Guimarães Raphael Mendonça, Oliveira Mariana Passos Ribeiro Pinto Basílio de, Dutra Viviane Gomes Parreira
Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sergio Arouca - Rio de Janeiro (RJ), Brazil.
Universidade Estácio de Sá, Escola de Medicina - Rio de Janeiro (RJ), Brazil.
Rev Bras Epidemiol. 2022 Oct 17;25:e220029. doi: 10.1590/1980-549720220029. eCollection 2022.
To estimate excess mortality by cause of death in Brazil and states in 2020.
We estimated the expected number of deaths considering a linear trend analysis with the number of deaths between 2015 and 2019 for each group of causes and each federative unit. We calculated standardized mortality ratios (SMR) and 95% confidence intervals for each SMR assuming a Poisson distribution. We performed the analyses in the R program, version 4.1.3.
We observed a 19% excess in deaths in 2020 (SMR=1.19; 95%CI=1.18-1.20). The Infectious and Parasitic Diseases group stood out among the defined causes (SMR=4.80; 95%CI 4.78-4.82). The ill-defined causes showed great magnitude in this period (SMR=6.08; 95%CI 6.06-6.10). Some groups had lower-than-expected deaths: respiratory diseases (10% lower than expected) and external causes (4% lower than expected). In addition to the global analysis of the country, we identified significant heterogeneity among the federative units. States with the highest SMR are concentrated in the northern region, and those with the lowest SMR are concentrated in the southern and southeastern regions.
Excess mortality occurs during the COVID-19 pandemic. This excess results not only from COVID-19 itself, but also from the social response and the management of the health system in responding to a myriad of causes that already had a trend pattern before it.
估算2020年巴西全国及各州按死因划分的超额死亡率。
我们通过对2015年至2019年每组死因及每个联邦单位的死亡人数进行线性趋势分析，估算预期死亡人数。我们假定为泊松分布，计算了标准化死亡率（SMR）及每个SMR的95%置信区间。我们在R程序4.1.3版本中进行了分析。
我们观察到2020年死亡人数超额19%（SMR = 1.19；95%CI = 1.18 - 1.20）。在已确定的死因中，传染病和寄生虫病组最为突出（SMR = 4.80；95%CI 4.78 - 4.82）。在此期间，不明原因导致的死亡人数众多（SMR = 6.08；95%CI 6.06 - 6.10）。一些组的死亡人数低于预期：呼吸系统疾病（比预期低10%）和外部原因（比预期低4%）。除了对全国进行整体分析外，我们还发现各联邦单位之间存在显著差异。SMR最高的州集中在北部地区，而SMR最低的州集中在南部和东南部地区。
在新冠疫情期间出现了超额死亡率。这种超额死亡率不仅源于新冠疫情本身，还源于社会应对措施以及卫生系统在应对众多此前已有趋势模式的病因时的管理情况。
