Background: From October 2010 through February 2016, Arizona conducted surveillance for severe acute respiratory infections (SARI) among adults hospitalized in the Arizona-Mexico border region. There are few accurate mortality estimates in SARI patients, particularly in adults >= 65 years old. The purpose of this study was to generate mortality estimates among SARI patients that include deaths occurring shortly after hospital discharge and identify risk factors for mortality. Methods: Patients admitted to two sentinel hospitals between 2010 and 2014 who met the SARI case definition were enrolled. Demographic data were used to link SARI patients to Arizona death certificates. Mortality within 30 days after the date of admission was calculated and risk factors were identified using logistic regression models. Results: Among 258 SARI patients, 47% were females, 51% were white, non-Hispanic and 39% were Hispanic. The median age was 63 years (range, 19 to 97 years) and 80% had one or more pre-existing health condition; 9% died in hospital. Mortality increased to 12% (30/258, 30% increase) when electronic vital records and a 30-day post-hospitalization time frame were used. Being age >= 65 years (OR = 4.0; 95% CI: 1.6-9.9) and having an intensive care unit admission (OR = 7.4; 95% CI: 3.0-17.9) were independently associated with mortality. Conclusion: The use of electronic vital records increased SARI-associated mortality estimates by 30%. These findings may help guide prevention and treatment measures, particularly in high-risk persons in this highly fluid border population.

BACKGROUND:Heart failure is sometimes incorrectly listed as the underlying cause of death (UCD) on death certificates, thus compromising the accuracy and comparability of mortality statistics. Statistical redistribution of the UCD has been used to examine the effect of misclassification of the UCD attributed to heart failure, but sex- and race-specific redistribution of deaths on coronary heart disease (CHD) mortality in the United States has not been examined.METHODS:We used coarsened exact matching to infer the UCD of vital records with heart failure as the UCD from 1999 to 2010 for decedents 55years old and older from states encompassing regions under surveillance by the Atherosclerosis Risk in Communities (ARIC) Study (Maryland, Minnesota, Mississippi, and North Carolina). Records with heart failure as the UCD were matched on decedent characteristics (five-year age groups, sex, race, education, year of death, and state) to records with heart failure listed among the multiple causes of death. Each heart failure death was then redistributed to plausible UCDs proportional to the frequency among matched records.RESULTS:After redistribution the proportion of deaths increased for CHD, chronic obstructive pulmonary disease, diabetes, hypertensive heart disease, and cardiomyopathy, P<0.001. The percent increase in CHD mortality after redistribution was the highest in Mississippi (12%) and lowest in Maryland (1.6%), with variations by year, race, and sex. Redistribution proportions for CHD were similar to CHD death classification by a panel of expert reviewers in the ARIC study.CONCLUSIONS:Redistribution of ill-defined UCD would improve the accuracy and comparability of mortality statistics used to allocate public health resources and monitor mortality trends.

Mortality statistics are much used although their accuracy is often questioned. Producers of mortality statistics check for errors in death certification but current methods only capture obvious mistakes. This thesis investigates whether non-obvious errors can be found by linking death certificates to hospital discharge data. Data: 69,818 deaths in Sweden 1995. Paper I: Analysing differences between the underlying cause of death from the death certificate (UC) and the main discharge condition from the patient’s last hospitalization (MDC). Paper II: Testing whether differences can be explained by ICD definitions of UC and MDC. Paper III: Surveying methods in 44 current studies on the accuracy of death certificates. Paper IV: Checking death certificates against case summaries for: i) 573 deaths where UC and MDC were the same or the difference could be explained; ii) 562 deaths where the difference could not be explained. Results: In 54% of deaths the MDC differed from the UC. Almost two-thirds of the differences were medically compatible since the MDC might have developed as a complication of the UC. Of 44 recent evaluation studies, only 8 describe the methods in such detail that the study could be replicated. Incompatibility between MDC and UC indicates a four-fold risk that the death certificate is inaccurate. For some diagnostic groups, however, death certificates are often inaccurate even when the UC and MDC are compatible. Conclusion: Producers of official mortality statistics could reduce the number of non-obvious errors in the statistics by collecting additional information on incompatible deaths and on deaths in high-risk diagnostic groups. ICD conventions contribute to the quality problem since they presuppose that all deaths are due to a single underlying cause. However, in an ageing population an increasing number of deaths are due to an accumulation of etiologically unrelated conditions.

