Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Cadernos de Saúde Pública |
Texto Completo: | https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8286 |
Resumo: | Contrary to international trends, the mortality rate of sickle cell disease increased in Brazil after the implementation of the neonatal screening program, probably due to improving access to diagnosis. This study aimed to assess differences in the temporal trend of the mortality rate and median age at death from sickle cell disease in Brazil, considering implemented measures to expand diagnosis, and improve health care access in-country and in the international scenario. Time series were extracted from the Brazilian Mortality Information System from 1996 to 2019. Changes in the mortality rate and median age at death were verified via segmented regression models, which were stratified by sex, region of residence, and age. Most deaths occurred in non-white people, young adults, and the Southeast and Northeast population. Sickle cell disease mortality rate increased until 2010 (13.31%; 95%CI: 6.37; 20.70), particularly in individuals aged 30 years or more (12.78%; 95%CI: 2.98; 23.53) and in the Northeast (12.27%; 95%CI: 8.92; 15.72). Most deaths occurred in the second decade of life (3.01 deaths/million), with a 59% increase in the median age of death in Brazil, from 27.6 to 30.3 years, more pronounced in females and the North Region. The observed gain in the survival of sickle cell disease in Brazil is still much lower than in developed countries and presents regional disparities, probably due to the lack of access to health care and recent treatments, such as hydroxyurea, still restricted to hematological referral centers in Brazilian capitals. |
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Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019Desigualdades sociales en la tendencia temporal de la mortalidad por enfermedad de células falciformes en Brasil, 1996-2019 Desigualdades sociais na tendência temporal de mortalidade por doença falciforme no Brasil, 1996-2019 Anemia FalciformeMortalidadeAnálise de Séries Temporais InterrompidaAnálise de RegressãoAnemia de Células FalciformesMortalidadAnálisis de Series de Tiempo InterrumpidoAnálisis de RegresiónSickle Cell AnemiaMortalityInterrupted Time Series AnalysisRegression AnalysisContrary to international trends, the mortality rate of sickle cell disease increased in Brazil after the implementation of the neonatal screening program, probably due to improving access to diagnosis. This study aimed to assess differences in the temporal trend of the mortality rate and median age at death from sickle cell disease in Brazil, considering implemented measures to expand diagnosis, and improve health care access in-country and in the international scenario. Time series were extracted from the Brazilian Mortality Information System from 1996 to 2019. Changes in the mortality rate and median age at death were verified via segmented regression models, which were stratified by sex, region of residence, and age. Most deaths occurred in non-white people, young adults, and the Southeast and Northeast population. Sickle cell disease mortality rate increased until 2010 (13.31%; 95%CI: 6.37; 20.70), particularly in individuals aged 30 years or more (12.78%; 95%CI: 2.98; 23.53) and in the Northeast (12.27%; 95%CI: 8.92; 15.72). Most deaths occurred in the second decade of life (3.01 deaths/million), with a 59% increase in the median age of death in Brazil, from 27.6 to 30.3 years, more pronounced in females and the North Region. The observed gain in the survival of sickle cell disease in Brazil is still much lower than in developed countries and presents regional disparities, probably due to the lack of access to health care and recent treatments, such as hydroxyurea, still restricted to hematological referral centers in Brazilian capitals.A diferencia de los estudios internacionales, en Brasil se produjo un aumento de la tasa de mortalidad por enfermedad de células falciformes tras la implantación del programa de tamizaje neonatal, probablemente debido a la mejora del acceso al diagnóstico. El objetivo del estudio es determinar las diferencias en la tendencia temporal de la tasa de mortalidad y la edad media de muerte por enfermedad de células falciformes en Brasil, teniendo en cuenta las medidas implementadas para ampliar el diagnóstico y mejorar el acceso a la atención sanitaria en el país y en el escenario internacional. Las series temporales fueron extraídas del Sistema de Información sobre de Mortalidad de 1996 a 2019. Los