Mortality from neglected tropical diseases in the state of Piauí, Northeast Brazil: temporal trend and spatial patterns, 2001-2018

Brito, Sheila Paloma de Sousa; Ferreira, Anderson Fuentes; Lima, Mauricélia da Silveira; Ramos Jr, Alberto Novaes

doi:10.1590/S1679-49742022000100014

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Original article • Epidemiol. Serv. Saúde 31 (1) • 2022 • https://doi.org/10.1590/S1679-49742022000100014 linkcopy

Mortality from neglected tropical diseases in the state of Piauí, Northeast Brazil: temporal trend and spatial patterns, 2001-2018

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objetive To analyze temporal trends and spatial patterns of mortality due to neglected tropical diseases (NTDs) in Piauí, Brazil, 2001-2018.

Methods This was a mixed ecological study, with risk ratio (RR) calculation, spatiotemporal trend analysis, Poisson joinpoint regression, using data from the Mortality Information System.

Results There were 2,609 deaths due to NTDs in the period (4.60/100,000 inhabitants), 55.2% were due to Chagas’ disease. There was a higher risk of death in male (RR=1.76; 95%CI 1.25;2.46), being aged ≥60 years (RR=40.71; 95%CI 10.01;165.53), municipalities with medium vulnerability social (RR=1.76; 95%CI 1.09;2.84), smaller population size (RR=1.99; 95%CI 1.28;3.10) and the Cerrados macro-region (RR=4.51; 95%CI 2.51;8.11). There was an upward trend in mortality rates from 2001-2008 and a falling trend from 2009-2018.

Conclusion Mortality due to NTDs in Piauí remains high, particularly due to Chagas’ disease, among groups with greater vulnerability, with concentration of higher rates in the southwest of the Semiarid macro-region and the northeast and south of the Cerrados macro-region.

Keywords:
Neglected Diseases; Mortality; Time Series Studies; Spatial Analysis; Ecological Studies

Neglected tropical diseases	ICD-10 codes^a	Underlying cause	Associated cause	Multiple cause (underlying + associated)^b
Neglected tropical diseases	ICD-10 codes^a	N(%)	N(%)	N(%)
Protozoal diseases
Chagas’ disease	B57	1,218 (61.2)	223 (36.0)	1,441 (55.2)
Leishmaniasis	B55	358 (18.0)	52 (8.4)	410 (15.7)
African trypanosomiasis (sleeping sickness)	B56	- (0.0)	1 (0.2)	1 (0.0)
Helminthiases
Schistosomiasis	B65/N22	10 (0.5)	1 (0.2)	11 (0.4)
*Soil-transmitted helminthiases*
Ascariasis/ancylostomiasis	B76-B77	- (0.0)	4 (0.6)	4 (0.2)
Onchocerciasis (river blindness)	B73	- (0.0)	1 (0.2)	1 (0.0)
Cysticercosis/taeniasis	B68-B69	34 (1.7)	14 (2.3)	48 (1.8)
Echinococcosis	B67	- (0.0)	3 (0.5)	3 (0.1)
Filariasis	B74	2 (0.1)	2 (0.3)	4 (0.2)
*Foodborne trematodiasis*
Opisthorchiasis/clonorchiasis/ fascioliasis/paragonimiasis	B66-B66.4	- (0.0)	1 (0.2)	1 (0.0)
Bacterial diseases
Leprosy	A30/B92	148 (7.4)	212 (34.2)	360 (13.8)
Trachoma	A71/B94	6 (0.3)	2 (0.3)	8 (0.3)
Buruli ulcer	A31.1	- (0.0)	1 (0.2)	1 (0.0)
Viral infections
Rabies	A82	4 (0.2)	- (0.0)	4 (0.2)
Dengue	A90-A91	65 (3.3)	13 (2.1)	78 (3.0)
Chikungunya	A92	8 (0.4)	1 (0.2)	9 (0.3)
Mycoses
Mycetoma	B47	2 (0.1)	1 (0.2)	3 (0.1)
Chromoblastomycosis	B43	1 (0.0)	- (0.0)	1 (0.0)
Histoplasmosis	B39	3 (0.1)	3 (0.5)	6 (0.2)
Coccidioidomycosis	B38	10 (0.5)	1 (0.2)	11 (0.4)
Paracoccidioidomycosis	B41	10 (0.5)	2 (0.3)	12 (0.5)
Cryptococcosis	B45	25 (1.3)	41 (6.6)	66 (2.5)
Parasitic diseases
Scabies	B86	- (0.0)	3 (0.5)	3 (0.1)
Visceral larva migrans	B83	2 (0.1)	3 (0.5)	5 (0.2)
Pediculosis (lice infestation)	B85	- (0.0)	1 (0.2)	1 (0.0)
Myiasis	B87	23 (1.2)	7 (1.1)	30 (1.1)
Accident with venomous animals
Snake venom	T63.0	- (0.0)	26 (4.2)	26 (1.0)
Contact with venomous snakes and lizards	X20	61 (3.1)	0 (0.0)	61 (2.3)
Total	-	1,990 (100.0)	619 (0.0)	2,609 (0.0)