<p>Mortality statistics are much used although their accuracy is often questioned. Producers of mortality statistics check for errors in death certification but current methods only capture obvious mistakes. This thesis investigates whether non-obvious errors can be found by linking death certificates to hospital discharge data.</p><p>Data: 69,818 deaths in Sweden 1995. Paper I: Analysing differences between the underlying cause of death from the death certificate (UC) and the main discharge condition from the patient’s last hospitalization (MDC). Paper II: Testing whether differences can be explained by ICD definitions of UC and MDC. Paper III: Surveying methods in 44 current studies on the accuracy of death certificates. Paper IV: Checking death certificates against case summaries for: i) 573 deaths where UC and MDC were the same or the difference could be explained; ii) 562 deaths where the difference could not be explained.</p><p>Results: In 54% of deaths the MDC differed from the UC. Almost two-thirds of the differences were medically compatible since the MDC might have developed as a complication of the UC. Of 44 recent evaluation studies, only 8 describe the methods in such detail that the study could be replicated. Incompatibility between MDC and UC indicates a four-fold risk that the death certificate is inaccurate. For some diagnostic groups, however, death certificates are often inaccurate even when the UC and MDC are compatible.</p><p>Conclusion: Producers of official mortality statistics could reduce the number of non-obvious errors in the statistics by collecting additional information on incompatible deaths and on deaths in high-risk diagnostic groups. ICD conventions contribute to the quality problem since they presuppose that all deaths are due to a single underlying cause. However, in an ageing population an increasing number of deaths are due to an accumulation of etiologically unrelated conditions.</p>

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2008. / Härtill 4 uppsatser.

Introdução: As estatísticas de mortalidade são usadas pelo mundo inteiro e por isso precisa ter dados confiáveis e comparáveis. Uma das estratégias para melhorar sua qualidade é a automação de etapas do fluxo dos dados. O Iris é um sistema que codifica as causas de morte da declaração de óbito (DO) e seleciona a causa básica de morte. Objetivos: adaptar o software para uso no Brasil, testá-lo e comparar seu uso com a codificação manual e com a seleção do sistema usado na rotina brasileira, o Sistema de Seleção da Causa Básica de Morte (SCB). Métodos: foram utilizadas uma amostra de declarações de óbito de óbitos ocorridos no período de janeiro a junho de 2014 em nove cidades representando as cinco regiões do Brasil. Foram selecionados óbitos pelas causas mais comuns, com menção de doença transmissível, assim como óbitos infantis, maternos e óbitos com menção de causa externa ou cirurgia. A fase 1 visou a conclusão do dicionário e a fase 2 testar e comparar o uso do Iris. Resultados: 1848 DO, com uma média de 3,1 linhas preenchidas por DO. Foram realizadas 618 ajustes ou adições nas tabelas do dicionário ou nas tabelas de padronização. Em 45,9 por cento das DO o Iris codificou todas as causas de morte presente na DO assim como selecionou a causa básica de morte. Das DO que o Iris não conseguiu concluir o processo, a maioria (97,8 por cento) dessas rejeições foi por dificuldade em encontrar ou processar um código da CID. A concordância do Iris com a codificação manual nos níveis de 4 caracteres, 3 caracteres e 1 caractere dos códigos da CID-10 foi de 73,3 por cento, 78,2 por cento e 83,9 por cento respectivamente. Isso representou uma discordância em 49,1 por cento das DO. A concordância da causa básica de morte com o SCB foi de 74,2por cento, 84,3 por cento e 91,8 por cento nos níveis de 4 caracteres, 3 caracteres e 1 caractere dos códigos da CID-10 respectivamente. A principal causa de discordância (71 por cento) foi por codificações diferentes. Após as pequenas correções, o Iris finaliza 66,6 por cento das DO. Conclusão: As discordâncias tiveram como causa os hábitos e rotinas dos codificadores que variam entre eles, enquanto no Iris a codificação de uma causa é sempre a mesma. As tabelas de decisão do SCB precisam ser revistas. Os dados mostram que é possível usar esta ferramenta e que ela vai diminuir o trabalho dos codificadores. O Iris teve uma boa taxa de finalização, semelhante a países que o utilizam na sua rotina. / Introduction: Mortality statistics is used all over the world and therefore needs reliable and comparable data. One of the strategies to improve quality is an automated data collection. Iris is a system that codes the causes of death of the death certificate (DC) and selects the underlying cause of death. Objective: To adapt Iris software to Brazil finalising the Portuguese dictionary, to test Iris and to compare it with manual coding and with the