title: Trends in schistosomiasis-related mortality in Brazil, 2000-2011.
abstract: Schistosomiasis is an important public health problem, with high morbidity and mortality in endemic countries. We analysed the epidemiological characteristics and time trends of schistosomiasis-related mortality in Brazil. We performed a nationwide study based on official mortality data obtained from the Brazilian Mortality Information System. We included all deaths in Brazil between 2000 and 2011, in which schistosomiasis was mentioned on the death certificate as an underlying or associated cause of death (multiple causes of death). We calculated crude and age-adjusted mortality rates (per 100,000 inhabitants), and proportional mortality rates. Trends over time were assessed using joinpoint regression models. Over the 12-year study period, 12,491,280 deaths were recorded in Brazil. Schistosomiasis was mentioned in 8,756 deaths, including in 6,319 (72.2%) as an underlying cause and in 2,437 (27.8%) as an associated cause. The average annual age-adjusted mortality rate was 0.49 deaths/100,000 inhabitants (95% confidence interval: 0.46-0.52) and proportional mortality rate was 0.070% (95% confidence interval: 0.069-0.072). Males (0.53 deaths/100,000 inhabitants), those aged ⩾70years (3.41 deaths/100,000 inhabitants), those of brown race/colour (0.44 deaths/100,000 inhabitants), and residents in the Northeast region of Brazil (1.19 deaths/100,000 inhabitants) had the highest schistosomiasis-related death rates. Age-adjusted mortality rates showed a significant decrease at a national level (Annual Percent Change: -2.8%; 95% confidence interval: -4.2 to -2.4) during the studied period. We observed decreasing mortality rates in the Northeast (Annual Percent Change: -2.5%; 95% confidence interval: -4.2 to -0.8), Southeast (Annual Percent Change: -2.2%; 95% confidence interval: -3.6 to -0.9), and Central-West (Annual Percent Change: -7.9%; 95% confidence interval: -11.3 to -4.3) regions, while the rates remained stable in the North and South regions. Despite the reduced mortality, schistosomiasis is still a neglected cause of death in Brazil, with considerable regional differences. Sustainable control measures should focus on increased coverage, and intensified and tailored control measures, to prevent the occurrence of severe forms of schistosomiasis and associated deaths.
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, CE, Brazil; Federal Institute of Education, Science and Technology of Ceará, Caucaia, CE, Brazil. Electronic address: rogerlandio@bol.com.br.
authors.forename: Francisco Rogerlândio
authors.initials: FR
authors.lastname: Martins-Melo
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, CE, Brazil; Department of Clinical Analysis and Toxicology, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Marta Cristhiany Cunha
authors.initials: MC
authors.lastname: Pinheiro
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, CE, Brazil.
authors.forename: Alberto Novaes
authors.initials: AN
authors.lastname: Ramos
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, CE, Brazil.
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Alencar
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, CE, Brazil; Department of Clinical Analysis and Toxicology, Federal University of Ceará, Fortaleza, CE, Brazil; Department of Pathology and Legal Medicine, Federal University of Ceará, Fortaleza, CE, Brazil.
authors.forename: Fernando Schemelzer de Moraes
authors.initials: FS
authors.lastname: Bezerra
authors.affiliation: Department of Community Health, School of Medicine, Federal University of Ceará, 60430-140 Fortaleza, CE, Brazil; Anton Breinl Centre for Public Health and Tropical Medicine, School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD 4811, Australia. Electronic address: heukelbach@web.de.
authors.forename: Jorg
authors.initials: J
authors.lastname: Heukelbach
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D012044:Regression Analysis; D012550:Schistosoma mansoni / Q000302:isolation & purification*; D012555:Schistosomiasis mansoni / Q000453:epidemiology / Q000401:mortality* / Q000469:parasitology; D012737:Sex Factors; D055815:Young Adult
keywords: Brazil; Epidemiology; Mortality; Schistosomiasis; Time trends