Variables^a	N (%)	Crude rate (95%CI^b)	RR^c (95%CI)	p-value^d
Total deaths from NTDs^e	2,609 (100.0)	4.60 (3.85;5.35)	RR^c (95%CI)	p-value^d
Sex
Female	968 (37.1)	3.36 (2.46;4.25)	1.00
Male	1,641 (62.9)	5.90 (4.68;7.11)	1.76 (1.25;2.46)	0.001
Age group (years)
0-4	146 (5.6)	2.93 (0.90;4.95)	4.72 (1.01;22.23)	0.050
5-14	46 (1.8)	0.50 (0.00;1.06)	0.80 (0.13;4.81)	0.812
15-19	28 (1.0)	0.62 (0.00;1.48)	1.00
20-39	268 (10.3)	1.48 (0.73;2.23)	2.39 (0.55;10.45)	0.247
40-59	642 (24.6)	5.84 (3.93;7.74)	9.42 (2.27;39.11)	0.002
≥60	1,478 (56.7)	25.24 (19.78;30.70)	40.71 (10.01;165.53)	<0.001
Ethnicity or race/skin color
White	457 (17.5)	3.31 (2.01;4.61)	1.00
Brown	1,613 (61.8)	4.49 (3.56;5.42)	1.36 (0.87;2.11)	0.177
Black	343 (13.2)	6.56 (3.61;9.51)	1.98 (1.09;3.60)	0.025
Yellow	13 (0.5)	1.51 (0.38;7.23)	5.94 (3.04;11.60)	<0.001
Indigenous	1 (0.0)	0.00 (0.00;88.88)	8.99 (1.22;66.30)	0.031
SVI^f
Low	589 (22.6)	3.49 (2.30;4.68)	1.00
Medium	606 (23.3)	6.15 (4.08;8.22)	1.76 (1.09;2.84)	0.021
High	861 (33.0)	5.40 (3.87;6.92)	15.46 (0.99;2.41)	0.054
Very high	551 (21.1)	4.24 (2.75;5.74)	12.16 (0.74;1.98)	0.435
Municipality size^g>
Small I	1,315 (50.4)	5.61 (4.32;6.90)	1.99 (1.28;3.10)	0.002
Small II	626 (24.0)	5.27 (3.52;7.01)	1.87 (1.13;3.09)	0.014
Medium	172 (6.6)	5.18 (1.97;8.40)	1.84 (0.89;3.81)	0.099
Large	494 (19.0)	2.81 (1.75;3.87)	1.00
Health macro-region
Litoral (Coast)	251 (9.6)	2.13 (1.01;3.24)	1.00
Meio Norte (Mid North)	713 (27.3)	3.00 (2.07;3.93)	1.41 (0.77;2.59)	0.270
Semiárido (Semiarid)	635 (24.4)	6.07 (4.06;8.09)	2.85 (1.54;5.30)	0.009
Cerrados (Savanna)	1,008 (38.7)	9.60 (7.09;12.12)	4.51 (2.51;8.11)	<0.001

