Lopes Lucas Casagrande Passoni
Faculdade de Medicina de Bauru, Universidade de São Paulo, Bauru, SP, 17012-901, Brazil.
Malar J. 2025 Apr 25;24(1):135. doi: 10.1186/s12936-025-05373-y.
Malaria is a parasitic disease caused by protozoa of the genus Plasmodium, transmitted through the bites of Anopheles mosquitoes. Despite significant progress in malaria control, the disease remains a persistent public health challenge, particularly in specific Brazilian regions where environmental and socioeconomic factors contribute to its transmission. Understanding mortality trends across different age groups, periods, births cohorts, and regions is essential for developing targeted intervention strategies and optimizing resource allocation. This study aimed to analyse malaria mortality trends in Brazil, focusing on regional differences using an age-period cohort (APC) model.
This ecological study analysed malaria mortality data in Brazil from 1980 to 2024, sourced from DATASUS. Population estimates by sex were retrieved from the Instituto Brasileiro de Geografia e Estatística. Mortality data, including age, year of death, Brazillian macrorregions and admnistratvive Brazilian Amazon legal, as well as the cause of death (ICD-9: 084; ICD-10: B50-B53), were analysed using an APC model. A Poisson distribution was assumed for mortality counts, and analyses were conducted using Holford's method and its adaptations.
In the North region, malaria mortality showed an age-related increase, with the highest rates observed in individuals over 80 years old. A significant decline in mortality was observed over the study periods, particularly from 1980 to 1985 to 2020-2024. In the Midwest, the period effect showed fluctuations with an overall decline in recent decades. In the Northeast and Legal Amazon regions, age, period, and cohort effects highlighted clear trends of decreasing mortality over time, particularly for younger cohorts.
Malaria mortality is influenced by age, period, cohort, and regions. The regional disparities emphasize the need for localized strategies, considering demographic shifts and epidemiological patterns. By integrating these findings into public health planning, policymakers can enhance malaria surveillance, improve healthcare access in vulnerable regions, and refine control measures to further reduce mortality. The study underscores the necessity of continuous investment in malaria prevention, particularly for older adults in endemic areas, to sustain progress and mitigate resurgence risks.
疟疾是一种由疟原虫属原生动物引起的寄生虫病，通过按蚊叮咬传播。尽管在疟疾控制方面取得了重大进展，但该疾病仍然是一个持续存在的公共卫生挑战，特别是在巴西的特定地区，环境和社会经济因素助长了其传播。了解不同年龄组、时期、出生队列和地区的死亡率趋势对于制定有针对性的干预策略和优化资源分配至关重要。本研究旨在分析巴西的疟疾死亡率趋势，使用年龄-时期队列（APC）模型关注地区差异。
这项生态学研究分析了1980年至2024年巴西的疟疾死亡率数据，数据来源于DATASUS。按性别划分的人口估计数来自巴西地理与统计研究所。使用APC模型分析死亡率数据，包括年龄、死亡年份、巴西大区域和巴西合法亚马逊行政区，以及死因（国际疾病分类第九版：084；国际疾病分类第十版：B50-B53）。死亡率计数假定服从泊松分布，并使用霍尔福德方法及其改进方法进行分析。
在北部地区，疟疾死亡率呈现与年龄相关的上升趋势，80岁以上人群的死亡率最高。在研究期间观察到死亡率显著下降，特别是从1980年至1985年到2020年至2024年。在中西部地区，时期效应呈现波动，近几十年来总体呈下降趋势。在东北部和合法亚马逊地区，年龄、时期和队列效应突出显示随着时间推移死亡率明显下降的趋势，特别是对于较年轻的队列。
疟疾死亡率受年龄、时期、队列和地区的影响。地区差异强调了需要因地制宜的策略，考虑人口结构变化和流行病学模式。通过将这些发现纳入公共卫生规划，政策制定者可以加强疟疾监测，改善脆弱地区的医疗服务可及性，并完善控制措施以进一步降低死亡率。该研究强调了持续投资疟疾预防的必要性，特别是针对流行地区的老年人，以维持进展并降低疫情复发风险。
