Time trends of avoidable deaths in Brazil, 1996 to 2019
Main Article Content
Abstract
Introduction: The known achievements of the Brazilian Unified Health System (SUS) stand against an adverse context. This makes it necessary to examine the effect of the SUS on the population’s health, using indicators such as deaths by avoidable causes. Objective: To describe the time trends of mortality from avoidable causes in Brazil and compare them to those of non-avidable causes. Methods: Ecological time-series study with official mortality data, during years 1996-2019, in the age group 5-74 years. Time trends in mortality were estimated as the annual percent reduction in mortality rates, and impact of SUS was calculated as the difference in trend between avoidable (immunization-sensitive, infectious and noncommunicable diseases, maternal deaths, external causes) and non-avoidable causes. The analyses consisted of multivariable binomial regression models, by quadrennium. Results: Death rates for each avoidability group remained stable or declined throughout the study period. The probability of a positive impact was greater than 90% for immunization-sensitive diseases throughout the study period; infectious diseases in 1996-2003 and 2016-2019; noncommunicable diseases in 1996-2003 and 2008-2019; maternal deaths in 1996-1999; and external causes in 1996-2007. This probability was less than 10% for maternal deaths in 2016-2019; and external causes in 2008-2015. Conclusion: SUS has had a positive impact in reducing deaths from immunization-sensitive, infectious and noncommunicable diseases in Brazil, although not so much for maternal deaths and external causes.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY) that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.References
Pinto LF, Giovanella L. Do Programa à Estratégia Saúde da Família: expansão do acesso e redução das internações por condições sensíveis à atenção básica (ICSAB). Cienc Saude Coletiva. 2018;23(6):1903-14. https://doi.org/10.1590/1413-81232018236.05592018
Portes LH, Machado CV, Turci SRB, Figueiredo VC, Cavalcante TM, Silva VLC. Tobacco Control Policies in Brazil: a 30-year assessment. Cienc Saude Coletiva. 2018;23(6):1837-48. https://doi.org/10.1590/1413-81232018236.05202018
Santos L. The first 30 years of the SUS: an uncomfortable balance? Cienc Saude Coletiva. 2018;23(6):2043-50. https://doi.org/10.1590/1413-81232018236.06082018
Malta DC, Duarte EC. Causas de mortes evitáveis por ações efetivas dos serviços de saúde: uma revisão da literatura. Cienc Saude Coletiva. 2007;12(3):765-76. https://doi.org/10.1590/S1413-81232007000300027
Gérvas J. Risco cardiovascular, efetividade e mortalidade. Rev Bras Med Fam Comunidade. 2011;6(20):165-70. https://doi.org/10.5712/rbmfc6(20)437
Malta DC, Duarte EC, Almeida MF, Dias MAS, Morais Neto OL, Moura L, et al. Lista de causas de mortes evitáveis por intervenções do Sistema Único de Saúde do Brasil. Epidemiol Serv Saude. 2007;16(4):233-44. http://dx.doi.org/10.5123/S1679-49742007000400002
Malta DC, Sardinha LMV, Moura L, Lansky S, Leal MC, Szwarcwald CL, et al. Atualização da lista de causas de mortes evitáveis por intervenções do Sistema Único de Saúde do Brasil. Epidemiol Serv Saude. 2010;19(2):173-6. http://dx.doi.org/10.5123/S1679-49742010000200010
Malta DC, França E, Abreu DX, Oliveira H, Monteiro RA, Sardinha LMV, et al. Atualização da lista de causas de mortes evitáveis (5 a 74 anos de idade) por intervenções do Sistema Único de Saúde do Brasil. Epidemiol Serv Saude. 2011;20(3):409-12. http://dx.doi.org/10.5123/S1679-49742011000300016
Abreu DMX, César CC, França EB. Relação entre as causas de morte evitáveis por atenção à saúde e a implementação do Sistema Único de Saúde no Brasil. Rev Panam Salud Publica. 2007;21(5):282-91. https://doi.org/10.1590/S0102-311X2010000300006
Malta DC, Duarte EC, Escalante JJC, Almeida MF, Sardinha LMV, Macário EM, et al. Mortes evitáveis em menores de um ano, Brasil, 1997 a 2006: contribuições para a avaliação de desempenho do Sistema Único de Saúde. Cad Saude Publica. 2010;26(3):481-91. https://doi.org/10.1590/S0102-311X2010000300006
Malta DC, Saltarelli RMF, Prado RR, Monteiro RA, Almeida MF. Mortes evitáveis no Sistema Único de Saúde na população brasileira, entre 5 e 69 anos, 2000-2013. Rev Bras Epidemiol. 2018;21:e180008. https://doi.org/10.1590/1980-549720180008
