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OBJECTIVES: To estimate mortality rates and mortality trends from SLE in the state of São Paulo, Brazil. MATERIAL AND METHODS: The official data bank was used to study all deaths occurred from 1985 to 2004 in which SLE was mentioned as the underlying cause of death. Besides the overall mortality rate, the annual gender- and age-specific mortality rates were estimated for each calendar year by age bracket (0-19 years, 20-39 years, 40-59 years and over 60 years) and for the sub-periods 1985-1995 (first) and 1996-2004 (second), by decades. Chi-square test was used to compare the mortality rates between the two periods, as well the mortality rates according to educational level considering years of study. Pearson correlation coefficient test was used to analyse mortality trends. The crude rates were adjusted for age by the direct method, using the standard Brazilian population in 2000. RESULTS: A total of 2,601 deaths (90% female) attributed to SLE were analysed. The mean age at death was significantly higher in the second than in the first sub-period (36.6+/-15.6 years vs. 33.9+/-14.0 years; p<0.001). The overall adjusted mortality rate was 3.8 deaths/million habitants/year for the entire period and 3.4 deaths/million inhabitants/year for the first and 4.0 deaths/million inhabitants/year for the second sub-period (p<0.001). In each calendar year, the mortality rate was significantly lower for the better educated group. Throughout the period, there was a significant increase in mortality rates only among women over 40. CONCLUSIONS: SLE patients living in the state of São Paulo still die at younger ages than those living in developed countries. Our data do not support the theory that there was an improvement in the SLE mortality rate in the last 20 years in the state of Sao Paulo. Socio-economic factors, such as the difficulty to get medical care and adequate treatment, may be the main factors to explain the worst prognosis for our patients.

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OBJECTIVE: To evaluate the comparability of the underlying cause and multiple causes of death identified according to the ninth and tenth revisions of the International Classification of Diseases. METHODS: Study data was obtained by a random sample of 3,313 death certificates of individuals living in the State of S. Paulo and whose death was registered during the year of 1992. They corresponded to 1.6% of the total deaths of that year. The corresponding file was processed by the Automated Classification of Medical Entities system, and codes were assigned to all mentioned conditions. The underlying cause of death had been evaluated and revised according to the ninth revision. All the conditions mentioned on the medical form of the corresponding death certificates were coded according to the tenth revision and the codes were introduced in the original file in order to assess the causes of death by the Declarações de Obito de S. Paulo system to obtain the underlying cause of death. Multiple causes of death tabulations for both ninth and tenth revisions codes were produced by the respective versions of the Multiple Causes of Death Tabulator software. The comparisons of causes of death are circumscribed to the chapters of both revisions. RESULTS/CONCLUSIONS: The most important changes with the underlying causes of death occurred in chapters I, III and VIII of the ninth revision and the corresponding chapters I, IV and X of the tenth revision of the International Classification of Diseases. They were due to the displacement of deaths related to the human immunodeficiency virus disease and the dismissal of pneumonias as a cause of death. Regarding multiple causes of death, it was observed an increase ofrespiratory diseases and a corresponding reduction of causes included in the chapter of ill-defined affections due to recoding of respiratory failure.

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OBJECTIVES: To describe the Aids mortality according to its underlying and associated causes of death in the State of S. Paulo in 1998. METHODS: Mortality and population data for 1998 were obtained from the State Data Analysis System Department (Fundação Sistema Estadual de Análise de Dados - Seade). Causes of death were coded according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems. RESULTS: Aids was the underlying cause in 4,619 deaths, corresponding to the 10th leading cause of death (2.0%) and a mortality rate of 13.1/100,000 population. Male/female death ratio and rate ratios were respectively 2.4 and 2.5. Aids was the second leading cause of death among men aged 20--34 and women aged 25--34 years. Median age at death for women (34.1+/-12.2 years old) was lower than men (36.4+/-10.7 years old) - p<0,001. The main associated causes of Aids deaths were respiratory insufficiency (36.1%), pneumonia (27.0%), tuberculosis (19.6%), septicemia (18.6%), toxoplasmosis (12.2%), P. carinii pneumonia (8.3%) and cachexia (7.9%). Aids was an associated cause of death in additional 84 cases. The main underlying causes of these deaths were malignant neoplasms (28/84), conditions secondary to alcohol abuse (23/84) and diabetes mellitus (7/84). The median age at death due to Aids as an underlying cause (35.7+/-11.2 years old) was lower than the age at death with Aids as an associated cause (39.9+/-11.8 years old - p<0.001). CONCLUSIONS: Multiple causes of death allow to track part of the Aids natural history and provide additional data to develop adequate and specific preventive actions.

