 anos ocorreram 1 950 óbitos, sendo a paracoccidioidomicose a causa básica de morte em 1 164 (59,7%) e uma causa associada de morte em 786 (40,3%). Entre 1985 e 2005 observou-se um declínio do coeficiente de mortalidade pela causa básica de 59,8% e pela causa associada, de 53,0%. O maior número de óbitos ocorreu entre os homens, nas idades mais avançadas, entre lavradores, com tendência de aumento nos meses de inverno. As principais causas associadas da paracoccidioidomicose como causa básica foram a fibrose pulmonar, as doenças crônicas das vias aéreas inferiores e as pneumonias. As neoplasias malignas e a AIDS foram as principais causas básicas estando a paracoccidioidomicose como causa associada. Verificou-se a necessidade de adequar as tabelas de decisão para o processamento automático de causas de morte nos atestados de óbito com a menção de paracoccidioidomicose. CONCLUSÕES: A metodologia das causas múltiplas de morte, conjugada com a metodologia tradicional da causa básica, abre novas perspectivas para a pesquisa que visa a ampliar o conhecimento sobre a história natural da paracoccidioidomicose.

OBJECTIVE: To investigate mortality in which paracoccidioidomycosis appears on any line or part of the death certificate. METHODS: Mortality data for 1985-2005 were obtained from the multiple cause-of-death database maintained by the São Paulo State Data Analysis System (SEADE). Standardized mortality coefficients were calculated for paracoccidioidomycosis as the underlying cause-of-death and as an associated cause-of-death, as well as for the total number of times paracoccidioidomycosis was mentioned on the death certificates. RESULTS: During this 21-year period, there were 1 950 deaths related to paracoccidioidomycosis; the disease was the underlying cause-of-death in 1 164 cases (59.69%) and an associated cause-of-death in 786 (40.31%). Between 1985 and 2005 records show a 59.8% decline in the mortality coefficient due to paracoccidioidomycosis as the underlying cause and a 53.0% decline in the mortality as associated cause. The largest number of deaths occurred among men, in the older age groups, and among rural workers, with an upward trend in winter months. The main causes associated with paracoccidioidomycosis as the underlying cause-of-death were pulmonary fibrosis, chronic lower respiratory tract diseases, and pneumonias. Malignant neoplasms and AIDS were the main underlying causes when paracoccidioidomycosis was an associated cause-of-death. The decision tables had to be adapted for the automated processing of causes of death in death certificates where paracoccidioidomycosis was mentioned. CONCLUSIONS: Using the multiple cause-of-death method together with the traditional underlying cause-of-death approach provides a new angle on research aimed at broadening our understanding of the natural history of paracoccidioidomycosis.

OBJETIVOS: Este trabalho estuda a distribuição dos óbitos por causas mal definidas no Brasil, no ano de 2003, entre as quais identifica a proporção de mortes sem assistência. MÉTODOS: Os dados provieram do Sistema de Informações Sobre Mortalidade, coordenado pelo Ministério da Saúde. As causas mal definidas de morte compreenderam as incluídas no "Capítulo XVIII - Sintomas, sinais e achados anormais de exames clínicos e de laboratório não classificados em outra parte" da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, décima revisão, capítulo este no qual a categoria R98 identificava a "morte sem assistência". RESULTADOS: No Brasil, em 2003, a causa básica de 13,3% dos óbitos foi identificada como mal definida, sendo que as proporções maiores ocorreram nas Regiões Nordeste e Norte. Do total de causas mal definidas no país, 53,3% corresponderam a mortes sem assistência, proporção esta que superou 70% nos Estados do Maranhão, Piauí, Rio Grande do Norte, Pernambuco, Bahia, Paraíba e Alagoas. CONCLUSÃO: Dada a estrutura descentralizada para o levantamento dos óbitos no país, identifica-se a maior responsabilidade dos municípios e, em seguida, dos Estados para o aprimoramento da qualidade das estatísticas de mortalidade.

BACKGROUND: We studied the distribution of deaths from ill-defined causes that occurred in Brazil during 2003, from which was identified the proportion of unattended deaths. METHODS: Data were obtained from the Mortality Information System, coordinated by the Ministry of Health. Causes of death included in "Chapter XVIII - Symptoms, signs and abnormal clinical and laboratory findings, not classified elsewhere" of the International Statistical Classification of Diseases and Related Health Problems, tenth revision, were considered ill-defined, among which the category R98 identified "unattended deaths". RESULTS: In Brazil during 2003 the underlying causes of 13.3% of deaths were included in the Chapter of ill-defined causes, and the highest proportions of these deaths occurred in the Northeast and North Regions. Considering the total deaths from ill-defined causes, 53 % correspond to unattended deaths. This proportion increased to over 70% in the states of Maranhão, Piauí, Rio Grande do Norte, Pernambuco, Bahia, Paraíba and Alagoas. CONCLUSION: Due to the decentralized structure of data collection in the country, we believe that the municipalities bear the major responsibility, followed by the states, for upgrading the quality of mortality statistics.