selection of the Basic Death Cause Selection System (Portuguese acronym is SCB). Methods: The sample was death certificates occurred from January to June of 2014 in nine cities representing the five regions of Brazil. Were selected to compose the sample: routine deaths, DC with mention of communicable disease, infant death, maternal death and DC with mention of external cause or surgery. Phase 1 aimed to complete the dictionary and phase 2 aimed to test and compare Iris. Results: The sample was1848 DC, with an average of 3.1 lines filled by DC. There were 618 adjustments or additions to dictionary tables or standardization tables. In 45.9 per cent of DC Iris coded all causes of death and selected the underlying cause of death. Of the DC that Iris was unable to complete the process, the majority (97.8 per cent) of these rejections were due to difficulty in finding or processing an ICD code. Iris agreement with manual coding at the 4-character, 3- character, and 1-character levels of ICD-10 codes was 73.3 per cent, 78.2 per cent and 83.9 per cent, respectively. This represented a disagreement in 49.1 per cent of DC. The concordance of the underlying cause of death with SCB was 74.2 per cent, 84.3 per cent and 91.8 per cent at the 4- character, 3-character and 1-character levels respectively. The main cause of discordance (71 per cent) was by different codes for the same cause of death. After the small corrections, Iris finalised 66.6 per cent of the DC. Conclusion: The disagreements were caused by coders routines that can vary between them, whereas in Iris the codification of a cause is always the same. The SCB decision tables need to be reviewed. The data show that it is possible to use this tool and that it will decrease the work of the coders. Iris had a good finalisation rate, similar to countries that use it in their routine.

Comitês de Mortalidade Materna, que não investigam todos os óbitos de mulheres de 10 a 49 anos, utilizam lista de causas presumíveis de morte materna para a busca ativa de causas maternas de óbito. Mediante dados do Comitê de Estudo e Prevenção da Mortalidade Materna, para o Município de São Paulo (CMMSP), e do “Estudo de mortalidade de mulheres de 10 a 49 anos, com ênfase na mortalidade materna", realizado nas capitais de estados brasileiros e Distrito Federal (GPP), analisou-se a utilização da lista de causas presumíveis do Manual dos Comitês de Mortalidade Materna do Ministério da Saúde. Conforme investigação do CMMSP, em relação às causas maternas declaradas em 2001, houve um acréscimo de 72,7% de causas maternas. A análise dos dados com a utilização da lista mostrou que 39,4% eram causas maternas presumíveis e 33,3% não eram causas presumíveis. Entre as Declarações de Óbito (D.O.) originais do primeiro semestre de 2002, do estudo do GPP, em que causas maternas não estavam declaradas e se tornaram causas maternas, verificou-se que 52,6% eram presumíveis e 47,4% não eram presumíveis. Quanto à variável da D.O., que informa se a mulher estava grávida no momento da morte, ou esteve grávida nos doze meses que antecederam a morte, verificou-se a ausência de preenchimento dos campos 43 e 44, em mais de 50% das D.O. com outras causas declaradas e que se tornaram causas maternas, tanto na investigação do CMMSP quanto na do GPP. Concluiu-se que os Comitês de Prevenção da Mortalidade Materna deveriam investigar todas as mortes de mulheres de 10 a 49 anos. / Committees of Maternal Mortality, which do not investigate all the deaths of women between 10 and 49 years old, use a list of presumable causes of maternal death for the active search of maternal causes of death. Based on the data from the Committee of Studies and Prevention of Maternal Mortality for the Municipality of São Paulo (CMMSP) and on the “Study of mortality of women between 10 and 49 years old with an emphasis on maternal mortality", developed for the Brazilian state capitals and the Federal District (GPP), the utilization of the list of presumable causes from the Health Ministry Manual of the Committees of Maternal Mortality was analyzed. According to the CMMSP data, there was an increase of 72,7% of maternal causes in relation to the declared maternal causes in 2001. The analysis of data with the use of the list showed that 39,4% were presumable maternal causes and 33,3% were not presumable causes. Among the maternal causes which were not declared in the original Death Certificates of the GPP Study for the first semester of 2002, it was verified that 52,6% were presumable and 47,4% were not presumable. As to the pregnancy variable of Death Certificates, it was verified the absence of information in the form in more than 50% of the Certificates with other causes declared and that were maternal causes in the CMMSP and in the GPP investigation. The conclusion is that the Committees of Prevention of Maternal Mortality should investigate all the deaths of women in ages between 10 to 49 years old.