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INTRODUCTION: The correct identification of the underlying cause of death and its precise assignment to a code from the International Classification of Diseases are important issues to achieve accurate and universally comparable mortality statistics. These factors, among other ones, led to the development of computer software programs in order to automatically identify the underlying cause of death. OBJECTIVE: This work was conceived to compare the underlying causes of death processed respectively by the Automated Classification of Medical Entities (ACME) and the "Sistema de Seleção de Causa Básica de Morte" (SCB) programs. MATERIAL AND METHOD: The comparative evaluation of the underlying causes of death processed respectively by ACME and SCB systems was performed using the input data file for the ACME system that included deaths which occurred in the State of S. Paulo from June to December 1993, totalling 129,104 records of the corresponding death certificates. The differences between underlying causes selected by ACME and SCB systems verified in the month of June, when considered as SCB errors, were used to correct and improve SCB processing logic and its decision tables. RESULTS: The processing of the underlying causes of death by the ACME and SCB systems resulted in 3,278 differences, that were analysed and ascribed to lack of answer to dialogue boxes during processing, to deaths due to human immunodeficiency virus [HIV] disease for which there was no specific provision in any of the systems, to coding and/or keying errors and to actual problems. The detailed analysis of these latter disclosed that the majority of the underlying causes of death processed by the SCB system were correct and that different interpretations were given to the mortality coding rules by each system, that some particular problems could not be explained with the available documentation and that a smaller proportion of problems were identified as SCB errors. CONCLUSION: These results, disclosing a very low and insignificant number of actual problems, guarantees the use of the version of the SCB system for the Ninth Revision of the International Classification of Diseases and assures the continuity of the work which is being undertaken for the Tenth Revision version.

PIP: Problems in collecting data on causes of death are examined by comparing data collected in two different programs in Brazil, the Automated Classification of Medical Entities (ACME) and the Sistema de Selecao de Causa Basica de Morte (SCB). The data concern 129,104 death certificates recorded in the state of Sao Paulo in 1993. The analysis revealed 3,278 differences in the causes of death between the two systems, primarily due to failure to record the necessary information, deaths associated with HIV for which there was no provision for recording the appropriate information, and coding or keying errors. The relatively low and insignificant number of problems recorded indicates the high quality of the data collected, particularly in the SCB system.

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INTRODUCTION: Infant mortality was studied in an urban area of Southeastern Brazil in the period from 1990 to 1992 using data from death certificates collected at the registry office, by the application of methods for obtaining a collective diagnosis which will assist in the identification and choice of strategies for the control of local problems. MATERIAL AND METHOD: The original data were corrected using documental research into health services and household interviews. Data of the Live Birth Information System (SINASC) was used to study variables such as maternal age and birthweight. The quality of original death certificates was initially analyzed using the amount of information, sensitivity, specificity and Kappa value. RESULTS: The global sensitivity for the underlying cause was 78.84% and Kappa 71.32% for the total of causes. One hundred and eighty-nine deaths occurred, 66.15% of them in the neonatal period, (41.28% during the first day of life) and 33.85% in late childhood. The birthweight of 58.28% of deaths was less than 2.500 g. The underlying causes of death were studied the by possibility, of their avoidance (a method developed by Erica Taucher), by a "reduced" group of causes (utilized in International Collaborative Effort (ICE)), multiple causes statistics and geographical distribution. It was observed that in the deaths occurring up to 27 days, 22.23% could have been avoided by adequate care during labour, and 20.64% could have been avoided by early diagnosis and early treatment, 13.75% by good pregnancy care and only 7.94% were unavoidable. Of the deaths occurring in late childhood, 12.17% were classified as of avoidable causes and 4.23% were considered as unavoidable. Using ICE groups, 58.74% died of immaturity or asphyxia, 19.58 of infection and 12.17% from congenital abnormalities. CONCLUSIONS: The results suggest that priority be given to obstetrical care at delivery and during labour and to the pediatric care of low birth weight, among others. The analysis using multiple causes statistics shows that 76.05% of the deaths have underlying causes related to neonatal disorders and confirms the relationship with the weight deficiencies of the newborn. The maternal complications were also related to weight deficiencies. Great differences were identified in infant mortality rates in urban zones not only restricted to the value of the rates but also to the diseases responsible for the occurrence of deaths. We therefore conclude that there is an advantage to be gained in using the four methods, which are complementary, for studying or planning actions with a view to prevent infant mortality.

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The article begins with a discussion of some mortality statistics issues, problems encountered in the manual selection of underlying cause of death, and also the increasing need for information on associated causes. These circumstances led the National Center for Health Statistics to develop the computerized ACME System, which has been in use in São Paulo State since 1983. The ACME System's requirement of a mainframe computer, as well as other operational limitations, has prevented its installation throughout the country. In order to standardize and improve the quality of mortality data in Brazil, the Informatics Department of the Ministry of Health's National Health Foundation and the World Health Organization (WHO) Collaborating Center for the Classification of Diseases in Portuguese developed the microcomputer-based Underlying Cause Selection System (SCB) in 1993. This is an expert system that employs artificial intelligence techniques to reproduce the reasoning of a coder in selecting the underlying cause of death, according to the rules and provisions of the Ninth Revision of the International Classification of Diseases. The SCB has a very user-friendly interface, occupies 2.6 megabytes of hard disk space, and can run on any 386 or higher XT or AT computer. In addition to selecting the underlying cause of death, the system stores data on associated conditions.