cambios en la magnitud de la tasa de mortalidad y la edad media de la muerte se identificaron con modelos de regresión segmentados, estratificados por sexo, región de residencia y edad. La mayoría de las muertes ocurrieron en personas de color, adultos jóvenes y los habitantes del sureste y noreste. Hubo un aumento de la tasa de mortalidad por enfermedad de células falciformes hasta 2010 (13,31%; IC95%: 6,37; 20,70), sobre todo en individuos de 30 años o más (12,78%; IC95%: 2,98; 23,53) y en el Noreste (12,27%; IC95%: 8,92; 15,72). La mayoría de las muertes ocurrió en la segunda década de la vida (3,01 muertes/millón), con un aumento del 59% en la edad media de muerte en Brasil, de 27,6 a 30,3 años, más pronunciado en las mujeres y en el Norte. La ganancia observada en la supervivencia de la enfermedad de células falciformes en Brasil es todavía muy inferior a la de los países desarrollados y con disparidades regionales, probablemente debido a la falta de acceso a la asistencia sanitaria y a los tratamientos recientes, como la hidroxiurea, todavía restringidos a los centros de referencia hematológica de las capitales brasileñas.Ao contrário dos estudos internacionais, houve um aumento da taxa de mortalidade por doença falciforme no Brasil após a implantação do programa de triagem neonatal, provavelmente devido à melhoria do acesso ao diagnóstico. O objetivo deste estudo foi avaliar as diferenças na tendência temporal da taxa de mortalidade por doença falciforme e idade mediana ao morrer no Brasil, considerando as medidas implementadas para ampliar o diagnóstico e melhorar o acesso à saúde no país e no cenário internacional. As séries temporais foram extraídas do Sistema de Informação sobre Mortalidade de 1996 a 2019. Mudanças na magnitude da taxa de mortalidade e na idade mediana ao morrer foram verificadas via modelos de regressão segmentada, estratificados por sexo, região de residência e idade. A maioria dos óbitos ocorreu entre jovens, pretos ou pardos, e habitantes das regiões Sudeste e Nordeste. Houve um aumento da taxa de mortalidade por doença falciforme até 2010 (13,31%; IC95%: 6,37; 20,70), especialmente em indivíduos com 30 anos ou mais (12,78%; IC95%: 2,98; 23,53) e habitantes do Nordeste (12,27%; IC95%: 8,92; 15,72). A maioria dos óbitos ocorreu durante a segunda década de vida (3,01 óbitos/milhão), com um aumento de 59% na idade mediana ao morrer no Brasil (de 27,6 para 30,3 anos), mais acentuada entre mulheres e na Região Norte. O aumento observado na sobrevivência da doença falciforme no Brasil ainda é muito menor do que em países desenvolvidos e com disparidades regionais, provavelmente pela falta de acesso aos serviços de saúde e aos tratamentos recentes, como a hidroxiureia, que ainda é restrita aos centros de referência hematológicos das capitais brasileiras.Reports in Public HealthCadernos de Saúde Pública2023-07-02info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/xmlapplication/pdfhttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8286Reports in Public Health; Vol. 39 No. 1 (2023): JanuaryCadernos de Saúde Pública; v. 39 n. 1 (2023): Janeiro1678-44640102-311Xreponame:Cadernos de Saúde Públicainstname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZenghttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8286/18509https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8286/18510Copyright (c) 2023 Cadernos de Saúde Públicainfo:eu-repo/semantics/openAccessCordovil, KarenTassinari, Wagnerde Vasconcellos Carvalhaes de Oliveira, RaquelHökerberg, Yara2023-07-02T18:57:01Zoai:ojs.teste-cadernos.ensp.fiocruz.br:article/8286Revistahttps://cadernos.ensp.fiocruz.br/ojs/index.php/csphttps://cadernos.ensp.fiocruz.br/ojs/index.php/csp/oaicadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br1678-44640102-311Xopendoar:2024-03-06T13:09:27.599562Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ)true |
dc.title.none.fl_str_mv |
Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 Desigualdades sociales en la tendencia temporal de la mortalidad por enfermedad de células falciformes en Brasil, 1996-2019 Desigualdades sociais na tendência temporal de mortalidade por doença falciforme no Brasil, 1996-2019 |
title |
Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 |
spellingShingle |
Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 Cordovil, Karen Anemia Falciforme Mortalidade Análise de Séries Temporais Interrompida Análise de Regressão Anemia de Células Falciformes Mortalidad Análisis de Series de Tiempo Interrumpido Análisis de Regresión Sickle Cell Anemia Mortality Interrupted Time Series Analysis Regression Analysis |