Introdução: A proporção de óbitos classificados como de causa básica mal definida é um dos principais indicadores da qualidade das estatísticas de mortalidade, de grande importância na avaliação da situação e na orientação das políticas de saúde. Estudos preliminares encontraram uma evolução temporal discrepante na comparação da mortalidade proporcional por causa mal definida no Brasil, no Estado de São Paulo, na Baixada Santista e no Município do Guarujá. Este estudo foi realizado com o objetivo de tentar compreender tais diferenças. Métodos: A evolução temporal da proporção de óbitos por causa mal definida foi analisada no período de 1980 a 2002, dividindo-se o Estado de São Paulo em grupos de municípios com e sem o Serviço de Verificação de Óbitos (SVO) e a Baixada Santista. Além da mortalidade proporcional, a classificação do óbito por causa mal definida foi estudada com base no que se convencionou chamar de ?primeiro médico? a avaliar a causa de morte. Ou seja, o profissional que preenche a Declaração de Óbito ou encaminha o caso ao SVO ou ao Instituto Médico Legal (IML). Exclui os médicos do SVO e do IML que preenchem a declaração. A qualidade do preenchimento foi avaliada nos óbitos ocorridos em hospitais e em domicílios, baseada nas informações do tipo de atestante. Resultados: Observou-se um aumento na proporção de óbitos por causa mal definida pelo primeiro médico avaliador da causa de morte em todas as áreas do Estado de São Paulo. Em 1980, na Baixada Santista, a mortalidade proporcional por causa mal definida (MPCMD) era muito baixa, pois mais de 90% dos casos classificados como de causa mal definida pelo primeiro médico avaliador da causa de morte eram encaminhados aos IMLs da região ou ao SVO do Guarujá, onde a maioria dos casos era reclassificada para óbito de causa definida sem a realização de necropsia. A partir de 1984, progressivamente, os casos deixaram de ser encaminhados aos IMLs e passaram a ser classificados como de causa mal definida, com aumento da mortalidade proporcional de mais de nove vezes. A MPCMD no Estado de São Paulo manteve-se estável no período analisado em virtude do aumento da proporção de óbitos em serviços de saúde e de realização de necropsias. No Brasil, onde se observou uma queda de 36,4% da MPCMD, pode-se atribuir ao aumento dos óbitos hospitalares mais de 50% da redução desse indicador. O aumento do encaminhamento dos casos aos SVOs e aos IMLs foi fator importante na redução da mortalidade por causa mal definida nos óbitos domiciliares. Na Baixada Santista, no Estado de São Paulo e nos óbitos hospitalares do país, verificou-se uma piora na qualidade do preenchimento da Declaração de Óbito. Conclusão: A despeito da melhoria dos recursos diagnósticos, observou-se no período estudado uma piora na qualidade do preenchimento da Declaração de Óbito no Estado de São Paulo e nos óbitos hospitalares do país. Para enfrentar o problema da elevada mortalidade proporcional por causa mal definida, sugere-se rediscutir o modelo do fluxo de preenchimento das declarações de óbito, com redefinição das atribuições dos SVOs e dos IMLs. / Introduction: The proportion of deaths classified as due to ill-defined causes is one of the major indicators of the quality of mortality statistics, and is of great value for evaluating and orienting public policies. Preliminary studies indicate discrepant time trends in the evolution of the proportion of deaths due to ill-defined causes between Brazil as a whole, the state of Sao Paulo, the Baixada Santista region, and the municipality of Guarujá. The present study was designed as an attempt to understand these discrepancies. Methods: We analyzed the temporal evolution in the proportion of deaths due to illdefined causes between 1980 and 2002, dividing the state of Sao Paulo into three groups of municipalities: those with Death Verification Service (DVS), those without DVS, and those located in the Baixada Santista. In addition to proportional mortality, we also studied the classification of ill-defined deaths based on what was defined as the ?first physician? to evaluate cause of death. This consisted either of the professional who completed the Death Certificate or who referred the case to the DVS or medical examiner. This definition excludes any DVS or Medical Examiner physicians who filled certificates. The quality of the information in the certificate was evaluated for deaths occurred in hospitals and at home based on information on the type of physician. Results: There was an increase in the proportion of deaths due to ill-defined causes as defined by the first physician to evaluate cause of death in all areas of the State of Sao Paulo. In 1980, in the Baixada