Variable	Trends		Total period
Variable	Period	APC^a (95%CI^b)	AAPC^c (95%CI^b)
Total deaths from NTDs^d	2001-2008	7.9^g (3.1;12.9)	1.3 (-0.9;3.5)
Total deaths from NTDs^d	2008-2018	-3.1^g (-5.5;-0.7)	1.3 (-0.9;3.5)
Sex
Female	2001-2011	4.6^g (0.1;9.3)	0.9 (-6.5;8.8)
	2011-2015	-12.2 (-33.6;16.1)
	2015-2018	7.6 (-18.7;42.4)
Male	2001-2008	8.8^g (3.1;14.7)	1.8 (-0.6;4.4)
Male	2008-2018	-2.7^g (-5.4;-0.0)	1.8 (-0.6;4.4)
Age group (in years)
0-4	2001-2016	-4.9^g (-9.5;-0.2)	-1.5 (-14.0;12.7)
0-4	2016-2018	28.1 (-61.8;330.0)	-1.5 (-14.0;12.7)
5-14	2001-2007	12.4 (-8.7;38.5)	-0.5 (-8.6;8.3)
5-14	2007-2018	-7.0 (-15.3;2.2)	-0.5 (-8.6;8.3)
15-19	2001-2018	-3.1 (-7.7;1.7)	-3.1 (-7.7;1.7)
20-39	2001-2018	0.9 (-1.8;3.6)	0.9 (-1.8;3.6)
40-59	2001-2010	1.9 (-3.3;7.3)	-2.6 (-6.2;1.1)
40-59	2010-2018	-7.5^g (-13.3;-1.2)	-2.6 (-6.2;1.1)
≥60	2001-2007	13.2^g (5.3;21.7)	1.5 (-1.2;4.2)
≥60	2007-2018	-4.4^g (-6.5;-2.2)	1.5 (-1.2;4.2)
Ethnicity or race/skin color
White	2001-2009	6.2 (-04;13.2)	0.1 (-3.6;4.0)
White	2009-2018	-5.0 (-10.0;0.4)	0.1 (-3.6;4.0)
Brown	2001-2008	11.9^g (6.7;17.4)	3.4^g (1.1;5.7)
Brown	2008-2018	-2.2 (-4.5;0.2)	3.4^g (1.1;5.7)
Black	2001-2010	4.5 (-3.3;12.9)	-0.1 (-5.5;5.5)
Black	2010-2018	-5.1 (-13.7;4.3)	-0.1 (-5.5;5.5)
Yellow	2001-2015	4.3 (-5.2;14.9)	-2.0 (-14.6;12.4)
Yellow	2015-2017	-36.9 (-84.4;155.5)	-2.0 (-14.6;12.4)
SVI^e
Low	2001-2008	6.9 (-3.4;18.2)	1.5 (-3.2;6.5)
Low	2008-2018	-2.1 (-7.4;3.5)	1.5 (-3.2;6.5)
Medium	2001-2004	-9.1 (-32.1;21.6)	-0.7 (-11.4;11.2)
	2004-2007	26.8 (-34.4;145.0)
	2007-2018	-4.9^g (-8.3;-1.3)
High	2001-2008	7.6^g (1.6;14.0)	1.6 (-1.1;4.4)
High	2008-2018	-2.4 (-5.4;0.6)	1.6 (-1.1;4.4)
Very high	2001-2008	13.2^g (3.7;23.6)	4.2^g (0.2;8.3)
Very high	2008-2018	-1.7 (-5.6;2.3)	4.2^g (0.2;8.3)
Municipality size^f
Small I	2001-2008	10.2^g (6.1;14.5)	2.4^g (0.6;4.2)
Small I	2008-2018	-2.8^g (-4.7;-0.9)	2.4^g (0.6;4.2)
Small II	2001-2004	-14.3 (-33.5;10.5)	-0.3 (-10.4;11.0)
	2004-2007	32.0 (-29.8;148.1)
	2007-2018	-3.7^g (-6.4;-0.9)
Medium	2001-2009	14.1^g (1.8;27.9)	2.9 (-3.6;9.8)
Medium	2009-2018	-6.1 (-14.3;2.8)	2.9 (-3.6;9.8)
Large	2001-2014	1.4 (-1.8;4.7)	-0.5 (-5.1;4.3)
Large	2014-2018	-6.5 (-23.0;13.6)	-0.5 (-5.1;4.3)
Health macro-region
Litoral (Coast)	2001-2010	4.0 (-4.0;12.6)	0.4 (-5.1;6.1)
Litoral (Coast)	2010-2018	-3.6 (-12.2;6.0)	0.4 (-5.1;6.1)
Meio Norte (Mid North)	2001-2003	27.3 (-35.4;150.7)	2.8 (-4.6;10.8)
Meio Norte (Mid North)	2003-2018	-0.0 (-2.4;2.3)	2.8 (-4.6;10.8)
Semiárido (Semiarid)	2001-2007	10.7 (-0.2;22.8)	2.5 (-1.5;6.7)
Semiárido (Semiarid)	2007-2018	-1.7 (-5.4;2.1)	2.5 (-1.5;6.7)
Cerrados (Savanna)	2001-2008	9.8^g (3.4;16.5)	0.7 (-2.1;3.6)
Cerrados (Savanna)	2008-2018	-5.2^g (-8.3;-2.0)	0.7 (-2.1;3.6)

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[TFN4] a) Tenth revision of the International Statistic Classification of Diseases and Related Health Problems (ICD-10);¹³ b) Death Certificate (DC) with record of at least one cause of death (underlying and/or associated) related to neglected tropical diseases.