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Ribeiro ALP, Machado Í, Cousin E, Perel P, Demacq C, Geissbühler Y, de Souza A, Liprandi AS, Nascimento BR, França EF, Martins-Melo FR, Roth GA, Molina I, Noronha K, Ishitani L, Carneiro M, Quijano M, Andrade MV, Naghavi M, Mosser JF, Piñeiro DJ. The Burden of Chagas Disease in the Contemporary World: The RAISE Study. Glob Heart 2024; 19:2. [PMID: 38222097 PMCID: PMC10785959 DOI: 10.5334/gh.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 01/16/2024] Open
Abstract
Chagas disease (ChD), a Neglected Tropical Disease, has witnessed a transformative epidemiological landscape characterized by a trend of reduction in prevalence, shifting modes of transmission, urbanization, and globalization. Historically a vector-borne disease in rural areas of Latin America, effective control measures have reduced the incidence in many countries, leading to a demographic shift where most affected individuals are now adults. However, challenges persist in regions like the Gran Chaco, and emerging oral transmission in the Amazon basin adds complexity. Urbanization and migration from rural to urban areas and to non-endemic countries, especially in Europe and the US, have redefined the disease's reach. These changing patterns contribute to uncertainties in estimating ChD prevalence, exacerbated by the lack of recent data, scarcity of surveys, and reliance on outdated models. Besides, ChD's lifelong natural history, marked by acute and chronic phases, introduces complexities in diagnosis, particularly in non-endemic regions where healthcare provider awareness is low. The temporal dissociation of infection and clinical manifestations, coupled with underreporting, has rendered ChD invisible in health statistics. Deaths attributed to ChD cardiomyopathy often go unrecognized, camouflaged under alternative causes. Understanding these challenges, the RAISE project aims to reassess the burden of ChD and ChD cardiomyopathy. The project is a collaborative effort of the World Heart Federation, Novartis Global Health, the University of Washington's Institute for Health Metrics and Evaluation, and a team of specialists coordinated by Brazil's Federal University of Minas Gerais. Employing a multidimensional strategy, the project seeks to refine estimates of ChD-related deaths, conduct systematic reviews on seroprevalence and prevalence of clinical forms, enhance existing modeling frameworks, and calculate the global economic burden, considering healthcare expenditures and service access. The RAISE project aspires to bridge knowledge gaps, raise awareness, and inform evidence-based health policies and research initiatives, positioning ChD prominently on the global health agenda.
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Affiliation(s)
- Antonio Luiz Pinho Ribeiro
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 –Santa Efigênia, Belo Horizonte –MG, 30130-100, BR
| | | | - Ísis Machado
- Department of Family Medicine, Mental and Collective Health, Universidade Federal de Ouro Preto, Ouro Preto, Brazil
| | - Ewerton Cousin
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, United States of America
| | - Pablo Perel
- World Heart Federation, Geneva, Switzerland
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Aline de Souza
- Department of Economics, Faculty of Economic Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Bruno R. Nascimento
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 110 –Santa Efigênia, Belo Horizonte –MG, 30130-100, BR
| | - Elisabeth F. França
- Postgraduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Gregory A. Roth
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, United States of America
- Department of Medicine, University of Washington, Seattle, United States of America
| | - Israel Molina
- International Health Unit Vall d’Hebron-Drassanes, Infectious Diseases Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Kenya Noronha
- Department of Economics, Faculty of Economic Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lenice Ishitani
- Epidemiological Surveillance Division, Belo Horizonte Municipal Health Department Belo Horizonte, Brazil
| | - Mariângela Carneiro
- Department of Parasitology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Monica V. Andrade
- Department of Economics, Faculty of Economic Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, United States of America
| | - Jonathan F. Mosser
- Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, United States of America
| | - Daniel J. Piñeiro
- World Heart Federation, Geneva, Switzerland
- Cardiology Department, Universidad de Buenos Aires, Buenos Aires, Argentina
