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Identifying and quantifying misclassified and under-reported AIDS deaths in Brazil: a retrospective analysis from 1985 to 2009
  1. Erika Fazito1,
  2. Paloma Cuchi2,
  3. Doris Ma Fat3,
  4. Peter Denis Ghys2,
  5. Mauricio G Pereira4,
  6. Ana Maria Nogales Vasconcelos1,
  7. Ana Roberta Pati Pascom5
  1. 1Faculty of Health Sciences, University of Brasília, Brazil
  2. 2Epidemiology and Analysis Division, UNAIDS, Geneva, Switzerland
  3. 3Health Statistics and Information Systems, WHO, Geneva, Switzerland
  4. 4Faculty of Medicine, University of Brasília, Brasília, Brazil
  5. 5Department of STD, AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
  1. Correspondence to Erika Fazito, 26 Chemin Colladon, 1209 Genève, Suisse, Brasília, Brazil; erikafazito{at}gmail.com

Abstract

Background A retrospective analysis of deaths registered in the Brazilian Mortality System was conducted to quantify the under-reporting of HIV/AIDS deaths and those misclassified to AIDS-related conditions in the 15–49 years old population in Brazil.

Methods Death rates for AIDS-related diseases were calculated by age and sex for 1985–2009. Changes in the age-sex-specific death rates over time were used to identify conditions likely to be misclassified AIDS deaths and to quantify the corresponding number of misclassified deaths. Deaths due to ill-defined causes were redistributed across all other natural causes of death. The resulting total number of AIDS deaths was further adjusted for incompleteness of the mortality reporting system.

Results Out of the 28 potential causes of death investigated, five increased in the same distinct age pattern as AIDS: pneumonia, Kaposi's sarcoma, other immunodeficiencies, other septicaemia and toxoplasmosis. 18 490 deaths due to these five causes were recoded to HIV/AIDS from 1985 to 2009. 38 145 deaths due to ill-defined causes were redistributed to AIDS and 15 485 were added to the number of AIDS deaths to correct for completeness of the mortality system in Brazil. Altogether, 72 120 deaths were recoded to AIDS between 1985 and 2009 and added to the reported 194 445 AIDS related deaths in the country, representing 27% misclassification of AIDS deaths in Brazil.

Conclusions This study demonstrated that AIDS mortality is underestimated by the official mortality information system in Brazil. Efforts need to be made to reduce misclassification of causes of death in the future and identify ways in which the confidentiality of information regarding cause of death can be maintained.

  • AIDS
  • Epidemiology (General)
  • HIV

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode

https://doi.org/10.1136/sextrans-2012-050632

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    Footnotes

    • Contributors All authors contributed to the conception and design of the study, to the interpretation of data, to the review of the paper for important intellectual content, and to final approval of the version to be published. EF, PC and DMF were also responsible for the acquisition of data.

    • Competing interests None.

    • Ethics approval Ethics committee from the Universidade de Brasília.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/