title_short |
Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 |
title_full |
Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 |
title_fullStr |
Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 |
title_full_unstemmed |
Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 |
title_sort |
Social inequalities in the temporal trend of mortality from sickle cell disease in Brazil, 1996-2019 |
author |
Cordovil, Karen |
author_facet |
Cordovil, Karen Tassinari, Wagner de Vasconcellos Carvalhaes de Oliveira, Raquel Hökerberg, Yara |
author_role |
author |
author2 |
Tassinari, Wagner de Vasconcellos Carvalhaes de Oliveira, Raquel Hökerberg, Yara |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Cordovil, Karen Tassinari, Wagner de Vasconcellos Carvalhaes de Oliveira, Raquel Hökerberg, Yara |
dc.subject.por.fl_str_mv |
Anemia Falciforme Mortalidade Análise de Séries Temporais Interrompida Análise de Regressão Anemia de Células Falciformes Mortalidad Análisis de Series de Tiempo Interrumpido Análisis de Regresión Sickle Cell Anemia Mortality Interrupted Time Series Analysis Regression Analysis |
topic |
Anemia Falciforme Mortalidade Análise de Séries Temporais Interrompida Análise de Regressão Anemia de Células Falciformes Mortalidad Análisis de Series de Tiempo Interrumpido Análisis de Regresión Sickle Cell Anemia Mortality Interrupted Time Series Analysis Regression Analysis |
description |
Contrary to international trends, the mortality rate of sickle cell disease increased in Brazil after the implementation of the neonatal screening program, probably due to improving access to diagnosis. This study aimed to assess differences in the temporal trend of the mortality rate and median age at death from sickle cell disease in Brazil, considering implemented measures to expand diagnosis, and improve health care access in-country and in the international scenario. Time series were extracted from the Brazilian Mortality Information System from 1996 to 2019. Changes in the mortality rate and median age at death were verified via segmented regression models, which were stratified by sex, region of residence, and age. Most deaths occurred in non-white people, young adults, and the Southeast and Northeast population. Sickle cell disease mortality rate increased until 2010 (13.31%; 95%CI: 6.37; 20.70), particularly in individuals aged 30 years or more (12.78%; 95%CI: 2.98; 23.53) and in the Northeast (12.27%; 95%CI: 8.92; 15.72). Most deaths occurred in the second decade of life (3.01 deaths/million), with a 59% increase in the median age of death in Brazil, from 27.6 to 30.3 years, more pronounced in females and the North Region. The observed gain in the survival of sickle cell disease in Brazil is still much lower than in developed countries and presents regional disparities, probably due to the lack of access to health care and recent treatments, such as hydroxyurea, still restricted to hematological referral centers in Brazilian capitals. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-07-02 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8286 |
url |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8286 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8286/18509 https://cadernos.ensp.fiocruz.br/ojs/index.php/csp/article/view/8286/18510 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2023 Cadernos de Saúde Pública info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2023 Cadernos de Saúde Pública |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/xml application/pdf |
dc.publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
publisher.none.fl_str_mv |
Reports in Public Health Cadernos de Saúde Pública |
dc.source.none.fl_str_mv |
Reports in Public Health; Vol. 39 No. 1 (2023): January Cadernos de Saúde Pública; v. 39 n. 1 (2023): Janeiro 1678-4464 0102-311X reponame:Cadernos de Saúde Pública instname:Fundação Oswaldo Cruz (FIOCRUZ) instacron:FIOCRUZ |
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Fundação Oswaldo Cruz (FIOCRUZ) |
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FIOCRUZ |
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FIOCRUZ |
reponame_str |
Cadernos de Saúde Pública |
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Cadernos de Saúde Pública |
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Cadernos de Saúde Pública - Fundação Oswaldo Cruz (FIOCRUZ) |
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cadernos@ensp.fiocruz.br||cadernos@ensp.fiocruz.br |
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1798943398860685312 |