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Teixeira RA, Vasconcelos AMN, Torens A, França EB, Ishitani L, Bierrenbach AL, de Abreu DMX, Marinho F. Excess Mortality due to natural causes among whites and blacks during the COVID-19 pandemic in Brazil. Rev Soc Bras Med Trop 2022; 55:e0283. [PMID: 35107533 PMCID: PMC9009425 DOI: 10.1590/0037-8682-0283-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/09/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Excess Mortality by all causes considers deaths directly related to COVID-19 and those attributed to conditions caused by the pandemic. When stratified by social dimensions, such as race/color, it allows for the evaluation of more vulnerable populations. The study estimated the excess mortality by natural causes, separating the white and black populations in 2020. METHODS Public civil registration data on deaths observed in 2020, corrected for under registration, were used. The expected number of deaths was estimated based on the mortality rates observed in 2019, applied to the estimated population in 2020. The difference between the values expected and observed and the proportion of excess was considered the excess mortality. RESULTS The present study found an excess of 270,321 deaths (22.2% above the expected) in 2020. Every state of Brazil reported deaths above the corresponding expected figure. The excess was higher for men (25.2%) than for women (19.0%). Blacks showed an excess of 27.8%, as compared to whites at 17.6%. In both sexes and all age groups, excess was higher in the black population, especially in the South, Southeast, and Midwest regions. São Paulo, the largest in population number, had twice as much excess death in the black population (25.1%) than in the white population (11.5%). CONCLUSIONS The present study showed racial disparities in excess mortality during the COVID-19 pandemic in Brazil. The higher excess found for the black suggests an intrinsic relationship with the socioeconomic situation, further exposing the Brazilian reality, in which social and structural inequality is evident.
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Affiliation(s)
- Renato Azeredo Teixeira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Belo Horizonte, MG, Brasil
- Vital Strategies, New York, United States of America
| | | | - Ana Torens
- Vital Strategies, New York, United States of America
| | - Elisabeth Barboza França
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Saúde Pública, Belo Horizonte, MG, Brasil
| | - Lenice Ishitani
- Universidade Federal de Minas Gerais, Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Belo Horizonte, MG, Brasil
| | | | - Daisy Maria Xavier de Abreu
- Universidade Federal de Minas Gerais, Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde, Belo Horizonte, MG, Brasil
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Nogales Vasconcelos AM, Ishitani L, Abreu DMX, França E. Covid Adult Mortality in Brazil: An Analysis of Multiple Causes of Death. Front Public Health 2022; 9:788932. [PMID: 35111718 PMCID: PMC8801696 DOI: 10.3389/fpubh.2021.788932] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 12/14/2021] [Indexed: 12/20/2022] Open
Abstract
Objective This study aimed to analyze the chain of events and contributing causes associated with COVID-19 adult mortality (30–69 years old), based on qualified data on CoD from three Brazilian capitals cities, Belo Horizonte, Salvador, and Natal, in 2020. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
| | - Lenice Ishitani
- Epidemiology and Health Assessment Research Group (GPEAS), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Daisy Maria Xavier Abreu
- Epidemiology and Health Assessment Research Group (GPEAS), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Elisabeth França
- Graduate Program in Public Health, School of Medicine and Epidemiology and Health Assessment Research Group (GPEAS), Federal University of Minas Gerais, Belo Horizonte, Brazil
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Ishitani L, Teixeira R, Abreu D, Paixão L, França E. Garbage codes as causes of death and quality of mortality statistics in Belo Horizonte, Brazil. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Quality of cause-of-death information is fundamental for health planning. Traditionally, this quality has been assessed by the analysis of ill-defined causes from chapter XVIII of the International Classification of Diseases - 10th revision (ICD-10). However, studies have considered other useless diagnoses for public health purposes, defined, in conjunction with ill-defined causes, as garbage codes (GC). In Brazil, despite the high completeness of the Mortality Information System, approximately 30% of deaths are attributable to GCs. This study aims to analyze the frequency of GCs in Belo Horizonte municipality, the capital of Minas Gerais state, Brazil.