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A cross-sectional study for prevalence of arterial hypertension in the population aged 15-74 years of age of the urban area of Araraquara County, 250 km from the city of S. Paulo, S. Paulo, State, Brazil, in 1987, was performed. The questionnaires presented to 1,199 people (533 men and 666 women) at the interview consisted of regarding sociodemographic variables, as well as the use of tobacco (smoking), the ways in which tobacco was used and the habit of inhaling the smoke. The sample was taken by the procedure of clustering, carried out in three stages. The sample was equiprobabilistic. The prevalence of tobacco smoking was very high being of 45.2% for men and 22.8% for women. The ex-smokers accounted for 15.9% of men and 8.0% of women. The men smoked much more than the women. The poorer smoked more than the richer, in both sexes. Among men, the prevalence of smoking was inversely proportional to duration of schooling, but that difference was not noted in women. As there have been other studies regarding the high prevalence of obesity and high blood pressure, it was concluded therefore that the population of Araraquara, an average town of the affluent urban interior of S. Paulo State, has a high frequency of risk factors for chronic non-transmissible diseases.

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Further to a research project into the accuracy of death given on the causes of death given on the death certificates of women of fertile age (10-49), resident in the City of S. Paulo, SP, Brazil, in 1986, the main causes of death for the population according to age, with remarks on the mortality from cardiovascular diseases (CVD), malignant neoplasms and external causes are presented. The CVD were responsible for 23.6% of all deaths in this age group, strokes occupying the position of greatest importance (51.1% of all CVD deaths) and coronary heart disease coming second (18.2% of all CVD deaths, the greater number of them being due to acute myocardial infarction). Comparing these results with those of a similar research project undertaken in the 60s, in the same place and using the same methodology, a decline of mortality from chronic rheumatic disease of the heart is to be noted, as also a rise in the mortality from stroke and coronary heart disease, but with a global reduction in age-adjusted rates for CVD overall. There was also a great number of references to arterial hypertension both combined with stroke (78.3% of all deaths due to this cause were of hypertensives) and with coronary heart disease (where this proportion was of 63.4%). The importance of the supposedly high prevalence of high blood pressure in the fertile female population and the indiscriminate use of oral contraceptives are discussed.

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In continuation to the research project on the accuracy of the certification of the underlying causes of death in women of child-bearing age (10-49), resident in the Municipality of S. Paulo, Brazil, in 1986, "original" death certificates were compared with "revised" death certificates (including additional information). The maternal mortality rate rose from 44.5 per 100,000 live births (l.b.) to 99.6 per 100,000 l.b., a high rate when compared with that of other places. When these data were compared with those of previous, similar investigations in the same city, the maternal mortality rate rose in the period 1962/4 through 1972/4 and fell in 1986. The main causes of death were: hypertension complicating pregnancy, other conditions of the mother which complicated pregnancy and puerperal complications. The need to extend the 42-day period related to the concept of maternal death, as well as the relationship between the non-maternal conditions (cancer, violence) and the gravidic-puerperal cycle are discussed.

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Mortality among adolescents (10-19 yrs. of age), resident in 9 states of Brazil in 1977, 1980 and 1985, was analysed according to age (10-14 and 15-19 yrs. of age), sex (male, female) and underlying cause of death. The mortality was greater among males aged 15-19. External causes were responsible for the great mortality in all strata, mainly in the metropolitan regions of the urban southeast, rising throughout the period in these regions. The chronic diseases (cancer and cardiovascular diseases) were also frequent as the underlying cause of death in adolescents; though in much lesser proportion than the non-natural causes.

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The purpose of this study was to evaluate the accuracy of the death certificates of a sample of a quarter of all deaths in women of reproductive age (10-49 years) resident in the Municipality of S. Paulo, SP, Brazil, in 1986. For each death, further data were gathered by means of household interviews and from medical records and autopsy information where available. Nine hundred and fifty-three deaths were analysed, for whom there were good quality death certificates except with regard to maternal deaths an terminal respiratory diseases, the former being greatly under-reported. The official maternal mortality rate was 44.5 per 100,000 live births but the true rate was 99.6 per 100,000 live births. The three main causes of death were cardiovascular diseases, neoplasms and external causes. A great proportion of smokers was found among the deceased women (40.4%). Eleven percent of the deceased consumed large amounts of alcoholic beverages regularly.

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