Burden of schistosomiasis‐related mortality in Brazil: epidemiological patterns and spatial–temporal distribution, 2003–2018

Abstract

abstarct Objective To characterise the epidemiological patterns and the spatial–temporal distribution of schistosomiasis‐related mortality in Brazil from 2003 to 2018. Methods A national population‐based ecological study that used official data from the Mortality Information System. The data included all deaths recorded in Brazil from 2003 to 2018 in which schistosomiasis was mentioned in the death certificate as an underlying or associated cause of death (multiple causes). The municipalities of residence were used as units of geographic analysis, and standardised and smoothed mortality rates (per 100 000 inhabitants) were calculated using the local empirical Bayes method. Spatial autocorrelation was evaluated using global and local Moran indexes. To analyse the spatial dependence, the Getis‐Ord G and Gi* statistics were used. Results During the study period, 18 421 113 deaths were recorded in Brazil. Schistosomiasis was mentioned in 11 487 deaths (proportional mortality: 0.06%); for 8141 deaths (70.87%), it was listed as the underlying cause, and for 3346 deaths (29.13%), it was listed as an associated cause. The mean mortality rate was 0.38 deaths/100 000 inhabitants. Individuals ≥ 70 years of age (RR: 115.34, 95% CI: 68.56–194.03) and residents in the Northeast region (RR: 10.81, 95% CI: 5.95–19.66) presented higher risks related to schistosomiasis. Municipalities with high mortality rates were identified in all regions, and high‐risk clusters were found in municipalities located in the Northeast and Southeast regions of the country. Conclusions Schistosomiasis remains an important cause of death in persistently endemic areas in Brazil, particularly in those with a high prevalence of the disease and a marked parasite load.

High schistosomiasis-related mortality in Northeast Brazil: trends and spatial patterns

“…This may also explain the maintenance of higher mortality rates in older people. In addition to being a chronic condition, the higher mortality risk in the population aged ≥ 70 years may indicate either continuous exposure to infection, low quality of life, or even the coexistence of other infectious or non-infectious diseases 9,11,23 . The coexistence of schistosomiasis with other agespecific physiological conditions caused a tendency towards greater vulnerability in this age group [23][24][25] .…”

“…In December 2020, the nationwide population coverage of the Family Health Strategy was 63.6%, whereas in the northeast region, the coverage was 82.3% 18 . The highest prevalence of schistosomiasis in the country is found in this region, with a high number of severe clinical forms and mortality 2,11 .…”

Persistence of Schistosomiasis-Related Morbidity in Northeast Brazil: An Integrated Spatio-Temporal Analysis

“…The higher concentration of hospital admissions of people from coastal areas may be related to the increased migration of people from rural areas (endemic) to urban areas, which, although there are more opportunities for work and employment, also suffer from serious problems of urban infrastructure and a lack of basic sanitation, which favors the installation of precarious housing without adequate sanitary infrastructure, and the formation of pockets of poverty, increasing the expansion of the disease [ 40 ]. Analyses performed with different tools (positivity rate, gross detection rate, spatial moving average rate “SMA”, and standardized morbidity ratio “SMR”) show that there is homogeneity in the spatial distribution of schistosomiasis, remaining in the same geographical spaces over time, although it presents with a focal characteristic [ 8 , 28 , 40 , 49 ].…”

Spatial distribution of the positivity of Schistosomiasis mansoni in Maranhao State, Northeastern Brazil, from 2007 to 2016

“…The occurrence of schistosomiasis is registered in 18 states and the Federal District, spread over all regions of the country. However, most cases are concentrated in the Northeastern and Southeastern regions, mainly in coastal areas 2,[7][8][9][10][11] .…”