Preventable deaths within Brazil’s Public Health System in a population from 5 to 69 years old, 2000 - 2013

Malta, Deborah Carvalho; Saltarelli, Rafaela Magalhães Fernandes; Prado, Rogério Ruscitto do; Monteiro, Rosane Aparecida; Almeida, Márcia Furquim de

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 21 • 2018 • https://doi.org/10.1590/1980-549720180008 copy

Preventable deaths within Brazil’s Public Health System in a population from 5 to 69 years old, 2000 - 2013

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objectives:

To analyze the mortality trend in the Brazilian population aged between 5 and 69 years old, using the “Brazilian List of Causes of Preventable Deaths”.

Methods:

This is an ecological study that uses a time-series analysis of the standardized mortality rate for preventable and unpreventable causes in the period from 2000 to 2013, with corrections for ill-defined causes and the under-reporting of informed deaths.

Results:

There was a decline in the mortality rate in the Brazilian population aged 5 to 69 due to preventable causes (1.6% per year) and unpreventable causes (1.4% per year), in addition to a decrease among all of the groups of causes of preventable deaths in the period from 2000 - 2013. The study draws attention to the increase in deaths from specific causes such as pneumonia (1.9% per year) and transportation accidents (0.6% per year), as well the stability in the number of deaths from aggression and intentional self-harm. Deaths from noncommunicable diseases fell by 2.2% per year and were highest in the age group of 60 - 69 years old in 2013 (209.9/100,000 inhabitants for ischemic heart disease deaths, 157.2/100,000 inhabitants for cerebrovascular diseases and 116.8/100,000 inhabitants for diabetes).

Conclusion:

The rates of preventable deaths are still high, especially for noncommunicable diseases and external causes. These causes of death are sensitive to health promotion interventions and, therefore, this study reinforces the need to remain focused on these causes of illness and death, as well as their risk factors.

Keywords:
Premature Mortality; Causes of Death; Chronic Disease; External Causes; Public Health System; Prevention & Control

Preventable causes	2000	2007	2013	% annual reduction	% reduction within the period	p-value
Immunoprevention
North	1.8	1.4	0.9	2.6	50.0	0.001
Northeast	0.7	0.6	0.3	5.2	57.1	< 0.001
Southeast	0.7	0.4	0.3	5.9	57.1	< 0.001
South	0.7	0.4	0.3	4.4	57.1	< 0.001
Mid-west	0.7	0.4	0.3	3.5	57.1	< 0.001
Brazil	0.8	0.5	0.3	5.9	62.5	< 0.001
Appropriate actions to promote health, prevention, control and attention to infectious diseases
North	39.7	38.9	37.9	0.2	4.5	0.002
Northeast	33.0	28.6	31.4	0.3	4.8	0.008
Southeast	40.2	36.2	36.7	0.7	8.7	0.001
South	28.4	28.3	29.0	-0.2	-2.1	0.227
Mid-west	28.0	28.3	26.7	0.3	4.6	0.600
Brazil	35.8	32.7	33.6	0.4	6.1	0.003
Appropriate actions to promote health, prevention, control and attention to non-communicable diseases
North	222.6	200.1	176.1	1.8	20.9	< 0.001
Northeast	226.3	213.8	192.2	1.2	15.1	< 0.001
Southeast	257.5	212.1	179.9	2.7	30.1	< 0.001
South	247.5	202.5	175.2	2.6	29.2	< 0.001
Mid-west	236.2	206.7	181.0	2.0	23.4	< 0.001
Brazil	244.8	210.1	182.1	2.2	25.6	< 0.001
Appropriate actions for the prevention, control, and attention to the causes of maternal death
North	2.4	1.8	1.8	1.7	25.0	0.001
Northeast	2.1	1.6	1.5	2.2	28.6	< 0.001
Southeast	1.0	0.8	0.9	0.6	10.0	0.752
South	1.1	0.9	0.7	3.3	36.4	< 0.001
Mid-west	0.9	0.9	1.1	-2.7	-22.2	0.225
Brazil	1.4	1.1	1.1	1.6	21.4	< 0.001
Appropriate intersectoral actions for health promotion, prevention, and attention to external causes
North	91.8	94.2	103.3	-1.0	-12.5	< 0.001
Northeast	91.4	91.5	105.4	-1.1	-15.3	< 0.001
Southeast	90.8	73.0	65.0	2.5	28.4	< 0.001
South	70.0	74.7	69.2	0.1	1.1	0.682
Mid-west	95.6	89.5	96.6	-0.1	-1.0	0.587
Brazil	87.9	81.1	82.3	0.5	6.4	0.001

