Guimarães Raphael Mendonça, Monteiro-da-Silva José Henrique Costa
Fundação Oswaldo Cruz, National School of Public Health - Rio de Janeiro (RJ), Brazil.
University of Pennsylvania, Population Studies Center - Philadelphia (PA), United States of America.
Rev Bras Epidemiol. 2025 Jul 21;28:e250039. doi: 10.1590/1980-549720250039. eCollection 2025.
The aim of this study was to estimate the impact of deaths of despair (DoD) on life expectancy at birth and by sex in Brazil in 2019, as well as the contribution of different age groups to this loss.
We used life tables from the Brazilian Institute of Geography and Statistics and cause-specific mortality data by age and sex from the Mortality Information System. A cause-deleted life table methodology was applied, assuming independence between DoD and other causes of death. The difference in life expectancy with and without DoD was decomposed by age using Arriaga's method. DoD included deaths from suicide, intentional or accidental poisoning, and mental and behavioral disorders due to substance use.
In 2019, there were 23,391 DoD in Brazil (1.73% of all deaths), 89% of which were due to suicide. Removing these deaths would increase life expectancy by 0.43 years for men and 0.12 years for women, with men experiencing a 3.5 times greater impact. The 35-49 age group had the highest relative contribution, especially among men, where DoD accounted for up to 9.7% of the loss in life expectancy. The impact was more concentrated and earlier in men and more diffuse among women.
Although lower in absolute numbers, DoD have a measurable impact on life expectancy, especially among young men. These findings highlight the need for public policies focused on suicide prevention and addressing the social determinants that sustain despair.
本研究旨在评估2019年巴西绝望死亡(DoD)对出生时预期寿命的影响及按性别划分的影响情况,以及不同年龄组对此损失的贡献。
我们使用了巴西地理与统计研究所的生命表以及来自死亡信息系统的按年龄和性别划分的特定病因死亡率数据。应用了一种去除病因的生命表方法,假定DoD与其他死亡原因之间相互独立。采用阿里亚加方法按年龄分解有DoD和无DoD情况下预期寿命的差异。DoD包括自杀、故意或意外中毒以及因物质使用导致的精神和行为障碍所致死亡。
2019年巴西有23391例DoD(占所有死亡人数的1.73%),其中89%是自杀所致。去除这些死亡将使男性预期寿命增加0.43岁,女性增加0.12岁,男性受到的影响是女性的3.5倍。35 - 49岁年龄组的相对贡献最高,尤其是在男性中,DoD占预期寿命损失的比例高达9.7%。这种影响在男性中更集中且出现得更早,在女性中则更分散。
尽管DoD的绝对数量较少,但对预期寿命有可衡量的影响,尤其是在年轻男性中。这些发现凸显了制定侧重于预防自杀和解决导致绝望的社会决定因素的公共政策的必要性。