Estimated mortality rate and leading causes of death among individuals with chikungunya in 2016 and 2017 in Brazil

Frutuoso, Livia Carla Vinhal; Freitas, André Ricardo Ribas; Cavalcanti, Luciano Pamplona de Góes; Duarte, Elisabeth Carmen

doi:10.1590/0037-8682-0580-2019

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Major Article • Rev. Soc. Bras. Med. Trop. 53 • 2020 • https://doi.org/10.1590/0037-8682-0580-2019 copy

Estimated mortality rate and leading causes of death among individuals with chikungunya in 2016 and 2017 in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

In 2014, the first cases of autochthonous chikungunya (CHIK) were recorded in Brazil. Lethality associated with this disease is underestimated. Thus, this study aimed to analyze the causes of death among individuals with CHIK in Brazil.

METHODS:

A descriptive observational study was conducted on individuals with CHIK who died within 6 months from symptom onset. Data pairing between the Information System for Notifiable Diseases and the Mortality Information System was performed. Deaths were classified according to case confirmation criterion, mention of CHIK in the death certificates (DCs), and disease phase. The lethality rate per 1,000 cases was corrected for underreporting and was estimated according to region, sex, age, years of education, race/color, and cause groups.

RESULTS:

We identified 3,135 deaths (mention of CHIK in the DCs, 764 [24.4%]). In 17.6% of these cases, CHIK was the underlying cause. Most deaths occurred in the acute (38.1%) and post-acute (29.6%) phases. The corrected LR (5.7; x1,000) was 6.8 times higher than that obtained from the Information System for Notifiable Diseases (0.8). The highest corrected LRs were estimated for among individuals living in the Northeast region (6.2), men (7.4), those with low years of education and those aged <1 year (8.6), 65-79 years (20.7), and ≥80 years (75.4).

CONCLUSIONS:

The LR of CHIK estimates based on information system linkage help to reveal the relevance of this disease as the direct cause or as a cause associated with serious or fatal events, provide timely interventions, and increase the knowledge about this disease.

Keywords:
Chikungunya fever; Mortality; Matched-pair analysis; Death certificate

Underlying cause group	Confirmed case		Probable case		Total
Underlying cause group	n	%	n	%	n	%
Arthropod-borne and viral hemorrhagic fevers (A90-A99)	271	40.4	360	14.6	631	20.1
Chikungunya (A920)	253	27.4	298	10.8	551	17.6
Malignant neoplasms (C00-C97)	27	4.0	220	8.9	247	7.9
Influenza and pneumonia (J09-J18)	38	5.7	177	7.2	215	6.9
Ischemic heart diseases (I20-I25)	27	4.0	164	6.7	191	6.1
Diabetes mellitus (E10-E140)	26	3.9	154	6.3	180	5.7
Cerebrovascular diseases (I60-I69)	30	4.5	143	5.8	173	5.5
Other types of heart disease (I30-I52)	17	2.5	120	4.9	137	4.4
Ill-defined conditions (R00-R99)	18	2.7	115	4.7	133	4.2
Other bacterial diseases (A30-A49)	13	1.9	81	3.3	94	3.0
Other respiratory system diseases (J60-J99)	15	2.2	79	3.2	94	3.0
Diseases of the blood and certain immune disorders (D50-D89)	21	3.1	70	2.8	91	2.9
Chronic diseases of the lower respiratory tract (J40-J47)	9	1.3	47	1.9	56	1.8
Diseases of the liver (K70-K77)	7	1.0	48	1.9	55	1.8
Kidney failure (N17-N19)	8	1.2	47	1.9	55	1.8
Other urinary system diseases (N30-N39)	9	1.3	45	1.8	54	1.7
Hypertensive diseases (I10-I15)	8	1.2	42	1.7	50	1.6
Systemic atrophy affecting the CNS (G10-G59 and G70-G99)	13	1.9	34	1.4	47	1.5
HIV disease (B20-B24)	4	0.6	41	1.7	45	1.4
Viral infection of the central nervous system (A80-A89)	12	1.8	22	0.9	34	1.1
Certain conditions that occurred in the perinatal period (P00-P96)	5	0.7	5	0.2	10	0.3
Other causes	93	13.9	450	18.3	543	17.3
Total	671	21.4	2,464	78.6	3,135	100

Chikungunya mentioned in the DC	Phase	Confirmed case		Probable case		Total
		n	%	n	%	n	%
Chikungunya as an underlying cause	Acute	140	57	72	75	212	62
	Post-acute	88	36	19	20	107	31
	Chronic	17	7	5	5	22	6
	Total	245	100	96	100	341	100
Chikungunya as the associated cause	Acute	17	43	18	49	35	45
	Post-acute	18	45	10	27	28	36
	Chronic	5	13	9	24	14	18
	Total	40	100	37	100	77	100
No mention of chikungunya	Acute	151	41	795	42	946	41
	Post-acute	141	38	653	34	794	35
	Chronic	79	21	466	24	545	24
	Total	371	100	1.914	100	2.285	100
Total		656	24.3	2,047	75.7	2,703	100

Characteristics	No. of	Incidence	No. of deaths	No. of	Lethality rate	Corrected	Lethality	Relative
	cases*	coefficient	in Sinan	corrected deaths	in Sinan	lethality rate	ratio**	risk***
Region
N	39,466	220.0	9	118	0.2	3.0	13.1	1.6
NE	437,327	763.8	414	2,703	0.9	6.2	6.5	3.3
SE	60,774	69.9	37	273	0.6	4.5	7.4	2.4
S	5,876	19.8	0	11	0.0	1.9	...	1.0
MW	8,872	55.9	4	30	0.5	3.4	7.5	1.8
Unknown/blank	36

Sex
Male	208,249	203.2	237	1,541	1.1	7.4	6.5	1.6
Female	343,671	326.7	227	1,594	0.7	4.6	7.0	1.0
Unknown/blank	431

Age range (years)
<1	7,484	274.2	19	64	2.5	8.6	3.4	5.6
1-14	64,475	149.2	22	106	0.3	1.6	4.8	1.1
15-44	281,567	299.6	54	428	0.2	1.5	7.9	1.0
45-64	139,571	379.7	78	673	0.6	4.8	8.6	3.2
65-79	47,490	425.2	137	982	2.9	20.7	7.2	13.6
≥80	11,695	400.9	154	882	13.3	75.4	5.7	49.6
Unknown/blank	69

Years of education
None	36,782	175.3	52	618	1.4	16.8	11.8	3.4
1-3	23,836	71.6	107	803	4.5	33.7	7.5	6.9
4-7	39,229	117.9	73	486	1.9	12.4	6.7	2.5
8-11	83,725	110.8	90	408	1.1	4.9	4.5	1.0
≥12	19,471	58.8	41	155	2.1	8.0	3.8	1.6
Unknown	349,308		60	495

Race/skin color
White	65,131	71.5	192	949	3.0	14.6	4.9	16.0
Black	16,475	113.5	17	183	1.0	11.1	10.8	12.2
Yellow	4,402	211.2	0	4	0.0	0.9	...	1.0
Brown	301,053	365.9	242	1871	0.8	6.2	7.7	6.8
Indigenous	1,923	235.1	1	7	0.5	3.6	7.0	4.0
Unknown	163,367		12	121
Total	552,351	266	464	3,135	0.8	5.7	6.8

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[1] Corresponding author: Livia Carla Vinhal Frutuoso. e-mail:liviavinhal@gmail.com