Martins-Melo Francisco Rogerlândio, Lima Mauricélia da Silveira, Ramos Alberto Novaes, Alencar Carlos Henrique, Heukelbach Jorg
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil.
Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Brazil; Anton Breinl Centre for Public Health and Tropical Medicine, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, Australia.
PLoS One. 2014 Apr 3;9(4):e93770. doi: 10.1371/journal.pone.0093770. eCollection 2014.
Visceral leishmaniasis (VL) is a significant public health problem in Brazil and several regions of the world. This study investigated the magnitude, temporal trends and spatial distribution of mortality related to VL in Brazil.
We performed a study based on secondary data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil from 2000 to 2011, in which VL was recorded as cause of death. We present epidemiological characteristics, trend analysis of mortality and case fatality rates by joinpoint regression models, and spatial analysis using municipalities as geographical units of analysis.
In the study period, 12,491,280 deaths were recorded in Brazil. VL was mentioned in 3,322 (0.03%) deaths. Average annual age-adjusted mortality rate was 0.15 deaths per 100,000 inhabitants and case fatality rate 8.1%. Highest mortality rates were observed in males (0.19 deaths/100,000 inhabitants), <1 year-olds (1.03 deaths/100,000 inhabitants) and residents in Northeast region (0.30 deaths/100,000 inhabitants). Highest case fatality rates were observed in males (8.8%), ≥ 70 year-olds (43.8%) and residents in South region (17.7%). Mortality and case fatality rates showed a significant increase in Brazil over the period, with different patterns between regions: increasing mortality rates in the North (Annual Percent Change--APC: 9.4%; 95% confidence interval--CI: 5.3 to 13.6), and Southeast (APC: 8.1%; 95% CI: 2.6 to 13.9); and increasing case fatality rates in the Northeast (APC: 4.0%; 95% CI: 0.8 to 7.4). Spatial analysis identified a major cluster of high mortality encompassing a wide geographic range in North and Northeast Brazil.
Despite ongoing control strategies, mortality related to VL in Brazil is increasing. Mortality and case fatality vary considerably between regions, and surveillance and control measures should be prioritized in high-risk clusters. Early diagnosis and treatment are fundamental strategies for reducing case fatality of VL in Brazil.
内脏利什曼病（VL）是巴西及世界其他几个地区的一个重大公共卫生问题。本研究调查了巴西与VL相关的死亡率的规模、时间趋势和空间分布。
我们基于从巴西死亡信息系统获得的二手数据进行了一项研究。我们纳入了2000年至2011年巴西所有将VL记录为死亡原因的死亡病例。我们呈现了流行病学特征、通过连接点回归模型对死亡率和病死率的趋势分析，以及以市为地理分析单位的空间分析。
在研究期间，巴西记录了12491280例死亡。3322例（0.03%）死亡病例提及了VL。年龄调整后的年平均死亡率为每10万居民0.15例死亡，病死率为8.1%。男性（每10万居民0.19例死亡）、<1岁儿童（每10万居民1.03例死亡）和东北地区居民（每10万居民0.30例死亡）的死亡率最高。男性（8.8%）、≥70岁老年人（43.8%）和南部地区居民（17.7%）的病死率最高。在此期间，巴西的死亡率和病死率显著上升，不同地区呈现不同模式：北部地区死亡率上升（年度百分比变化——APC：9.4%；95%置信区间——CI：5.3至13.6），东南部地区死亡率上升（APC：8.1%；95%CI：2.6至13.9）；东北地区病死率上升（APC：4.0%；95%CI：0.8至7.4）。空间分析确定了一个主要的高死亡率聚集区，覆盖巴西北部和东北部的广泛地理区域。
尽管实施了持续的控制策略，但巴西与VL相关的死亡率仍在上升。不同地区的死亡率和病死率差异很大，应优先在高风险聚集区开展监测和控制措施。早期诊断和治疗是降低巴西VL病死率的基本策略。
