Evolution of quality of information in death certificates mentioning congenital syphilis in perinatal deaths in Brazil

Abstract Objective Evaluate the quality of information in death certificates (DC) mentioning congenital syphilis (CS) in perinatal deaths in Brazil (2001/02 and 2012/13). Methods Crossectional study with data from the Mortality Information System about fetal and early neonates. Fetal, early neonatal and perinatal mortality rates specific by CS, percentage of incompleteness by selected variables, underlying causes and multiple causes of death ratio (CB/CM), and other indicators were calculated. The original underlying cause was compared to the underlying cause after investigation. Results In 2001/02 and 2012/13, 330 and 933 perinatal deaths, respectively, with CS occurred; perinatal mortality rate increased from 4.2 to 12.8 per 100.000 total births. The completion of the main required fields has improved. The CB/CM ratio was 0.8 for CS, indicating adequate registration of this cause, with use of multiple causes. CS percentage as the underlying cause increased post-investigation, from 31.2% to 85.4% (fetal deaths) and from 54.5% to 76.2% (early neonates). Conclusion perinatal mortality rate due to CS increased over the study period. There was improvement in the completion of the DC. The use of multiple causes of death allowed the analysis of all perinatal deaths with CS mention, which is important given efforts in reducing CS.目的：评估巴西2001/2002年及2012/2013年围产儿死亡（perinatal deaths）病例中提及先天性梅毒（Congenital Syphilis，CS）的死亡证明书（Death Certificates，DC）信息质量。 方法：本研究为横断面研究，采用巴西死亡信息系统中的胎儿死亡（fetal deaths）、早期新生儿死亡（early neonatal deaths）相关数据开展分析，计算了按先天性梅毒分组的胎儿、早期新生儿及围产儿死亡率、各选定变量的信息缺失率、根本死因（underlying causes）及多死因填报比（multiple causes of death ratio，CB/CM）等多项指标，并将原始填报的根本死因与调查后确认的根本死因进行对比。 结果：2001/2002年及2012/2013年分别有330例、933例合并先天性梅毒的围产儿死亡病例；围产儿死亡率从每10万活产4.2例升至12.8例。死亡证明书中必填核心字段的填写完整性有所提升。先天性梅毒的CB/CM比值为0.8，提示该死因的登记填报规范，且采用了多死因填报方式。经调查后，被归类为根本死因的先天性梅毒占比显著提升：胎儿死亡病例中从31.2%升至85.4%，早期新生儿死亡病例中从54.5%升至76.2%。 结论：研究期间，由先天性梅毒导致的围产儿死亡率呈上升趋势；死亡证明书的填写完整性有所改善。采用多死因填报方式可实现对所有提及先天性梅毒的围产儿死亡病例的分析，这对于当前先天性梅毒防控工作具有重要意义。