Methods
Data of deaths from 2011 to 2013 in Belo Horizonte were analyzed. GCs were classified according to the GBD 2015 study list. These codes were classified in: a) GCs from chapter XVIII of ICD-10 (GC-R), and b) GC from other chapters of ICD-10 (GC-nonR). Proportions of GC were calculated by sex, age, and place of occurrence.
Results
In Belo Horizonte, from the total of 44,123 deaths, 5.5% were classified as GC-R. The majority of GCs were GC-nonR (25% of total deaths). We observed a higher proportion of GC in children (1 to 4 years) and in people aged over 60 years. GC proportion was also higher in females, except in the age-groups under 1 year and 30-59 years. Home deaths (n = 7,760) had higher proportions of GCs compared with hospital deaths (n = 30,182), 36.9% and 28.7%, respectively. The leading GCs were the GC-R other ill-defined and unspecified causes of death (ICD-10 code R99)), and the GCs-nonR unspecified pneumonia (J18.9), unspecified stroke (I64), and unspecified septicemia (A41.9).
Conclusions
Analysis of GCs is essential to evaluate the quality of mortality information.
Key messages
Analysis of ill-defined causes (GC-R) is not sufficient to evaluate the quality of information on causes of death. Causes of death analysis should consider the total GC, in order to advance the discussion and promote adequate intervention on the quality of mortality statistics.
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Affiliation(s)
- L Ishitani
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - R Teixeira
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - D Abreu
- Center for Collective Health Education, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - L Paixão
- Board for Health Promotion and Epidemiological Surveillance, Municipal Health Department, Belo Horizonte, Brazil
| | - E França
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Graduate Program in Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
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Corrêa P, Ishitani L, Lansky S, Santos M, Teixeira R, França E. Investigation of hospital deaths declared as garbage codes in Belo Horizonte, Brazil, in 2017. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Improving the quality of causes of death (COD) is vital for defining adequate public policies. In Brazil, one third of deaths are reported as having a cause that is not useful for public health analysis of cause-of-death data, the so-called garbage codes (GC). The investigation of these deaths is one of the strategies that could improve the quality of mortality statistics in the country.
Methods
For all GCs identified in 2017 in the routine mortality information system from Belo Horizonte city, Brazil, municipal health professionals collected information about the final disease obtained from hospital records or autopsies in a standardized form. A trained physician analyzed this information and filled in a new death certificate (DC). The DC that originally showed a GC as an underlying COD was categorized into GC reclassified when the garbage cause changed to a specific cause after investigation. Causes of death derived from the reclassified GCs were analyzed to assess the impact on the mortality profile before and after the investigation.
Results
In Belo Horizonte, 1,395 deaths out of 3,038 registered as garbage codes were investigated, with a 35% reduction in deaths due to these causes. There was an increase in deaths from ischemic heart diseases, Alzheimer's disease, chronic obstructive pulmonary disease, hemorrhagic and ischemic stroke, and violence.
Conclusions
The investigation of deaths from garbage codes modified the mortality profile and improved its quality, providing direction for more assertive public health policies. Strategies for training physicians to report specific causes of death is another strategy that could improve the quality of mortality data.
Key messages
This study proved to be a feasible strategy in improving the quality of causes of death in mortality statistics and should be incorporated into the surveillance routine activities in Brazil. The evaluation of the GC investigation is an important instrument in helping management of health interventions aiming at better quality of information and more qualified health services.
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Affiliation(s)
- P Corrêa
- Board for Health Promotion and Epidemiological Surveillance, Municipal Health Department, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - L Ishitani
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - S Lansky
- Board for Health Promotion and Epidemiological Surveillance, Municipal Health Department, Belo Horizonte, Brazil
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - M Santos
- Board for Health Promotion and Epidemiological Surveillance, Municipal Health Department, Belo Horizonte, Brazil
| | - R Teixeira
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - E França
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Graduate Program in Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
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França E, Ishitani L, Teixeira R, Cunha C, Marinho F. Improving the usefulness of mortality data in Brazil: reclassification of ill-defined causes of death. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Garbage codes (GC) among registered causes of death can bias mortality analysis. In Brazil, more than one million deaths occurred annually in 2006-2017 and around 100,000 deaths per year were originally attributed to GC ill-defined causes of death (IDCD) in the Mortality Information System (SIM - Sistema de Informação sobre Mortalidade). To provide more accurate cause-of-death analysis, routine investigations of IDCD in the health surveillance system have been implemented in the country since 2005. The objective of this study was to analyze specific underlying causes for deaths originally assigned as IDCD in the SIM in 2006-2017.
