[Paracoccidioidomycosis-related mortality trend, state of São Paulo, Brazil: a study using multiple causes of death].
OBJECTIVE
To investigate mortality in which paracoccidioidomycosis appears on any line or part of the death certificate.


METHODS
Mortality data for 1985-2005 were obtained from the multiple cause-of-death database maintained by the São Paulo State Data Analysis System (SEADE). Standardized mortality coefficients were calculated for paracoccidioidomycosis as the underlying cause-of-death and as an associated cause-of-death, as well as for the total number of times paracoccidioidomycosis was mentioned on the death certificates.


RESULTS
During this 21-year period, there were 1 950 deaths related to paracoccidioidomycosis; the disease was the underlying cause-of-death in 1 164 cases (59.69%) and an associated cause-of-death in 786 (40.31%). Between 1985 and 2005 records show a 59.8% decline in the mortality coefficient due to paracoccidioidomycosis as the underlying cause and a 53.0% decline in the mortality as associated cause. The largest number of deaths occurred among men, in the older age groups, and among rural workers, with an upward trend in winter months. The main causes associated with paracoccidioidomycosis as the underlying cause-of-death were pulmonary fibrosis, chronic lower respiratory tract diseases, and pneumonias. Malignant neoplasms and AIDS were the main underlying causes when paracoccidioidomycosis was an associated cause-of-death. The decision tables had to be adapted for the automated processing of causes of death in death certificates where paracoccidioidomycosis was mentioned.


CONCLUSIONS
Using the multiple cause-of-death method together with the traditional underlying cause-of-death approach provides a new angle on research aimed at broadening our understanding of the natural history of paracoccidioidomycosis.
Universidade de São Paulo, Faculdade de Saúde Pública, Departamento de Epidemiologia, São Paulo, Brasil. auhsanto@usp.br
Augusto Hasiak
AH
Santo
D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002391:Catchment Area, Health; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010229:Paracoccidioidomycosis / Q000401:mortality*; D015995:Prevalence