Garbage codes as the underlying cause of death: a cross-sectional study, state of Rio de Janeiro, 1998–2023

Carvalho, Luciana Freire de

doi:10.1590/S2237-96222026v35e20251137.en

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 35 • 2026 • https://doi.org/10.1590/S2237-96222026v35e20251137.en linkcopy

This document is related to:

10.1590/S2237-96222026v35e20251137.a

This document is related to:

10.1590/S2237-96222026v35e20251137.b

Garbage codes as the underlying cause of death: a cross-sectional study, state of Rio de Janeiro, 1998–2023

Códigos basura como causa básica de defunción: estudio transversal, estado de Río de Janeiro, 1998–2023

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objectives To describe the temporal evolution and geographic distribution of deaths due to garbage codes, as well as to analyze the prevalence and characteristics associated with the occurrence of garbage codes as the underlying cause of death in the state of Rio de Janeiro between 1998 and 2023.

Methods Cross-sectional study of deaths among residents of the state obtained from the Brazilian Mortality Information System (Sistema de Informações sobre Mortalidade, SIM). Garbage codes were classified according to the methodology of the Global Burden of Disease Study. Descriptive analyses of temporal evolution and distribution by municipalities were conducted. The associations with sociodemographic variables, place of occurrence, and health region were analyzed using Poisson regression with robust variance and described using prevalence ratios (PR) and their respective 95% confidence intervals (95%CI).

Results Of the 3,399,380 deaths, 1,510,135 (44.4%) were classified as garbage codes. The proportion remained high, ranging from 48.0% (1998) to 46.3% (2023), with a transient reduction to 38.1% in 2021. Level 1 (worst quality) accounted for the highest proportion (22.9%). Higher prevalences were associated with unknown sex (PR 1.18; 95%CI 1.11; 1.23), Black (PR 1.17; 95%CI 1.16; 1.17) and Indigenous race/skin color (PR 1.16; 95%CI 1.10; 1.22), age group ≥80 years (PR 1.74; 95%CI 1.71; 1.75), and deaths with unknown place of occurrence (PR 1.30; 95%CI 1.25; 1.34).

Conclusion Half of the deaths had the underlying cause recorded as a garbage code, with higher prevalence among unknown sex and place of occurrence, older adults, and Black and Indigenous race/skin color. Active investigation, algorithm-based redistribution, and database integration are promising for improving data quality.

Keywords
Underlying Cause of Death; Vital Statistics; Data Accuracy; Health Information Systems; International Classification of Diseases

ICD-10 code^a	Description of the underlying cause	n (%)^b
Level 1 – Worst quality
R99	Other ill-defined and unspecified causes of mortality	232,787 (32.5)
E149	Unspecified Diabetes mellitus	87,567 (12.2)
A419	Unspecified septicemia	77,872 (10.9)
I500	Congestive heart failure	36,632 (5.1)
I509	Unspecified heart failure	27,350 (3.8)
Level 2 – Low quality
I10	Essential (primary) hypertension	88,799 (39.4)
Y349	Events of undetermined intent	31,023 (13.8)
R092	Respiratory arrest	19,104 (8.5)
J81	Pulmonary edema	14,281 (6.3)
K920	Hematemesis	11,862 (5.3)
Level 3 – Intermediate quality
J984	Other pulmonary disorders	20,360 (17.4)
C80	Malignant neoplasm without specification of site	16,706 (14.3)
I499	Unspecified cardiac arrhythmia	9,653 (8.2)
J988	Other specified respiratory disorders	9,245 (7.9)
C260	Malignant neoplasm of unspecified part of the intestinal tract	7,928 (6.8)
Level 4 – Best quality
J189	Unspecified pneumonia	150,091 (33.2)
I64	Stroke, not specified as hemorrhagic or ischemic	120,713 (26.7)
I678	Other specified cerebrovascular diseases	47,548 (10.5)
I694	Sequelae of stroke, not specified as hemorrhagic or ischemic	28,541 (6.3)
I420	Dilated cardiomyopathy	24,126 (5.3)