Santista, proportional mortality due to ill-defined causes (PMIDC) was very low, with over 90% of cases considered as due to illdefined causes by the first physician being referred to the region?s Medical Examiners or to the Guarujá DVS, where the majority of cases was assigned to a defined cause without need for autopsy. Beginning in 1984, the number of cases referred to Medical Examiners began to fall, leading to a 9-fold increase in PMIDC. PMIDC in the State of Sao Paulo remained stable throughout the period as a consequence of the increase in the proportion of autopsies and of deaths occurred within healthcare facilities. In the country as a whole, there was a 36.4% decrease in PMIDC, of which more than 50% can be attributed to the increase in the number of hospital deaths. Increased referral of cases to DVSs and medical examiners was an important factor in the reduction of mortality due to ill-defined causes among athome deaths. The quality of information in Death Certificates decreased in the Baixada Santista, in the State of Sao Paulo, and among hospital deaths in Brazil as a whole. Conclusion: Despite improvements in diagnosis, quality of information in Death Certificates decreased during the studied period in the State of Sao Paulo and among hospital deaths in the country as a whole. In order to tackle the issue of high proportional mortality due to ill-defined causes, we suggest a reevaluation of the flow of information in Death Certificates, with a redefinition of the role of medical examiners and DVSs.

Introdução: As estatísticas de mortalidade são usadas pelo mundo inteiro e por isso precisa ter dados confiáveis e comparáveis. Uma das estratégias para melhorar sua qualidade é a automação de etapas do fluxo dos dados. O Iris é um sistema que codifica as causas de morte da declaração de óbito (DO) e seleciona a causa básica de morte. Objetivos: adaptar o software para uso no Brasil, testá-lo e comparar seu uso com a codificação manual e com a seleção do sistema usado na rotina brasileira, o Sistema de Seleção da Causa Básica de Morte (SCB). Métodos: foram utilizadas uma amostra de declarações de óbito de óbitos ocorridos no período de janeiro a junho de 2014 em nove cidades representando as cinco regiões do Brasil. Foram selecionados óbitos pelas causas mais comuns, com menção de doença transmissível, assim como óbitos infantis, maternos e óbitos com menção de causa externa ou cirurgia. A fase 1 visou a conclusão do dicionário e a fase 2 testar e comparar o uso do Iris. Resultados: 1848 DO, com uma média de 3,1 linhas preenchidas por DO. Foram realizadas 618 ajustes ou adições nas tabelas do dicionário ou nas tabelas de padronização. Em 45,9 por cento das DO o Iris codificou todas as causas de morte presente na DO assim como selecionou a causa básica de morte. Das DO que o Iris não conseguiu concluir o processo, a maioria (97,8 por cento) dessas rejeições foi por dificuldade em encontrar ou processar um código da CID. A concordância do Iris com a codificação manual nos níveis de 4 caracteres, 3 caracteres e 1 caractere dos códigos da CID-10 foi de 73,3 por cento, 78,2 por cento e 83,9 por cento respectivamente. Isso representou uma discordância em 49,1 por cento das DO. A concordância da causa básica de morte com o SCB foi de 74,2por cento, 84,3 por cento e 91,8 por cento nos níveis de 4 caracteres, 3 caracteres e 1 caractere dos códigos da CID-10 respectivamente. A principal causa de discordância (71 por cento) foi por codificações diferentes. Após as pequenas correções, o Iris finaliza 66,6 por cento das DO. Conclusão: As discordâncias tiveram como causa os hábitos e rotinas dos codificadores que variam entre eles, enquanto no Iris a codificação de uma causa é sempre a mesma. As tabelas de decisão do SCB precisam ser revistas. Os dados mostram que é possível usar esta ferramenta e que ela vai diminuir o trabalho dos codificadores. O Iris teve uma boa taxa de finalização, semelhante a países que o utilizam na sua rotina. / Introduction: Mortality statistics is used all over the world and therefore needs reliable and comparable data. One of the strategies to improve quality is an automated data collection. Iris is a system that codes the causes of death of the death certificate (DC) and selects the underlying cause of death. Objective: To adapt Iris software to Brazil finalising the Portuguese dictionary, to test Iris and to compare it with manual coding and with the selection of the Basic Death Cause Selection System (Portuguese acronym is SCB). Methods: The sample was death certificates occurred from January to June of 2014 in nine cities representing the five regions of Brazil. Were selected to compose the sample: