{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:10:04Z","timestamp":1791778204358,"version":"4.3.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study aimed to analyze the chain of events and contributing causes associated with COVID-19 adult mortality (30\u201369 years old), based on qualified data on CoD from three Brazilian capitals cities, Belo Horizonte, Salvador, and Natal, in 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data of all deaths among residents in the three capitals in 2020 were provided by these municipalities' routine Mortality Information System (SIM). Mentions B34.2 with the markers U07.1 and U07.2 in the death certificate identified COVID-19 deaths. We used a multiple-cause-of-death approach better to understand the complexity of the morbid process of COVID-19. Conditions that appeared more frequently in the same line or above the COVID-19 mentions in the death certificate were considered a chain-of-event. Conditions that occurred more often after the codes for COVID-19 were considered as contributing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 2020, 7,029 records from COVID-19 as the underlying cause of death were registered in SIM in the three capitals. Among these, 2,921 (41.6%) were deceased between 30 and 69 years old, representing 17.0% of deaths in this age group. As chain-of-events, the most frequent conditions mentioned were sepsis (33.4%), SARS (32.0%), acute respiratory failure (31.9%), unspecified lower respiratory infections (unspecified pneumonia) (20.1%), and other specified respiratory disorders (14.1%). Hypertension (33.3%), diabetes unspecified type (21.7%), renal failure (12.7%), obesity (9.8%), other chronic kidney diseases (4.9%), and diabetes mellitus type 2 (4.7%) were the most frequent contributing conditions. On average, 3.04 conditions were mentioned in the death certificate besides COVID-19. This average varied according to age, place of death, and capital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The multiple-cause analysis is a powerful tool to better understand the morbid process due to COVID-19 and highlight the importance of chronic non-communicable diseases as contributing conditions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2021.788932","type":"journal-article","created":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T06:18:18Z","timestamp":1642400298000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Covid Adult Mortality in Brazil: An Analysis of Multiple Causes of Death"],"prefix":"10.3389","volume":"9","author":[{"given":"Ana Maria","family":"Nogales Vasconcelos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenice","family":"Ishitani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy Maria Xavier","family":"Abreu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Fran\u00e7a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1016\/S0140-6736(15)60173-8","article-title":"Civil registration and vital statistics: progress in the data revolution for counting and accountability","volume":"386","author":"AbouZahr","year":"2015","journal-title":"Lancet."},{"key":"B2","unstructured":"World Health OrganizationGeneva2010"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.2105\/AJPH.2021.306203","article-title":"The COVID-19 pandemic: effects on civil registration of births and deaths and on availability and utility of vital events data","volume":"111","author":"AbouZahr","year":"2021","journal-title":"Am J Public Health."},{"key":"B4","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1590\/S1413-81232007000300014","article-title":"An\u00e1lise da qualidade das estat\u00edsticas vitais brasileiras: a experi\u00eancia de implanta\u00e7\u00e3o do SIM e do SINASC [Quality analysis of Brazilian vital statistics: the experience of implementing the SIM and SINASC systems]","volume":"12","author":"Mello Jorge","year":"2007","journal-title":"Cien Saude Colet"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e210003","DOI":"10.1590\/1980-549720210003.supl.1","article-title":"Mortality due to garbage codes in Brazilian municipalities: differences in rate estimates by the direct and Bayesian methods from 2015 to 2017","volume":"24","author":"Teixeira","year":"2021","journal-title":"Rev Bras Epidemiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e19005","DOI":"10.1590\/1980-549720190005.supl.3","article-title":"Data for health: impact on improving the quality of cause-of-death information in Brazil","volume":"22","author":"Marinho","year":"2019","journal-title":"Rev Bras Epidemiol"},{"key":"B7","unstructured":"Estimativas de popula\u00e7\u00e3o"},{"key":"B8","doi-asserted-by":"publisher","first-page":"149","DOI":"10.5327\/Z2447-21232020v14n3EDT1","article-title":"SARS-COV-2: the first wave of disease outbreak and its barriers to chronic diseases management","volume":"14","author":"Moreira","year":"2020","journal-title":"Geriatr Gerontol Aging."},{"key":"B9","unstructured":"2016"},{"key":"B10","unstructured":"2014"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1007\/s40520-020-01601-4","article-title":"The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing","volume":"32","author":"Palmer","year":"2020","journal-title":"Aging Clin Exp Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1186\/s12889-021-11116-w","article-title":"Covid-19 and non-communicable diseases: evidence from a systematic literature review","volume":"21","author":"Nikoloski","year":"2021","journal-title":"BMC Public Health."},{"key":"B13","unstructured":"WHO Global Action Plan for the Prevention and Control Of Noncommunicable Diseases 2013-2020"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e210005","DOI":"10.1590\/1980-549720210005.supl.1","article-title":"Premature mortality due to non-communicable diseases in Brazilian municipalities estimated for the three-year periods of 2010 to 2012 and 2015 to 2017","volume":"24","author":"Cardoso","year":"2021","journal-title":"Rev Bras Epidemiol"},{"key":"B15","unstructured":"BrasilMinist\u00e9rio da Sa\u00fade,. 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