Deaths and hospitalizations resulting from poisoning by prescription and over-the-counter drugs in Brazil

Duarte, Fernanda Gross; Paula, Marcelo Neubauer de; Vianna, Nelzair Araújo; Almeida, Maria Conceição Chagas de; Moreira Junior, Edson Duarte

doi:10.11606/s1518-8787.2021055003551

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Original Article • Rev. Saúde Pública 55 • 2021 • https://doi.org/10.11606/s1518-8787.2021055003551 copy

Deaths and hospitalizations resulting from poisoning by prescription and over-the-counter drugs in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE:

To estimate the incidence of hospitalizations considering drug intoxication and the mortality of these diseases in Brazil, given trends from 2009 to 2018.

METHODS:

Data on hospital admissions and deaths come from DATASUS and demographic data from the Brazilian Institute of Geography and Statistics (IBGE). Hospital admissions with Autorização para Internação Hospitalar (AIH - Authorization for Hospital Admission) indicated as a procedure “treatment of intoxication or poisoning due to exposure to drugs and substances for non-drug use” were selected, with only cases of hospitalization due to drug intoxication being analyzed. The incidence of hospitalization and mortality were calculated separately for intoxications caused by medicamentos com prescrição (MRx - prescription drugs) and medicamentos isentos de prescrição (MIP - over-the-counter drugs). Rates were further stratified by sex, age group, and region of residence in Brazil. Trend analysis was performed by generalized linear regression using the Prais-Winsten method.

RESULTS:

MRx caused most hospitalizations (97%), with mortality approximately 50 times higher when compared to hospitalizations for MIP. The incidence trend in hospitalizations for MRx was stationary and mortality increased during the study period, whereas the trend in mortality and in the incidence of hospitalizations for MIP decreased.

CONCLUSIONS:

Hospitalizations for drug intoxication, especially those caused by MRx, have a great impact and importance on public health considering that prevention is possible.

DESCRITORES:
Medicamentos sem Prescrição, envenenamento; Medicamentos sob Prescrição, envenenamento; Hospitalização; Envenenamento, mortalidade

		Drugs with Prescription (MRx)				Over-the-counter drugs (MIP)				Total
		Hospitalizations		Deaths		Hospitalizations		Deaths		Hospitalizations		Deaths
		n	(%)	n	%	n	%	n	%	n	%	n	%
Total		83,275	100	2,595	100	2,536	100	49	100	85,811	100	2,644	100
Sex
	Female	47,252	56.7	1,267	48.8	1,391	54.9	13	26.5	48,643	56.7	1,280	48,4
	Male	36,023	43.3	1,328	51.2	1,145	45.1	36	73.5	37,168	43.3	1,364	51.6
Age group
	< 5	7,600	9.1	40	1.5	529	20.9	4	8.2	8,129	9.5	44	1.7
	5–9	3,399	4.1	14	0.5	194	7.6	1	2.0	3,593	4.2	15	0.6
	10–14	4,623	5.6	29	1.1	144	5.7	0	0	4,767	5.6	29	1.1
	15–19	8,468	10.2	129	5.0	279	11.0	2	4.1	8,747	10.2	131	5.0
	20–29	15,679	18.8	401	15.5	476	18.8	7	14.3	16,155	18.8	408	15.4
	30–39	14,851	17.8	504	19.4	304	12.0	10	20.4	15,155	17.7	514	19.4
	40–49	11,857	14.2	543	20.9	257	10.1	4	8.2	12,114	14.1	547	20.7
	50–59	7,497	9.0	401	15.5	155	6.1	7	14.3	7,652	8.9	408	15.4
	60–69	4,331	5.2	244	9.4	88	3.5	6	12.2	4,419	5.1	250	9.5
	70 or more	4,970	6.0	290	11.2	110	4.3	8	16.3	5,080	5.9	298	11.3
Skin color/race
	White	32,814	39.4	921	36	911	35.9	11	22.4	33,725	39.3	932	35.2
	Brown	22,076	26.5	704	27	768	30.3	14	28.6	22,844	26.6	718	27.2
	Black	2,787	3.3	93	4	77	3.0	3	6.1	2,864	3.3	96	3.6
	Other	835	1.1	25	1	24	1.0	0	0	859	1.1	25	1.0
	Not informed	24,763	29.7	852	33	756	29.8	21	42.9	25,519	29.7	873	33.0
Regions
	North	3,868	4.6	108	4.2	142	5.6	5	10.2	4,010	4.7	113	4.3
	Northeast	7,064	8.5	172	6.6	317	12.5	5	10.2	7,381	8.6	177	6.7
	Midwest	14,375	17.3	621	23.9	545	21.5	20	40.8	14,920	17.4	641	24.2
	Southeast	41,522	49.9	1,278	49.2	977	38.5	11	22.4	42,499	49.5	1,289	48.8
	South	16,446	19.7	416	16.0	555	21.9	8	16.3	17,001	19.8	424	16.0
Character of admission
	Urgency	81,513	97.9	2,536	97.7	2,474	97.6	49	100	83,987	97.9	2,585	97.8
	Elective	1,762	2.1	59	2.3	62	2.4	0	0	1,824	2.1	59	2.2