Variables	Total deaths	Deaths classified as garbage codes – n (%)	Unadjusted PR (95%CI)	p-value	Adjusted PR (95%CI)^a,d	p-value
Sex				<0.001		<0.001
Male	1,837,839	770,190 (41.9)	1		1
Female	1,558,618	738,311 (47.4)	1.13 (1.12; 1.13)		1.06 (1.06; 1.06)
Unknown	2,923	1,634 (55.9)	1.33 (1.29; 1.38)		1.18 (1.11; 1.23)
Race/skin color				<0.001		<0.001
White	1,827,802	789,877 (43.2)	1		1
Black	489,258	233,242 (47.7)	1.10 (1.10; 1.11)		1.17 (1.16; 1.17)
Asian	5,822	2,671 (45.8)	1.06 (1.03; 1.09)		1.06 (1.03; 1.09)
Brown [Brazilian mixed race]	961,009	428,903 (44.6)	1.03 (1.03; 1.04)		1.13 (1.12; 1.13)
Indigenous	1,713	834 (48.7)	1.13 (1.07; 1.18)		1.16 (1.10; 1.22)
Unknown	113,776	54,608 (48.0)	1.11 (1.10; 1.12)		1.15 (1.13; 1.15)
Age group (years)^b				<0.001		<0.001
<1	88,298	14,671 (16.6)	0.56 (0.55; 0.57)		0.52 (0.51; 0.53)
1–9	21,756	9,005 (41.4)	1.40 (1.37; 1.43)		1.30 (1.27; 1.32)
10–19	60,090	17,799 (29.6)	1		1
20–39	292,051	91,843 (31.4)	1.06 (1.05; 1.08)		1.04 (1.02; 1.05)
40–59	679,181	272,006 (40.0)	1.35 (1.34; 1.37)		1.28 (1.26; 1.29)
60–79	1,341,140	617,182 (46.0)	1.55 (1.53; 1.57)		1.49 (1.46; 1.50)
≥80	916,864	487,629 (53.2)	1.80 (1.77; 1.82)		1.74 (1.71; 1.75)
Place of occurrence				<0.001		<0.001
Hospital	2,441,787	1,062,323 (43.5)	1		1
Unknown	3,269	1,759 (53.8)	1.24 (1.20; 1.28)		1.30 (1.25; 1.34)
Other health facilities	255,956	139,001 (54.3)	1.25 (1.24; 1.25)		1.26 (1.25; 1.26)
At home	468,159	227,807 (48.7)	1.12 (1.11; 1.12)		1.08 (1.07; 1.08)
Public road	129,966	37,181 (28.6)	0.66 (0.65; 0.66)		0.74 (0.72; 0.74)
Other	100,243	42,064 (42.0)	0.96 (0.96; 0.97)		1.01 (1.00; 1.02)
Health region				<0.001		<0.001
Baía da Ilha Grande	36,804	14,269 (38.8)	0.86 (0.85; 0.87)		0.92 (0.90; 0.92)
Baixada Litorânea	137,815	62,673 (45.5)	1.00 (1.00; 1.01)		1.04 (1.03; 1.04)
Centro-Sul	70,304	30,957 (44.0)	0.97 (0.96; 0.98)		0.98 (0.97; 0.99)
Médio Paraíba	168,556	66,614 (39.5)	0.87 (0.87; 0.88)		0.90 (0.89; 0.90)
Metropolitana I	2,111,347	955,390 (45.2)	1		1
Metropolitana II	403,987	175,141 (43.3)	0.96 (0.95; 0.96)		0.97 (0.97; 0.98)
Noroeste	72,405	31,117 (43.0)	0.95 (0.94; 0.96)		0.95 (0.94; 0.96)
Norte	159,752	72,305 (45.3)	1.00 (0.99; 1.01)		1.04 (1.03; 1.04)
Serrana	195,953	79,614 (40.6)	0.90 (0.89; 0.90)		0.92 (0.91; 0.92)
Unknown	42,457	22,055 (51.9)	1.15 (1.14; 1.16)		1.08 (1.07; 1.09)
Year of ^deathc ^bold>				0.001		0.001
1998	115,382	55,383 (48.1)	1		1
2011	127,095	55,718 (43.8)	0.91 (0.90; 0.92)		0.85 (0.84; 0.86)
2021	189,232	72,165 (38.1)	0.79 (0.79; 0.80)		0.71 (0.70; 0.71)
2023	145,148	67,133 (46.3)	0.96 (0.96; 0.97)		0.85 (0.84; 0.86)

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[fnte1] ^aInternational Classification of Diseases – 10th Revision (ICD-10); ^bProportions were calculated based on the total number of deaths in each GBD level, considering only the five most frequent causes per level.