Social EpidemiologyStudying Geographic Inequalities in Mortality in Contexts with Deficient Data Sources: Lessons from EcuadorPeralta, Andrésa,b,c; Benach, Joanb,c,d; Espinel-Flores, Verónicaa,e; Gotsens, Mercèa,f; Borrell, Carmea,e,f,g; Marí-Dell’Olmo, Marca,f,gAuthor Information From the aAgència de Salut Pública de Barcelona, Barcelona, Catalonia, Spain bHealth Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain cJohns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Spain dTransdisciplinary Research Group on Socioecological Transitions (GinTRANS2). Universidad Autónoma Madrid, 28049 Madrid, Spain eDepartment of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain fInstitut d’Investigació Biomèdica (IIB Sant Pau). Barcelona, Spain gCIBER Epidemiología y Salud Pública (CIBERESP), Spain. Submitted February 12, 2019; accepted November 20, 2019. A.P. and V.E.-F. were funded by scholarships by the National Secretary of Higher Education, Science, Technology and Innovation of Ecuador (SENESCYT) - Convocatoria Abierta 2013. J.B. is the recipient of an Institució Catalana de Recerca i Estudis Avançats (ICREA) Academia award (Generalitat de Catalunya). The authors report no conflicts of interest. The data used for this study are publicly available from official sources in Ecuador. The code required to replicate the results is available as supplementary material of the article. The complete set of databases and R-scripts can be obtained upon request to the corresponding author. Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com). Correspondence: Andrés Peralta, Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023 Barcelona, Spain. E-mail: [email protected]. Epidemiology: March 2020 - Volume 31 - Issue 2 - p 290-300 doi: 10.1097/EDE.0000000000001146 Buy SDC Metrics Abstract Background: In Ecuador, there are inequalities in the completeness and quality of the mortality registry between men and women and among geographical areas. Consequently, using cause of death statistics leads to several difficulties. Our aim was to analyze geographical inequalities in mortality due to some of the main specific causes of death in the provinces of Ecuador (2001–2016) after correction for the deficiencies found in the mortality registry. Methods: This ecologic study used mortality data from 2001 to 2016 for the 22 provinces of Ecuador at the beginning of the study period. We assessed completeness using death distribution methods for the intercensal period 2001–2010. We assessed quality by estimating the percentage of garbage codes for the entire study period. We corrected mortality using completeness as a correction factor and applying a garbage code redistribution protocol. We estimated age-standardized mortality ratios in the provinces of Ecuador for men and women, before and after applying the correction methods. Results: We found substantial changes in the number of deaths due to the selected causes after garbage code redistribution and correction for completeness. These changes corresponded to the deficiencies in completeness and quality found in the study areas and the manner in which garbage codes were redistributed to each of the studied causes. We observed changes in the geographical patterns of mortality due to specific causes. Conclusions: Correcting deficiencies in the mortality registry resulted not only in changes in the number of deaths but also in the geographical patterns of mortality in Ecuador. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.