Brazilian Data Sources
Non-communicable diseases (NCDs), including CVD, have multifactorial causes and share several risk factors (RF). Accumulated evidence points to the need for comprehensive and sustainable strategies for the prevention and control of NCDs, based on their main risk factors (RFs): smoking, physical inactivity, inadequate diet, alcohol consumption, obesity, dyslipidemia, hypertension and diabetes. For the monitoring of these diseases and their RF, the surveillance of NCDs is essential. This surveillance is important for public health, which aims to subsidize the planning, execution and evaluation of prevention and control efforts. The surveillance of NCDs must combine a set of actions that provides information as to the distribution, magnitude and trends of these diseases. The main sources of data in Brazil are morbidity and mortality information systems (SIM, SIH, APAC) and periodic health surveys, like the National Health Survey.
In the present version of the “Brazilian Cardiovascular Statistics” document, besides the articles that resulted from the systematic review, primary data from sources provided by the Brazilian government were cited along the chapters:
SIM (Sistema de Informação de Mortalidade)
In Brazil, the Mortality Information System (SIM), created in 1975 by the Ministry of Health (MS), is responsible for collecting, storing, managing and disseminating national mortality data. This health information system represented a major advance in the country's epidemiological surveillance, since its main task is to record all deaths that occurred in the Brazilian territory. In addition to the implementation of a single Death Certificate (DO) model, a document for collecting information on death, which uses the International Classification of Diseases (ICD) to code the causes of death, a standardized flow of collection, processing and distribution of death information was implemented in all 5,570 municipalities across the country. However, despite the importance of the Ministry of Health efforts for managers in the three spheres of government, National, State and Municipal, the quality of statistics on causes of death in Brazil still have questionable and geographically heterogeneous quality. To assess the quality of mortality systems, the coverage of death records and the proportion of ill-defined causes of death (chapter XVIII of ICD-10) are traditionally used as indicators. Knowing the heterogeneity of these indicators in Brazil, the results of Cardiovascular Statistics treated the data to estimate information closer to the real, with the correction of underreporting and redistribution of ill-defined causes of death.
SIH (Sistema de Informação Hospitalar)
The aim of the SIH-SUS database is to register all hospitalizations that were funded by SUS. SIH-SUS comprehends the hospitalizations at the municipal level through the “Authorization for Hospitalization” (Autorização de Internação Hospitalar - AIH), which has information about the diseases that led to hospitalization (using ICD-10), length of stay, procedures and costs. The SIH-SUS information permit the development of methodologies and the definition of indicators to identify geographical disparities related to hospital resources.
National Health Survey (Pesquisa Nacional de Saúde - PNS)
Although it was not in the scope of this year’s document to describe the statistics for cardiovascular risk factors, some chapters cite the metrics for some risk factors in the context of the specified disease. In that case, a preference for the PNS survey was made. National Health Survey (PNS) is a home-based epidemiological survey, representative for Brazil, its large regions, UF, metropolitan regions, capitals and other municipalities in each UF. The PNS 2013 sample was composed of 64,348 households. The survey was carried out by IBGE in partnership with MS. Most health topics were included, such as NCDs, RF, elderly, women, children, use of services, health inequalities, and physical and laboratory measurements, arterial and anthropometric pressure measurement. PNS data are used by GBD in its estimates for Brazil.
For population estimates
The most updated population estimates generated by Geography and Statistics Brazilian Institute (Instituto Brasileiro de Geografia e Estatística – IBGE) were used in the denominator. For the hospitalizations and costs analyses, the resident population estimated for the National Audit Office yearly, from 2008 to 2018, were used.
More details can be found in the article by Malta et al.