A mortalidade relacionada à cisticercose na população não tem sido pesquisada no Brasil. Foram estudados os óbitos registrados entre 1985 e 2004 no Estado de São Paulo em que a cisticercose foi mencionada em qualquer linha ou parte da Declaração de Óbito. As causas de morte foram processadas pelo Tabulador de Causas Múltiplas. No período de vinte anos ocorreram 1.570 óbitos, sendo a cisticercose causa básica em 1.131 e causa associada de morte em 439. Os coeficientes padronizados de mortalidade por cisticercose como causa básica apresentaram tendência de declínio, foram maiores entre os homens e nas idades mais avançadas. As principais causas associadas nas mortes por cisticercose foram hipertensão intracraniana, edema cerebral, hidrocefalias, doenças inflamatórias do sistema nervoso central e doenças cerebrovasculares. A AIDS foi a principal causa básica nas mortes com a cisticercose como causa associada. Os municípios com maior número de mortes foram São Paulo, Campinas, Ribeirão Preto e Santo André. Observou-se grande variação entre os municípios na valorização da cisticercose como causa básica de morte, determinando sua subestima para subsidiar o planejamento de políticas de saúde.

Cysticercosis-related mortality has not been studied in Brazil. Deaths recorded in the State of São Paulo from 1985 to 2004 in which cysticercosis was mentioned on any line or in any part of the death certificate were studied. Causes of death were processed using the Multiple Cause Tabulator. Over this 20-year period, cysticercosis was identified in 1,570 deaths: as the underlying cause in 1,131 and as an associated cause of death in 439. Standardized mortality rates with cysticercosis as the underlying cause showed a downward trend and were higher among men and older individuals. Intracranial hypertension, cerebral edema, hydrocephalus, inflammatory diseases of the central nervous system, and cerebrovascular diseases were the main associated causes in deaths due to cysticercosis. AIDS was the principal underlying cause of death in which cysticercosis was an associated cause. The counties (municipalities) with the most cysticercosis-related deaths were São Paulo, Campinas, Ribeirão Preto, and Santo André. Wide variation was observed between counties regarding the value ascribed to cysticercosis as the underlying cause of death. This leads to underestimation of the disease's importance in planning health interventions.

A mortalidade relacionada à cisticercose na população não tem sido pesquisada no Brasil. Foram estudados os óbitos registrados entre 1985 e 2004 no Estado de São Paulo em que a cisticercose foi mencionada em qualquer linha ou parte da Declaração de Óbito. As causas de morte foram processadas pelo Tabulador de Causas Múltiplas. No período de vinte anos ocorreram 1.570 óbitos, sendo a cisticercose causa básica em 1.131 e causa associada de morte em 439. Os coeficientes padronizados de mortalidade por cisticercose como causa básica apresentaram tendência de declínio, foram maiores entre os homens e nas idades mais avançadas. As principais causas associadas nas mortes por cisticercose foram hipertensão intracraniana, edema cerebral, hidrocefalias, doenças inflamatórias do sistema nervoso central e doenças cerebrovasculares. A AIDS foi a principal causa básica nas mortes com a cisticercose como causa associada. Os municípios com maior número de mortes foram São Paulo, Campinas, Ribeirão Preto e Santo André. Observou-se grande variação entre os municípios na valorização da cisticercose como causa básica de morte, determinando sua subestima para subsidiar o planejamento de políticas de saúde.

Cysticercosis-related mortality has not been studied in Brazil. Deaths recorded in the State of São Paulo from 1985 to 2004 in which cysticercosis was mentioned on any line or in any part of the death certificate were studied. Causes of death were processed using the Multiple Cause Tabulator. Over this 20-year period, cysticercosis was identified in 1,570 deaths: as the underlying cause in 1,131 and as an associated cause of death in 439. Standardized mortality rates with cysticercosis as the underlying cause showed a downward trend and were higher among men and older individuals. Intracranial hypertension, cerebral edema, hydrocephalus, inflammatory diseases of the central nervous system, and cerebrovascular diseases were the main associated causes in deaths due to cysticercosis. AIDS was the principal underlying cause of death in which cysticercosis was an associated cause. The counties (municipalities) with the most cysticercosis-related deaths were São Paulo, Campinas, Ribeirão Preto, and Santo André. Wide variation was observed between counties regarding the value ascribed to cysticercosis as the underlying cause of death. This leads to underestimation of the disease's importance in planning health interventions.

