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Measuring misclassification of Covid-19 as garbage codes: Results of investigating 1,365 deaths and implications for

Elisabeth B França1,2, Lenice H Ishitani2, Daisy Maria Xavier de Abreu2

  • 1Graduate Program in Public Health, School of Medicine, Federal University of Minas Gerais - Belo Horizonte, Minas Gerais, Brazil.

PLOS Global Public Health
|March 24, 2023
PubMed

Insights

Brazil

Area of Science:

  • Epidemiology
  • Public Health
  • Vital Statistics

Background:

  • Misclassification of Coronavirus Disease-2019 (COVID-19) mortality is a significant issue in Brazil.
  • Deaths attributed to garbage codes (GC) obscure the true COVID-19 death toll.
  • Accurate vital statistics are crucial for understanding the pandemic's impact.

Purpose of the Study:

  • To quantify COVID-19 mortality misclassification in Brazilian hospitals.
  • To identify factors contributing to misclassification.
  • To assess the implications for national vital statistics.

Main Methods:

  • Analysis of hospital deaths assigned to garbage codes in three Brazilian state capitals.
  • Review of medical charts and forensic reports by physicians.
  • Re-assignment of underlying causes based on standardized criteria.
  • Extrapolation of findings to national data.

Main Results:

  • COVID-19 was confirmed in 17.3% of investigated GC deaths (0-59 years) and 25.5% (≥60 years).
  • Garbage codes accounted for 211,611 registered deaths in 2020.
  • National extrapolation suggests an undercount of at least 18% in 2020 COVID-19 deaths.

Conclusions:

  • Significant undercounting of COVID-19 deaths occurred in Brazil due to misclassification.
  • The true burden of COVID-19 in Brazil's 2020 vital statistics was likely underestimated.
  • Addressing garbage code deaths is essential for accurate pandemic surveillance.

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