Leônidas and Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil.
Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
PLoS One. 2022 Oct 20;17(10):e0275333. doi: 10.1371/journal.pone.0275333. eCollection 2022.
The COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic.
This study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335.
There were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths.
Excess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic's greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil's health crisis.
COVID-19 大流行已导致超过 600 万人与疾病相关的死亡，且有证据表明孕产妇死亡人数有所增加，尤其是在中低收入国家。本研究旨在评估 COVID-19 大流行的前 15 个月期间巴西及其各地区的孕产妇死亡人数，并评估其死亡人数轨迹。
本研究评估了卫生部死亡信息系统中的孕产妇死亡情况，通过调整过离散度的准泊松广义加性模型来评估 2020 年 3 月至 2021 年 5 月间的超额死亡人数。将观察到的死亡人数与没有大流行时的预期死亡人数进行比较，并根据地区、年龄组和发生的孕早期、孕中期和孕晚期给出 95%置信区间。分析在 R 版本 3.6.1 和 RStudio 版本 1.2.1335 中进行。
在研究期间共报告了 3291 例孕产妇死亡，导致无论地区如何，死亡人数均超额 70%，而在北部、东北部、南部和东南部地区，无论年龄组如何，均出现了超额死亡。在 2021 年 3 月至 5 月期间，各地区和各年龄组均出现了超额死亡。在东南部地区，无论评估的孕早期、孕中期还是孕晚期，25-36 岁年龄组都出现了超额死亡，而在北部、中西部和南部地区，唯一未出现超额死亡的时期是 2020 年 9 月至 11 月。在北部地区，37-49 岁年龄组无论孕早期、孕中期还是孕晚期，均出现了超额死亡，而南部地区在 2021 年 3 月至 5 月期间出现了爆炸式的死亡人数增长，超额死亡人数达 375%。
孕产妇死亡人数出现了地域差异明显且轨迹不一致的情况，且在疫情最严重时期的死亡人数一直居高不下，这不仅反映了先前社会经济不平等和获得孕产妇保健服务有限的影响，更反映了巴西卫生危机管理不善的情况。