Methods
For all IDCD (ICD codes from chapter 18, or R-codes) identified in the SIM, municipal health professionals collected information about the final disease obtained from hospital records, autopsies, forms of family health teams, and home investigation. Proportions of reclassified deaths by cause-specific mortality fractions (CSMF) derived from the reclassified IDCD by age and four calendar periods were analyzed to assess specific causes detected after investigation.
Results
A high proportion of deaths due to IDCD was investigated in 2006-2017 (32%). From a total of 257,367 IDCD reclassified, chronic diseases (56.6%), injuries (7.2%), and infectious (5.2%) or neonatal, maternal, malnutrition (1.7%) were the underlying causes detected among IDCD. Neonatal-related conditions, interpersonal violence, ischemic heart disease and stroke were the leading causes detected in the age groups 0-9 years, 10-29 years, 30-69 years, 70 years and over, respectively.
Conclusions
High proportions of IDCD reassigned to more informative causes after review indicate the success of this approach to correct misclassification in the SIM, an initiative that should be maintained. Training physicians on death certification along with better quality of medical care and access to health services would lead to further improvement.
Key messages
Investigation of IDCD as part of routine data collection on a large scale as had occurred in Brazil in 2006-2017 is an innovative approach to strengthen population-level mortality statistics. In addition to reducing the proportions of IDCD by their reclassification into specific causes, this initiative opens up the prospect of using these results for redistributing remaining cases of IDCD.
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Affiliation(s)
- E França
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Graduate Program in Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - L Ishitani
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - R Teixeira
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - C Cunha
- Epidemiology and Health Assessment Research Group, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Data for Health Initiative, Bloomberg Foundation, New York, USA
| | - F Marinho
- Data for Health Initiative, Bloomberg Foundation, New York, USA
- Vital Strategies, Bloomberg Foundation, New York, USA
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França EB, Passos VMDA, Malta DC, Duncan BB, Ribeiro ALP, Guimarães MDC, Abreu DMX, Vasconcelos AMN, Carneiro M, Teixeira R, Camargos P, Melo APS, Queiroz BL, Schmidt MI, Ishitani L, Ladeira RM, Morais-Neto OL, Bustamante-Teixeira MT, Guerra MR, Bensenor I, Lotufo P, Mooney M, Naghavi M. Cause-specific mortality for 249 causes in Brazil and states during 1990-2015: a systematic analysis for the global burden of disease study 2015. Popul Health Metr 2017; 15:39. [PMID: 29166948 PMCID: PMC5700707 DOI: 10.1186/s12963-017-0156-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
Background Reliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015. Methods We describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states. Results There was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country’s Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI. Conclusions A widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly. Electronic supplementary material The online version of this article (10.1186/s12963-017-0156-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabeth B França
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação em Saúde Pública, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil.