routine deaths, DC with mention of communicable disease, infant death, maternal death and DC with mention of external cause or surgery. Phase 1 aimed to complete the dictionary and phase 2 aimed to test and compare Iris. Results: The sample was1848 DC, with an average of 3.1 lines filled by DC. There were 618 adjustments or additions to dictionary tables or standardization tables. In 45.9 per cent of DC Iris coded all causes of death and selected the underlying cause of death. Of the DC that Iris was unable to complete the process, the majority (97.8 per cent) of these rejections were due to difficulty in finding or processing an ICD code. Iris agreement with manual coding at the 4-character, 3- character, and 1-character levels of ICD-10 codes was 73.3 per cent, 78.2 per cent and 83.9 per cent, respectively. This represented a disagreement in 49.1 per cent of DC. The concordance of the underlying cause of death with SCB was 74.2 per cent, 84.3 per cent and 91.8 per cent at the 4- character, 3-character and 1-character levels respectively. The main cause of discordance (71 per cent) was by different codes for the same cause of death. After the small corrections, Iris finalised 66.6 per cent of the DC. Conclusion: The disagreements were caused by coders routines that can vary between them, whereas in Iris the codification of a cause is always the same. The SCB decision tables need to be reviewed. The data show that it is possible to use this tool and that it will decrease the work of the coders. Iris had a good finalisation rate, similar to countries that use it in their routine.

Comitês de Mortalidade Materna, que não investigam todos os óbitos de mulheres de 10 a 49 anos, utilizam lista de causas presumíveis de morte materna para a busca ativa de causas maternas de óbito. Mediante dados do Comitê de Estudo e Prevenção da Mortalidade Materna, para o Município de São Paulo (CMMSP), e do “Estudo de mortalidade de mulheres de 10 a 49 anos, com ênfase na mortalidade materna”, realizado nas capitais de estados brasileiros e Distrito Federal (GPP), analisou-se a utilização da lista de causas presumíveis do Manual dos Comitês de Mortalidade Materna do Ministério da Saúde. Conforme investigação do CMMSP, em relação às causas maternas declaradas em 2001, houve um acréscimo de 72,7% de causas maternas. A análise dos dados com a utilização da lista mostrou que 39,4% eram causas maternas presumíveis e 33,3% não eram causas presumíveis. Entre as Declarações de Óbito (D.O.) originais do primeiro semestre de 2002, do estudo do GPP, em que causas maternas não estavam declaradas e se tornaram causas maternas, verificou-se que 52,6% eram presumíveis e 47,4% não eram presumíveis. Quanto à variável da D.O., que informa se a mulher estava grávida no momento da morte, ou esteve grávida nos doze meses que antecederam a morte, verificou-se a ausência de preenchimento dos campos 43 e 44, em mais de 50% das D.O. com outras causas declaradas e que se tornaram causas maternas, tanto na investigação do CMMSP quanto na do GPP. Concluiu-se que os Comitês de Prevenção da Mortalidade Materna deveriam investigar todas as mortes de mulheres de 10 a 49 anos. / Committees of Maternal Mortality, which do not investigate all the deaths of women between 10 and 49 years old, use a list of presumable causes of maternal death for the active search of maternal causes of death. Based on the data from the Committee of Studies and Prevention of Maternal Mortality for the Municipality of São Paulo (CMMSP) and on the “Study of mortality of women between 10 and 49 years old with an emphasis on maternal mortality”, developed for the Brazilian state capitals and the Federal District (GPP), the utilization of the list of presumable causes from the Health Ministry Manual of the Committees of Maternal Mortality was analyzed. According to the CMMSP data, there was an increase of 72,7% of maternal causes in relation to the declared maternal causes in 2001. The analysis of data with the use of the list showed that 39,4% were presumable maternal causes and 33,3% were not presumable causes. Among the maternal causes which were not declared in the original Death Certificates of the GPP Study for the first semester of 2002, it was verified that 52,6% were presumable and 47,4% were not presumable. As to the pregnancy variable of Death Certificates, it was verified the absence of information in the form in more than 50% of the Certificates with other causes declared and that were maternal causes in the CMMSP and in the GPP investigation. The conclusion is that the Committees of Prevention of Maternal Mortality should investigate all the deaths of women in ages between 10 to 49 years old.