		Year										Annual average
		2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	Annual average
Hospitalization ^a a Incidence of hospitalization per 100,000 inhabitants.
MRx (age group)
	0 to 4 years	7.62	6.10	5.37	5.99	5.57	5.67	4.88	5.07	5.27	5.67	5.72
	5 to 19	4.47	3.23	3.32	3.25	3.25	2.95	2.86	2.83	3.85	4.40	3.44
	20 to 59 years	7.00	4.58	4.40	4.49	4.32	3.90	3.66	3.62	3.99	4.45	4.44
	60 years or older	4.49	3.55	3.37	3.09	3.23	3.45	3.44	3.26	3.66	3.51	3.50
	Total	6.10	4.22	4.07	4.11	4.00	3.73	3.52	3.48	3.99	4.37	4.16
MIP (age group)
	0 to 4 years	0.58	0.27	0.42	0.42	0.49	0.41	0.34	0.32	0.43	0.30	0.40
	5 to 19	0.15	0.11	0.08	0.13	0.13	0.14	0.15	0.13	0.13	0.14	0.13
	20 to 59 years	0.20	0.11	0.12	0.10	0.11	0.09	0.09	0.08	0.08	0.08	0.11
	60 years o older	0.14	0.08	0.10	0.10	0.05	0.08	0.08	0.06	0.04	0.04	0.08
	Total	0.21	0.12	0.13	0.13	0.13	0.12	0.12	0.11	0.10	0.10	0.13
Mortality ^b b Mortality per 100 million inhabitants.
MRx (age group)
	0 to 4 years	66	37	22	15	7	23	15	23	38	53	30
	5 to 19	38	26	30	33	35	31	34	32	57	44	36
	20 to 59 years	221	137	155	155	148	152	155	160	164	191	164
	60 years or older	214	151	134	181	207	215	215	173	239	247	198
	Total	162	103	112	119	119	124	126	125	143	159	129
MIP (age group)
	0 to 4 years	7.4	14.8	0	0	0	7.7	0	0	0	0	3.0
	5 to 19	0	0	0	0	6.2	0	0	0	0	0	0.6
	20 to 59 years	5.6	3.7	5.4	1.8	0.9	2.7	0.9	0	3.4	0.8	2.5
	60 years or older	4.5	8.9	13.0	3.9	0	7.3	0	10.2	3.3	3.1	5.4
	Total	4.1	4.1	4.6	1.5	2.0	3.0	0.5	1.5	2.4	1.0	2.5