| | | | - Deborah Carvalho Malta
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Enfermagem Materno Infantil, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Bruce B Duncan
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, R. Ramiro Barcelos 2600/414, Porto Alegre, 90035-003, Brazil
| | - Antonio Luiz P Ribeiro
- Universidade Federal de Minas Gerais, School of Medicine, Av. Alfredo Balena, 190., Belo Horizonte, 30130-100, Brazil
| | - Mark D C Guimarães
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação em Saúde Pública, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Daisy M X Abreu
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Nescon, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Ana Maria N Vasconcelos
- Universidade de Brasília, Programa de Pós-graduação em Desenvolvimento, Sociedade e Cooperação Internacional, Asa Norte, Brasília, 70910-900, Brazil
| | - Mariângela Carneiro
- Universidade de Federal de Minas Gerais, Instituto de Ciências Biológicas, Departamento de Parasitologia. Avenida Antônio Carlos, 6670, Belo Horizonte, MG, 31270-901, Brazil
| | - Renato Teixeira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-graduação em Saúde Pública, Av. Prof. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Paulo Camargos
- Universidade Federal de São João Del Rei, Faculdade de Medicina. Praça Frei Orlando, 170, Centro, São João del-Rei, 36307-352, Brazil
| | - Ana Paula S Melo
- Universidade Federal de São João Del Rei, Faculdade de Medicina. Praça Frei Orlando, 170, Centro, São João del-Rei, 36307-352, Brazil
| | - Bernardo L Queiroz
- Universidade Federal de Minas Gerais, Faculdade de Ciências Econômicas, Departamento de Demografia, Av. Antônio Carlos, 6670, Belo Horizonte, 31270-901, Brazil
| | - Maria Inês Schmidt
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Epidemiologia, R. Ramiro Barcelos 2600/414, Porto Alegre, 90035-003, Brazil
| | - Lenice Ishitani
- Universidade Federal de Minas Gerais, Grupo de Pesquisas em Epidemiologia e Avaliação em Saúde-GPEAS, Av. Alfredo Balena, 190, Belo Horizonte, 30130-100, Brazil
| | - Roberto Marini Ladeira
- Fundação Hospitalar do Estado de Minas Gerais, Alameda Alvaro Celso 100/231, Belo Horizonte, 30150-260, Brazil
| | - Otaliba L Morais-Neto
- Universidade Federal de Goiás, Departamento de Saúde Coletiva. Instituto de Patologia Tropical e Saúde Pública. Rua 235, S/N, Setor Universitário, Goiânia, Goiás, 74605050, Brazil
| | - Maria Tereza Bustamante-Teixeira
- Universidade Federal de Juiz de Fora, Programa de Pós-graduação em Saúde Coletiva, Campus Universitario da UFJF, Rua José Lourenço Kelmer, S/n, Martelos, Juiz de Fora, 36036-330, Brazil
| | - Maximiliano R Guerra
- Universidade Federal de Juiz de Fora, Programa de Pós-graduação em Saúde Coletiva, Campus Universitario da UFJF, Rua José Lourenço Kelmer, S/n, Martelos, Juiz de Fora, 36036-330, Brazil
| | - Isabela Bensenor
- Universidade de São Paulo. Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Av. Lineu Prestes, 2565 / 3° andar, São Paulo, 05508-000, Brazil
| | - Paulo Lotufo
- Universidade de São Paulo. Centro de Pesquisa Clínica e Epidemiológica, Hospital Universitário, Av. Lineu Prestes, 2565 / 3° andar, São Paulo, 05508-000, Brazil
| | - Meghan Mooney
- Institute for Health Metrics and Evaluation, 2301 5th Avenue, Suite 600, Box 358210, Seattle, WA, 98121, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, 2301 5th Avenue, Suite 600, Box 358210, Seattle, WA, 98121, USA
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França E, Teixeira R, Ishitani L, Duncan BB, Cortez-Escalante JJ, Morais Neto OLD, Szwarcwald CL. Ill-defined causes of death in Brazil: a redistribution method based on the investigation of such causes. Rev Saude Publica 2015; 48:671-81; discussion 681. [PMID: 25210826 PMCID: PMC4181094 DOI: 10.1590/s0034-8910.2014048005146] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 03/17/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To propose a method of redistributing ill-defined causes of death (IDCD) based on the investigation of such causes. METHODS In 2010, an evaluation of the results of investigating the causes of death classified as IDCD in accordance with chapter 18 of the International Classification of Diseases (ICD-10) by the Mortality Information System was performed. The redistribution coefficients were calculated according to the proportional distribution of ill-defined causes reclassified after investigation in any chapter of the ICD-10, except for chapter 18, and used to redistribute the ill-defined causes not investigated and remaining by sex and age. The IDCD redistribution coefficient was compared with two usual methods of redistribution: a) Total redistribution coefficient, based on the proportional distribution of all the defined causes originally notified and b) Non-external redistribution coefficient, similar to the previous, but excluding external causes. RESULTS Of the 97,314 deaths by ill-defined causes reported in 2010, 30.3% were investigated, and 65.5% of those were reclassified as defined causes after the investigation. Endocrine diseases, mental disorders, and maternal causes had a higher representation among the reclassified ill-defined causes, contrary to infectious diseases, neoplasms, and genitourinary diseases, with higher proportions among the defined causes reported. External causes represented 9.3% of the ill-defined causes reclassified. The correction of mortality rates by the total redistribution coefficient and non-external redistribution coefficient increased the magnitude of the rates by a relatively similar factor for most causes, contrary to the IDCD redistribution coefficient that corrected the different causes of death with differentiated weights. CONCLUSIONS The proportional distribution of causes among the ill-defined causes reclassified after investigation was not similar to the original distribution of defined causes. Therefore, the redistribution of the remaining ill-defined causes based on the investigation allows for more appropriate estimates of the mortality risk due to specific causes.
