Ferreira Guilherme A T, Cherchiglia Mariângela L, Valk Márcio, Pilecco Flávia B
Programa de Pós Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
Lancet Reg Health Am. 2025 Jul 12;48:101183. doi: 10.1016/j.lana.2025.101183. eCollection 2025 Aug.
Reports on Brazilian Indigenous peoples highlight mortality disparities, yet little is known about death aetiology-particularly among women of reproductive age-or how structural discrimination based on race/skin colour influences mortality rates in this group. This study aimed to assess and compare cause-specific mortality rates between Indigenous and White Brazilian women of reproductive age, identifying health disparities to inform targeted public health interventions.
This ecological study used mortality data from Brazil's Mortality Information System (SIM). Population estimates were based on census projections. We calculated annual age-standardized mortality rates (ASMR) for women of reproductive age (10-49 years) from Indigenous and White groups who died between 2010 and 2019 all over the country. Causes of death were classified by ICD-10. Trends were estimated using Prais-Winsten regression, expressed as annual percentage change.
We analysed 3185 deaths among Indigenous women and 274,393 among White women. ASMR among Indigenous women did not decline for any ICD-10 cause. Unlike White women, Indigenous women exhibited rising ASMR for digestive (+12·36%), circulatory (+8·88%), and respiratory (+4·56%) causes. Both groups experienced rising ASMR due to neoplasms and endocrine, metabolic, and nutritional diseases, with higher increases among Indigenous women. Maternal deaths remained stable in both groups but at different magnitudes. ASMR from external and infectious/parasitic causes remained stable among Indigenous women but declined among White women.
Mortality from predominantly chronic circulatory, digestive and respiratory diseases is increasing without a decline in infectious/parasitic, maternal, or external causes. Further investigation into rising chronic disease deaths could reveal inequities driving early mortality. Identifying gaps in Indigenous health policies may guide more effective interventions tailored to Indigenous people needs.
This study was funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Ministério da Educação, and Pró-Reitoria de Pesquisa, Universidade Federal de Minas Gerais.
关于巴西原住民的报告突出了死亡率差异，但对于死亡病因，尤其是育龄妇女的死亡病因，人们了解甚少，对于基于种族/肤色的结构性歧视如何影响该群体的死亡率也知之甚少。本研究旨在评估和比较巴西育龄原住民妇女和白人妇女的特定病因死亡率，确定健康差异，为有针对性的公共卫生干预提供依据。
这项生态学研究使用了巴西死亡率信息系统（SIM）的死亡率数据。人口估计基于人口普查预测。我们计算了2010年至2019年期间在全国范围内死亡的原住民和白人育龄妇女（10 - 49岁）的年度年龄标准化死亡率（ASMR）。死亡原因按照国际疾病分类第10版（ICD - 10）进行分类。趋势采用普雷斯 - 温斯顿回归进行估计，以年度百分比变化表示。
我们分析了3185例原住民妇女死亡病例和274393例白人妇女死亡病例。对于任何ICD - 10病因，原住民妇女的ASMR均未下降。与白人妇女不同，原住民妇女消化系统（+12.36%）、循环系统（+8.88%）和呼吸系统（+4.56%）病因的ASMR呈上升趋势。两组因肿瘤以及内分泌、代谢和营养疾病导致的ASMR均呈上升趋势，原住民妇女的上升幅度更大。两组的孕产妇死亡率均保持稳定，但幅度不同。原住民妇女因外部因素以及感染/寄生虫病导致的ASMR保持稳定，而白人妇女则有所下降。
主要由慢性循环系统、消化系统和呼吸系统疾病导致的死亡率在上升，而感染/寄生虫病、孕产妇或外部因素导致的死亡率并未下降。对慢性病死亡人数上升的进一步调查可能揭示导致过早死亡的不平等现象。找出原住民健康政策中的差距可能有助于指导更符合原住民需求的有效干预措施。
本研究由巴西高等教育人员协调办公室（CAPES）、教育部以及米纳斯吉拉斯联邦大学研究副校长办公室资助。
