Martins-Melo Francisco Rogerlândio, Pinheiro Marta Cristhiany Cunha, Ramos Alberto Novaes, Alencar Carlos Henrique, Bezerra Fernando Schemelzer de Moraes, Heukelbach Jorg
Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, CE, Brazil; Federal Institute of Education, Science and Technology of Ceará, Caucaia, CE, Brazil.
Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, CE, Brazil; Department of Clinical Analysis and Toxicology, Federal University of Ceará, Fortaleza, CE, Brazil.
Int J Parasitol. 2014 Dec;44(14):1055-62. doi: 10.1016/j.ijpara.2014.07.009. Epub 2014 Aug 23.
Schistosomiasis is an important public health problem, with high morbidity and mortality in endemic countries. We analysed the epidemiological characteristics and time trends of schistosomiasis-related mortality in Brazil. We performed a nationwide study based on official mortality data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil between 2000 and 2011, in which schistosomiasis was mentioned on the death certificate as an underlying or associated cause of death (multiple causes of death). We calculated crude and age-adjusted mortality rates (per 100,000 inhabitants), and proportional mortality rates. Trends over time were assessed using joinpoint regression models. Over the 12-year study period, 12,491,280 deaths were recorded in Brazil. Schistosomiasis was mentioned in 8,756 deaths, including in 6,319 (72.2%) as an underlying cause and in 2,437 (27.8%) as an associated cause. The average annual age-adjusted mortality rate was 0.49 deaths/100,000 inhabitants (95% confidence interval: 0.46-0.52) and proportional mortality rate was 0.070% (95% confidence interval: 0.069-0.072). Males (0.53 deaths/100,000 inhabitants), those aged ⩾70years (3.41 deaths/100,000 inhabitants), those of brown race/colour (0.44 deaths/100,000 inhabitants), and residents in the Northeast region of Brazil (1.19 deaths/100,000 inhabitants) had the highest schistosomiasis-related death rates. Age-adjusted mortality rates showed a significant decrease at a national level (Annual Percent Change: -2.8%; 95% confidence interval: -4.2 to -2.4) during the studied period. We observed decreasing mortality rates in the Northeast (Annual Percent Change: -2.5%; 95% confidence interval: -4.2 to -0.8), Southeast (Annual Percent Change: -2.2%; 95% confidence interval: -3.6 to -0.9), and Central-West (Annual Percent Change: -7.9%; 95% confidence interval: -11.3 to -4.3) regions, while the rates remained stable in the North and South regions. Despite the reduced mortality, schistosomiasis is still a neglected cause of death in Brazil, with considerable regional differences. Sustainable control measures should focus on increased coverage, and intensified and tailored control measures, to prevent the occurrence of severe forms of schistosomiasis and associated deaths.
血吸虫病是一个重要的公共卫生问题，在流行国家具有高发病率和死亡率。我们分析了巴西血吸虫病相关死亡率的流行病学特征和时间趋势。我们基于从巴西死亡信息系统获得的官方死亡率数据进行了一项全国性研究。我们纳入了2000年至2011年间巴西所有死亡病例，其中死亡证明上提及血吸虫病作为根本或相关死因（多种死因）。我们计算了粗死亡率和年龄调整死亡率（每10万居民）以及比例死亡率。使用连接点回归模型评估随时间的趋势。在12年的研究期间，巴西记录了12491280例死亡。血吸虫病在8756例死亡中被提及，其中6319例（72.2%）作为根本死因，2437例（27.8%）作为相关死因。年龄调整后的平均年死亡率为0.49例/10万居民（95%置信区间：0.46 - 0.52），比例死亡率为0.070%（95%置信区间：0.069 - 0.072）。男性（0.53例/10万居民）、年龄≥70岁者（3.41例/10万居民）、棕色种族/肤色者（0.44例/10万居民）以及巴西东北部地区居民（1.19例/10万居民）的血吸虫病相关死亡率最高。在研究期间，全国年龄调整死亡率显示出显著下降（年度变化百分比：-2.8%；95%置信区间：-4.2至-2.4）。我们观察到东北部（年度变化百分比：-2.5%；95%置信区间：-4.2至-0.8）、东南部（年度变化百分比：-2.2%；95%置信区间：-3.6至-0.9）和中西部（年度变化百分比：-7.9%；95%置信区间：-11.3至-4.3）地区的死亡率在下降，而北部和南部地区的死亡率保持稳定。尽管死亡率有所降低，但血吸虫病在巴西仍是一个被忽视的死因，存在相当大的地区差异。可持续控制措施应侧重于扩大覆盖范围，加强并量身定制控制措施，以预防严重血吸虫病形式及相关死亡的发生。