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Affiliation(s)
- Elisabeth França
- Faculdade de Medicina, Belo Horizonte, Belo Horizonte, MG, Brasil
| | - Renato Teixeira
- Grupo de Pesquisa e Avaliação em Saúde, Faculdade de Medicina, Belo Horizonte, Belo Horizonte, MG, Brasil
| | - Lenice Ishitani
- Gerência de Epidemiologia e Informação, Belo Horizonte, Belo Horizonte, MG, Brasil
| | | | - Juan José Cortez-Escalante
- Coordenação Geral de Informações e Análise Epidemiológica, Secretaria de Vigilância à Saúde, Ministério da Saúde, Brasília, DF, Brasil
| | | | - Célia Landman Szwarcwald
- Centro de Informação Científica e Tecnológica, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Schmidt MI, Duncan BB, Ishitani L, da Conceição Franco G, de Abreu DMX, Lana GC, França E. Trends in mortality due to diabetes in Brazil, 1996-2011. Diabetol Metab Syndr 2015; 7:109. [PMID: 26617678 PMCID: PMC4661935 DOI: 10.1186/s13098-015-0105-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/11/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Over recent decades, Brazilian mortality registration has undergone increasing improvement in terms of completeness and quality in cause of death reporting. These improvements, however, complicate the description of mortality trends over this period. We aim to characterize the trend in diabetes mortality in Brazil and its five regions in adults (30-69 years), from 1996 to 2011 after corrections for underreporting of deaths and redistribution of ill-defined causes and "garbage codes". METHODS Starting with official data from the Brazilian Mortality Information System (SIM) for adults aged 30-69 in the period 1996 to 2011 for diabetes (ICD-10 codes E10-14), we redistributed garbage codes using methods based on the Global Burden of Disease Study (2010), redistributed ill-defined causes based on recent Brazilian investigations of similar cases and corrected for underreporting using official estimates of deaths. RESULTS With these corrections, age-standardized mortality fell approximately 1.1 %/year for men and 2.2 %/year for women from 1996 to 2011. The rate of decline first accelerated and then decelerated, reaching stable rates in men and minimal declines in women from 2005 onward. Regional inequalities decreased during the period in both relative and absolute terms. CONCLUSION Mortality due to diabetes declined in Brazil from 1996 to 2011, minimally in men and considerably in women. The lesser declines in recent years may reflect the increasing prevalence of diabetes, and suggest that current efforts to prevent diabetes and minimize the impact of its complications need to be reinforced to ensure that declines will continue.
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Affiliation(s)
- Maria Inês Schmidt
- />Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600/414, Porto Alegre, RS 90035-003 Brazil
| | - Bruce B. Duncan
- />Postgraduate Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Rua Ramiro Barcelos, 2600/414, Porto Alegre, RS 90035-003 Brazil
| | - Lenice Ishitani
- />Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, MG Brazil
| | | | - Daisy Maria Xavier de Abreu
- />Grupo de Pesquisa em Epidemiologia e Avaliação em Saúde-(GPEAS), Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Gustavo C. Lana
- />Statistics Department, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Elisabeth França
- />Postgraduate Program in Public Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
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