OBJETIVO: Avaliar o processamento automático e o potencial epidemiológico da utilização das causas múltiplas de morte por meio de suas menções nas declarações de óbito no Brasil em 2003. MÉTODOS: Os óbitos estudados provieram do banco de dados do Sistema de Informação sobre Mortalidade. A distribuição do número de causas informadas por declaração de óbito foi processada pelo Tabulador de Causas Múltiplas e descrita por meio de porcentagens em relação aos totais de óbitos nas unidades da federação, nas regiões e no País. Para as principais causas identificadas no Brasil em 2003, calculou-se a proporção de ocorrência de cada uma delas como causa como básica em relação ao número total de vezes que foi mencionada. RESULTADOS: O número médio de causas por declaração de óbito variou de 2,07 no Estado do Maranhão a 3,15 no Estado de São Paulo; entre as regiões, esse número variou de 2,45 no Nordeste até 2,99 no Centro-Oeste. Para o Brasil, o número médio de causas por declaração de óbito foi 2,81. As causas externas e as neoplasias, a morte sem assistência, as doenças pelo vírus da imunodeficiência humana (HIV) e a doença alcoólica do fígado apareceram como causa básica em mais de 90% das vezes em que foram mencionadas; as neoplasias, a doença de Chagas, as malformações congênitas, as doenças isquêmicas do coração e as doenças cerebrovasculares, entre 70 e menos de 90% das menções; e as pneumonias, a insuficiência cardíaca, o alcoolismo, a desnutrição, as doenças hipertensivas, as anemias, as causas mal definidas, a prematuridade, as septicemias e a insuficiência respiratória, em menos de 40%. Conclusões. Embora a causa básica de morte continue a ser essencial para a análise de tendências históricas, para a comparabilidade entre países e para orientar a prevenção da morte, a metodologia das causas múltiplas permite vislumbrar uma nova dimensão no estudo da mortalidade. A combinação das duas metodologias é mais útil do que o uso de uma delas isoladamente.

OBJECTIVE: To evaluate the automated processing and the epidemiological potential of multiple-cause-of-death data listed on death certificates in Brazil in 2003. METHODS: Data were obtained from the Brazilian Mortality Information System. The distribution of the number of causes per death certificate was processed using the Multiple Cause of Death Tabulator software and expressed as a percentage of the total deaths in federation units, regions, and in the country as a whole. For the main causes of death identified in Brazil in 2003, we calculated the rate at which each cause was listed as the "underlying cause of death" in relation to the total times the cause was mentioned. RESULTS: The mean number of causes of death per certificate ranged from 2.07 in the state of Maranhão to 3.15 in the state of São Paulo, and from 2.45 in the Northeast to 2.99 in the Mid-West. For the entire country, the mean number of causes of death per certificate was 2.81. External causes and neoplasms, unattended deaths, human immunodeficiency virus, and alcoholic liver disease were listed as the underlying cause more than 90% of the times they were mentioned; neoplasms, Chagas’ disease, congenital malformations, ischemic heart diseases, and cerebrovascular diseases, between 70% to less than 90% of the times they were mentioned; and pneumonias, heart failure, alcohol dependence, malnutrition, hypertensive diseases, anemias, ill-defined causes, prematurity, septicemias, and respiratory failure, less than 40% of the times they were mentioned. CONCLUSIONS: Although underlying causes of death are still essential to analyze historical trends, compare countries, and to guide the prevention of death, multiple-cause-of-death-data offer a new insight into the study of mortality. The combination of the two methodologies is more useful than the isolated use of either approach.

OBJETIVO: Estudar a tendência da mortalidade relacionada à varicela tanto como causa básica quanto como causa associada de morte (informada em qualquer linha ou parte do atestado médico da declaração de óbito). MÉTODOS: Os dados provieram dos bancos de causas múltiplas de morte da Fundação Sistema Estadual de Análise de Dados de São Paulo (SEADE) entre 1985 e 2004. As causas de morte foram processadas pelo Tabulador de Causas Múltiplas. RESULTADOS: Nesse período de 20 anos, ocorreram 1 037 óbitos em que a varicela foi identificada como causa básica e 150 nos quais foi causa associada. Os coeficientes de mortalidade pela causa básica foram superiores e declinaram, ao passo que a mortalidade por varicela como causa associada apresentou um pequeno aumento. Setenta e seis por cento das mortes ocorreram em menores de 10 anos de idade, especialmente nos menores de 1 ano. Ocorreu concentração de mortes entre os meses de julho e janeiro (86,8% do total de 1 187 óbitos), com valores máximos em outubro. Os coeficientes de mortalidade da capital para a varicela como causa básica e associada foram, respectivamente, 47,1 e 50,0% maiores do que os do interior do Estado. Para a varicela como causa básica, as pneumonias e septicemias foram as principais causas associadas, ao passo que para a varicela como causa associada, a AIDS e as neoplasias foram as principais causas básicas de morte. CONCLUSÕES: Em que pese o declínio da varicela como causa básica de morte, este estudo permitiu evidenciar o impacto da mortalidade relacionada à varicela em grupos de risco específicos, entre os quais as crianças entre 1 e 4 anos e os indivíduos com AIDS e neoplasias.