		Year										Annual average
		2009	2010	2011	2012	2013	2014	2015	2016	2017	2018	Annual average
Hospitalization ^a a Incidence of hospitalization per 100,000 inhabitants standardized for world population distribution (WHO, 2000–2025).
MRx (by region)
	North	3.23	2.54	2.80	3.72	3.71	1.62	1.29	1.17	1.52	1.33	2.29
	Central-West Region	9.28	5.91	5.34	5.17	4.81	3.84	2.99	3.49	3.94	3.63	4.84
	Northeast	4.83	2.83	2.73	2.79	2.42	2.34	2.18	2.00	2.09	2.43	2.66
	Southeast	6.64	5.09	5.08	4.88	4.85	4.94	4.38	4.61	5.18	5.76	5.14
	South	8.35	5.53	4.81	4.94	5.35	5.38	4.96	5.81	7.18	7.72	6.00
	Brazil	6.10	4.23	4.08	4.10	3.99	3.72	3.49	3.47	3.98	4.36	4.15
MIP (by region)
	North	0.13	0.05	0.06	0.10	0.11	0.12	0.09	0.02	0.08	0.04	0.08
	Central-West Region	0.57	0.26	0.21	0.20	0.19	0.24	0.10	0.11	0.13	0.15	0.22
	Northeast	0.17	0.11	0.15	0.10	0.11	0.08	0.09	0.07	0.05	0.06	0.10
	Southeast	0.17	0.09	0.10	0.12	0.12	0.12	0.12	0.12	0.10	0.09	0.12
	South	0.27	0.17	0.15	0.21	0.17	0.18	0.21	0.19	0.20	0.21	0.20
	Brazil	0.21	0.12	0.13	0.13	0.14	0.13	0.12	0.11	0.11	0.11	0.13
Mortality ^b b Mortality per 100 million population standardized for world population distribution (WHO, 2000–2025).
MRx (by region)
	North	68	80	58	74	67	49	53	48	128	53	68
	Central-West Region	222	130	111	113	177	103	116	71	148	111	130
	Northeast	224	76	105	131	120	103	91	135	101	147	123
	Southeast	153	137	149	154	155	191	148	176	194	226	168
	South	205	136	123	124	132	157	134	139	236	249	164
	Brazil	158	101	108	115	115	120	121	120	139	155	125
MIP (by region)
	North	0	5.73	0	0	10.94	5.41	0	0	0	5.52	2.76
	Central-West Region	7.07	0	25.42	0	0	6.60	0	0	0	0	3.91
	Northeast	5.60	13.52	6.79	1.83	1.54	6.11	0	3.02	3.56	2.99	4.50
	Southeast	5.70	1.22	2.05	2.03	0	1.18	1.08	1.96	1.15	0	1.64
	South	0	0	7.14	3.54	2.98	3.48	0	5.78	9.14	0	3.21
	Brazil	4.09	4.24	4.43	1.46	2.06	3.02	0.46	1.49	2.32	0.94	2.45

		N	Coefficient	95%CI	p	Estimated date
		Hospitalization
MRx (by region)
	North	3,868	−0.268	−0.586; 0.050	0.087	Stationary
	Central-West Region	7,064	−0.224	−0.407; −0.041	0.023	Decreasing
	Northeast	14,375	−0.080	−0.146; −0.014	0.024	Decreasing
	Southeast	41,522	0.124	−0.020; 0.268	0.082	Stationary
	South	16,446	0.514	0.328; 0.700	0.000	Upwardly
	Brazil	83,275	0.049	−0.072; 0.169	0.371	Stationary
MIP (by region)
	North	142	−0.002	−0.0153; 0.010	0.605	Stationary
	Central-West Region	317	−0.014	−0.026; −0.002	0.025	Decreasing
	Northeast	545	−0.010	−0.011; −0.009	0.000	Decreasing
	Southeast	977	−0.000	−0.003; 0.002	0.705	Stationary
	South	555	0.004	−0.000; 0.009	0.052	Stationary
	Brazil	2,536	−0.004	−0.005; −0.002	0.001	Decreasing
Fatalities
MRx (by region)
	North	108	0.283	−5.478; 6.045	0.911	Stationary
	Central-West Region	172	−3.446	−9.001; 2.109	0.186	Stationary
	Northeast	621	1.772	−1.879; 5.423	0.289	Stationary
	Southeast	1,278	6.680	3.959; 9.401	0.001	Upwardly
	South	416	15.527	6.757; 24.297	0.004	Upwardly
	Brazil	2,595	5.885	3.635; 8.136	0.000	Upwardly
MIP (by region)
	North	108	0.283	−5.478; 6.045	0.911	Stationary
	Central-West Region	172	−3.446	−9.001; 2.109	0.186	Stationary
	Northeast	621	1.772	−1.879; 5.423	0.289	Stationary
	Southeast	1,278	6.680	3.959; 9.401	0.001	Upwardly
	South	416	15.527	6.757; 24.297	0.004	Upwardly
	Brazil	2,595	5.885	3.635; 8.136	0.000	Upwardly

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[1] Correspondence: Fernanda Gross Duarte, Rua Waldemar Falcão, 121 40296-710 Candeal, Salvador, BA E-mail: nandagross@gmail.com