Preventable causes	2000	2007	2013	% average annual reduction	p-value
Immunoprevention
Miliary tuberculosis	0.3	0.1	0.1	4.2	< 0.001
Acute hepatitis B	0.3	0.2	0.1	4.2	0.003
Tetanus	0.2	0.1	0.1	7.1	< 0.001
Attention actions for infectious diseases
Pneumonia	10.1	10.7	12.6	-1.9	< 0.001
Diseases from HIV	8.6	7.9	7.5	1.0	< 0.001
Intestinal infectious diseases	1.3	1.0	0.8	3.3	< 0.001
Other infections	5.5	4.4	4.4	1.5	< 0.001
Attention actions for non-communicable diseases
Ischemic heart diseases	44.2	37.6	32.8	2.2	< 0.001
Cerebrovascular diseases	43.3	31.5	24.0	4.4	< 0.001
Diabetes	20.7	18.2	16.1	1.9	< 0.001
Attention actions for maternal causes of death	1.4	1.1	1.1	1.6	< 0.001
Attention actions for external causes of death
Aggressions	33.7	31.6	34.7	-0.3	0.256
Transport accidents	23.6	25.0	25.1	-0.6	0.009
Self-inflicted injuries	5.5	5.9	6.1	-0.9	0.194

Preventable causes	2013
	Age range (years)
	05 - 09	10 - 14	15 - 19	20 - 29	30 - 39	40 - 49	50 - 59	60 - 69
Immunoprevention
Miliary tuberculosis	0.0	0.0	0.0	0.1	0.1	0.2	0.4	0.3
Acute hepatitis B	0.0	0.0	0.0	0.0	0.1	0.2	0.3	0.4
Tetanus	0.0	0.0	0.0	0.0	0.0	0.1	0.1	0.3
Attention actions for infectious diseases
Pneumonia	1.4	1.3	2.1	2.8	5.9	13.3	28.2	69.3
Diseases from HIV	0.1	0.1	0.8	5.3	12.5	16.4	11.6	7.1
Intestinal infectious diseases	0.3	0.2	0.2	0.2	0.4	0.8	1.9	4.0
Other infections	0.9	0.6	1.1	1.2	2.0	4.4	10.1	22.7
Attention actions for non-communicable diseases
Ischemic heart diseases	0.0	0.2	0.8	1.9	7.2	30.5	89.7	209.9
Cerebrovascular diseases	0.3	0.6	1.2	1.9	6.3	22.6	58.8	157.2
Diabetes mellitus	0.1	0.2	0.5	1.2	3.2	11.5	38.4	116.8
Attention actions for external causes of death
Aggressions	0.7	4.9	63.6	69.9	44.5	28.1	17.9	11.8
Transport accidents	3.7	5.1	23.2	34.7	30.1	30.3	28.8	31.2
Self-inflicted injuries	0.0	0.8	4.4	7.3	7.9	8.7	8.3	8.0

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[1] Corresponding author: Deborah Carvalho Malta. Universidade Federal de Minas Gerais, Escola de Enfermagem. Avenida Prof. Alfredo Balena, 190, CEP: 30130-100, Belo Horizonte, MG, Brasil. E-mail: dcmalta@uol.com.br