Experts warn that over three decades have passed since last analysis
Specialists at the National Observatory of Respiratory Diseases (ONDR) warn of the need to study the veracity of data on death certificates, recalling that almost half of people die outside in places other than hospitals.
Speaking to Lusa, president of the Portuguese Lung Federation (FPP) José Alves stresses that the last analysis of this kind – which only focused on asthma as a cause of death – dates back to 1992 and concluded that, in older age groups, only just over 10% of death certificates were correct.
The analysis – which he carried out as part of a doctoral thesis – concluded that, up to the age of 35, 40% of death certificates indicating asthma as the cause of death were correct, from the age of 40 to 75 only 18% were correct and, from the age of 75 onwards, this figure dropped to 12%.
“This was true. Then, to complement this story, from 1991 to 1992, the drop in mortality from asthma was 30% and, from then on, it has been systematically decreasing until it now has very low values”, he said, suggesting “many causes of death included in the data for respiratory diseases may not be correct”.
To ensure that cause of death data is as close to reality as possible, José Alves wants to see many more ‘auditing controls’
“There are people who are hospitalised for pneumonia and die of myocardial infarction. Therefore, the only thing we know is why they were hospitalised and why they died,” he said, adding: “one of the cases I found in the study I did, who supposedly died of asthma, actually died in a motorcycle accident.”
ONDR 2024, an initiative of the FPP, analyses the main indicators of respiratory health in Portugal, focusing on hospital admissions and mortality and the evolution of the main respiratory diseases and uses data provided by the Central Administration of Health Services (ACSS).
In addition to some individual pathologies, three large groups of patients were analysed: all those who were hospitalised, regardless of the cause; those who were hospitalised for any reason but who had a respiratory disease as a secondary diagnosis in their clinical history, and patients who had respiratory disease as the cause of their hospitalisation.
All these groups were divided into two parts: ‘with and without the need for ventilation’. To compare the groups, the number of deaths per 100 hospitalisations was used.
The findings point to a “sharp reduction” in hospitalisations in 2020 due to the Covid-19 pandemic, with a partial recovery in subsequent years.
Hospital mortality peaked in 2021 (71,305 deaths) – when it reached 107.8% of the 2018 figures (64,034 deaths) – and subsequently decreased. In 2023, 93.9% (60,990) of the deaths reported in 2018 were recorded.
“The measures taken to contain the pandemic (…) continued to have positive results even after the end of the pandemic,” the report states.
The document indicates that the decrease in deaths in absolute terms “does not correspond to a percentage decrease” because the drop in hospitalisations was greater than the drop in deaths – 9% in hospitalisations and 6.1% in deaths.
“Apparently it is easier to change the rules of hospitalisation than the severity of the diseases”, says Alves.
The ONDR report also warns that, in 2023, around half of deaths in Portugal occurred outside health units, “raising questions about the reliability of the recorded causes of death”.
“A study of the veracity of death certificates similar to that carried out in 1992 is recommended,” the document concludes.
LUSA
