Mortality related to sickle cell disease and COVID-19 in Brazil, 2020

Santo, Augusto Hasiak

doi:10.1590/1806-9282.20231466

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Sumário

Original Article • Rev. Assoc. Med. Bras. 70 (4) • 2024 • https://doi.org/10.1590/1806-9282.20231466 copy

Mortality related to sickle cell disease and COVID-19 in Brazil, 2020

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The ability to cause death is the definitive measure of an infectious disease severity, particularly one caused by a novel pathogen like severe acute respiratory syndrome-CoV-2 (COVID-19). This study describes sickle cell disease-related mortality issues during the COVID-19 pandemic in Brazil.

METHODS:

The provisional 2020 mortality data originated from the public databases of the Mortality Information System and were investigated using the multiple-cause-of-death methodology.

RESULTS:

In 2020, 688 sickle cell disease-related deaths occurred, of which 422 (61.3%) had an underlying cause of death and 266 (38.7%) had an associated cause of death. Furthermore, 98 COVID-19-related deaths occurred, of which 78 were underlying cause of death among sickle cell disease associated (non-underlying) cause of death. Sickle cell disease-related deaths occurred mostly among young adults aged 25–49 years. COVID-19 deaths occurred at ages older than among sickle cell disease-related deaths. Majority of deaths happened in the southeast (42.3%) and northeast regions (34.0%), while COVID-19 deaths prevailed in the northeast region (42.9%). Regarding overall deaths, the leading underlying cause of death was sickle cell disease itself, followed by infectious and parasitic diseases (14.8%), owing to COVID-19 deaths, and diseases of the circulatory system (8.9%). Next, in males, diseases of the digestive system (4.8%) occurred, while, in females, maternal deaths succeeded, included in the chapter on pregnancy, childbirth, and the puerperium, accounting for 5.9% of female deaths. The leading overall associated (non-underlying) cause of deaths were septicemias (29.4%), followed by respiratory failure (20.9%), pneumonias (18.3%), and renal failure (14.7%).

CONCLUSION:

In Brazil, COVID-19 deaths produced trend changes in sickle cell disease-related causes of death, age at death, and regional distribution of deaths in 2020.

KEYWORDS:
Sickle cell disease; COVID-19; Multiple-cause-of-death; Mortality; Cause of death; Brazil

		SCD causes of death						COVID-19 total deaths
		Underlying		Associated		Total		COVID-19 total deaths
		n	%	n	%	n	%	n	%	SPM%
All deaths		422	61.3	266	38.7	688	100.0	98	100.0	14.2
Sex
	Male	211	50.0	122	45.9	333	48.4	48	49.0	14.4
	Female	211	50.0	144	54.1	355	51.6	50	51.0	14.1
Age at death (years)
	00–04	20	62.9	4	37.1	24	3.5	2	2.0	8.3
	05–24	134	77.2	52	22.8	186	27.0	25	25.5	13.4
	25–49	177	73.5	129	26.5	306	44.5	46	46.9	15.0
	50–74	79	62.4	61	37.6	140	20.3	19	19.4	13.6
	75 and more	12	69.0	20	31.0	32	4.7	6	6.1	18.8
Race/color^* * Race/color available data on death certificates not totally complete.
	White	65	15.9	46	18.1	111	16.7	14	14.7	12.6
	Black	120	29.3	80	31.5	200	30.1	26	27.4	13.0
	Yellow	1	0.2	3	1.2	4	0.6	1	1.1	25.0
	Brown	221	53.9	125	49.2	346	52.1	54	56.8	15.6
	Indigenous	3	0.7	0	0.0	3	0.5	0	0.0	0
Brazilian regions
	North	42	79.2	11	20.8	53	7.7	7	7.1	13.2
	Northeast	136	58.1	98	41.9	234	34.0	42	42.9	17.9
	Southeast	178	61.0	114	39.0	292	42.4	33	33.7	11.3
	South	20	57.1	15	42.9	35	5.1	4	4.1	11.4
	Center_West	46	62.2	28	37.8	74	10.8	12	12.2	16.2

Underlying causes of death (ICD-10 chapters and rubrics)		Male		Female		Total
Underlying causes of death (ICD-10 chapters and rubrics)		n	%	n	%	n	%
Certain infectious and parasitic diseases (A00–B99)		52	15.6	50	14.1	102	14.8
	Intestinal infectious disease (A00–A09)	1	0.3	4	1.1	5	0.7
	Tuberculosis (A15–A19, B90)	3	0.9	0	0.0	3	0.4
	Dengue and dengue hemorrhagic fever (A90–A91)	3	0.9	2	0.6	5	0.7
	Viral hepatitis (B15–B19)	4	1.2	2	0.6	6	0.9
	Human immunodeficiency virus (HIV) disease (B20–B24)	1	0.3	2	0.6	3	0.4
	Coronavirus infection, unspecified (B34.2)	39	11.7	39	11.0	78	11.3
Neoplasm (C00–D48)		3	0.9	5	1.4	8	1.2
Diseases of blood and blood-forming organs (D50–D890)		215	64.6	217	61.1	432	62.8
	Sickle-cell disorders (D57)	211	63.4	211	59.4	422	61.3
Endocrine nutritional and metabolic diseases (E00–E90)		5	1.5	6	1.7	11	1.6
	Diabetes mellitus (E10–E14)	3	0.9	5	1.4	8	1.2
Diseases of the circulatory system (I00–I99)		30	9.0	31	8.7	61	8.9
	Hypertensive diseases (I10–I13)	7	2.1	4	1.1	11	1.6
	Ischemic heart diseases (I20–I25)	1	0.3	2	0.6	3	0.4
	Pulmonary heart diseases and diseases of pulmonary circulation (I26–I28)	2	0.6	4	1.1	6	0.9
	Heart failure (I50–I51)	2	0.6	3	0.8	5	0.7
	Cerebrovascular diseases (I60–I69)	11	3.3	13	3.7	24	3.5
Diseases of the respiratory system (J00–J99)		3	0.9	1	0.3	4	0.6
Diseases of the digestive system (K00–K93)		16	4.8	13	3.7	29	4.2
	Disease of liver (K70–K76)	7	2.1	6	1.7	13	1.9
	Disorders of gall bladder, biliary tract, and pancreas (K80–K86)	4	1.2	2	0.6	6	0.9
	Other diseases of the digestive system (K90–K92)	1	0.3	2	0.6	3	0.4
Diseases of the genitourinary system (N00–N99)		3	0.9	5	1.4	8	1.2
	Renal failure (N17–N19)	2	0.6	4	1.1	6	0.9
Pregnancy, childbirth, and the puerperium (O00–O99)		—	—	21	5.9	21	3.1
Other underlying causes of death		6	1.8	6	1.7	12	1.7
Total		333	100.0	355	100.0	688	100.0

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[1] *Corresponding author: auhsanto@usp.br