OBJECTIVE: To study mortality trends related to chickenpox, as either the underlying or associated cause-of-death (recorded in any field of the medical section of the death certificate), in São Paulo, Brazil. METHODS: Mortality data for 1985-2004 were obtained from the multiple cause-of-death database maintained by the São Paulo State Data Analysis System (SEADE). Causes-of-death were processed using the Multiple-Causes-of-Death Tabulator. RESULTS: During this 20-year period, chickenpox was identified as the underlying cause-of-death in 1 037 deaths and an associated cause in 150. The mortality coefficients were higher for chickenpox as the underlying, as opposed to the associated cause, and these declined in the analyzed period; whereas a slight increase was observed in mortality due to chickenpox as an associated cause. Seventy-six percent of the deaths were of children under 10 years of age, with the highest incidence among those under 1 year. Most deaths occurred from July to January (86.8% of 1 187 deaths), with a peak in October. In the state's capital city, the mortality coefficients for chickenpox as underlying cause and as associated cause were 47% and 50% higher, respectively, than in the rest of the state. Where chickenpox was identified as the underlying cause, pneumonias and septicemias were the major associated causes; where it was the associated cause, AIDS or neoplasia were most often the underlying cause. CONCLUSIONS: Although chickenpox as the underlying cause-of-death has declined, the present study indicates that certain groups are at risk of chickenpox-related mortality, namely children 1-4 years of age and individuals with AIDS or neoplasia.

No início dos anos 90, observou-se aumento da resistência do Mycobacterium tuberculosis às drogas antituberculose, com alta prevalência entre pacientes HIV+. Neste estudo, foram avaliados a freqüência de resistência, o perfil de sensibilidade do M. tuberculosis às drogas e os fatores predisponentes à resistência entre indivíduos HIV+ nos municípios de Santos, São Vicente, Cubatão, Praia Grande e Guarujá, Estado de São Paulo, Brasil. Foram pesquisados os prontuários de 301 pacientes com resultado de cultura positivo entre 1993 e 2003. A resistência ocorreu em 57 (18,9%) pacientes com a seguinte distribuição: 32 (10,6%) apresentaram tuberculose multirresistente (resistência ao menos à Rifampicina e Isoniazida); 4 (1,3%) casos apresentaram resistência a duas ou mais drogas e 21 (7%) à monorresistência. Observou-se resistência secundária em 70,2% dos casos. Estatisticamente associadas à tuberculose resistente foram: tratamento anterior com drogas antituberculose, tempo de diagnóstico de HIV e hospitalização prévia. Em análise multivariada, apenas tratamento anterior, ajustado por faixa etária, mostrou-se associado (OR = 5,49; IC95%: 2,60-11,60). A ocorrência de resistência em 18,9% dos casos e multirresistência em aproximadamente 10% confirmam a relevância deste problema entre pacientes HIV+ na Baixada Santista.

Since the early 1990s, an increase in Mycobacterium tuberculosis drug resistance has been reported, with high prevalence among HIV+ patients. We evaluated the sensitivity patterns of M. tuberculosis, resistance rate, and predisposing factors among HIV+ patients in Santos, São Vicente, Cubatão, Praia Grande, and Guarujá, São Paulo State, Brazil. The medical charts of 301 patients with positive cultures for M. tuberculosis from 1993 to 2003 were reviewed. Resistance occurred in 57 patients (18.9%), as follows: 32 (10.6%) displayed multidrug-resistant tuberculosis (resistant to at least Rifampicin and Isoniazid); 4 (1.3%) were resistant to two or more drugs; and 21 (7%) were resistant to a single drug. Acquired resistance was observed in 70.1% of cases. Drug resistance was significantly associated with previous tuberculosis treatment, duration of HIV diagnosis, and previous hospitalization. In logistic regression analysis, only previous tuberculosis treatment adjusted by age remained as an independent risk factor (OR = 5.49; 95%CI: 2.60-11.60). Drug resistance to at least one drug in 18.9% and multidrug resistance in 10.6% of cases highlight the relevance of this problem in HIV patients in the Baixada Santista.