Niti M, Ng T. Temporal trends and ethnic variations in amenable mortality in Singapore 1965-1994: the impact of health care in transition. Int J Epidemiol. 2001;30(5):966-73. https://doi.org/10.1093/ije/30.5.966
Santos IS, Ugá MAD, Porto SM. O mix público-privado no Sistema de Saúde Brasileiro: financiamento, oferta e utilização de serviços de saúde. Cienc Saude Coletiva. 2008;13(5):1431-40. https://doi.org/10.1590/S1413-81232008000500009
Fontenelle LF, Sarti TD, Camargo MBJ, Maciel ELN, Barros AJD. Utilization of the Brazilian public health system by privately insured individuals: a literature review. Cad Saude Publica. 2019;35(4):e00004118. https://doi.org/10.1590/0102-311X00004118
Teixeira RA, Naghavi M, Guimarães MDC, Ishitani LH, França EB. Quality of cause-of-death data in Brazil: Garbage codes among registered deaths in 2000 and 2015. Rev Bras Epidemiol. 2019;22(Suppl 3):E190002. https://doi.org/10.1590/1980-549720190002.supl.3
Domingues CMAS, Maranhão AGK, Teixeira AM, Fantinato FFS, Domingues RAS. 46 anos do Programa Nacional de Imunizações: uma história repleta de conquistas e desafios a serem superados. Cad Saude Publica. 2020;36(suppl 2):e00222919. https://doi.org/10.1590/0102-311X00222919
Teixeira MG, Costa MCN, Paixão ES, Carmo EH, Barreto FR, Penna GO. The achievements of the SUS in tackling the communicable diseases. Cienc Saude Coletiva. 2018;23(6):1819-28. https://doi.org/10.1590/1413-81232018236.08402018
Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among U.S. adults. N Engl J Med. 2015;373(5):415-27. https://doi.org/10.1056/NEJMoa1500245
Wang CC, Prather KA, Sznitman J, Jimenez JL, Lakdawala SS, Tufekci Z, et al. Airborne transmission of respiratory viruses. Science. 2021;373(6558):eabd9149. https://doi.org/10.1126/science.abd9149
Morawska L, Tang JW, Bahnfleth W, Bluyssen PM, Boerstra A, Buonanno G, et al. How can airborne transmission of COVID-19 indoors be minimised? Environ Int. 2020;142:105832. https://doi.org/10.1016/j.envint.2020.105832
Morawska L, Allen J, Bahnfleth W, Bluyssen PM, Boerstra A, Buonanno G, et al. A paradigm shift to combat indoor respiratory infection. Science. 2021;372(6543):689-91. https://doi.org/10.1126/science.abg2025
Malta DC, Silva AG, Teixeira RA, Machado IE, Coelho MRS, Hartz ZMA. Avaliação do alcance das metas do plano de enfrentamento das doenças crónicas não transmissíveis no Brasil, 2011-2022. Anais Inst Hig Med Trop. 2019;(Supl 1):S9-16. https://doi.org/10.25761/anaisihmt.316
Monteiro CA, Cannon G, Moubarac JC, Martins APB, Martins CA, Garzillo J, et al. Dietary guidelines to nourish humanity and the planet in the twenty-first century. A blueprint from Brazil. Public Health Nutr. 2015;18(13):2311-22. https://doi.org/10.1017/S1368980015002165
Malta DC, Silva MMA, Moura L, Morais Neto OL. A implantação do Sistema de Vigilância de Doenças Crônicas Não Transmissíveis no Brasil, 2003 a 2015: alcances e desafios. Rev Bras Epidemiol. 2017;20(4):661-75. https://doi.org/10.1590/1980-5497201700040009
Cabral NL, Franco S, Longo A, Moro C, Buss TA, Collares D, et al. The Brazilian Family Health Program and secondary stroke and myocardial infarction prevention: a 6-year cohort study. Am J Public Health. 2012;102(12):e90-5. https://doi.org/10.2105/AJPH.2012.301024
Malta DC, Duncan BB, Barros MBA, Katikireddi SV, Souza FM, Silva AG, et al. Medidas de austeridade fiscal comprometem metas de controle de doenças não transmissíveis no Brasil. Cienc Saude Coletiva. 2018;23(10):3115-22. https://doi.org/10.1590/1413-812320182310.25222018
Malta DC, Andrade SSCA, Oliveira TP, Moura L, Prado RR, Souza MFM. Probabilidade de morte prematura por doenças crônicas não transmissíveis, Brasil e regiões, projeções para 2025. Rev Bras Epidemiol. 2019;22:E190030. https://doi.org/10.1590/1980-549720190030
Leal MC, Szwarcwald CL, Almeida PVB, Aquino EML, Barreto ML, Barros F, et al. Reproductive, maternal, neonatal and child health in the 30 years since the creation of the Unified Health System (SUS). Cienc Saude Coletiva. 2018;23(6):1915-28. https://doi.org/10.1590/1413-81232018236.03942018
Szwarcwald CL, Escalante JJC, Rabello Neto DL, Souza Junior PRB, Victora CG. Estimação da razão de mortalidade materna no Brasil, 2008-2011. Cad Saude Publica. 2014;30(Suppl 1):S71-83. https://doi.org/10.1590/0102-311X00125313
Leal MC, Pereira APE, Domingues RMSM, Theme Filha MM, Dias MAB, Nakamura-Pereira M, et al. Obstetric interventions during labor and childbirth in Brazilian low-risk women. Cad Saude Publica. 2014;30(Suppl 1):S1-16. https://doi.org/10.1590/0102-311x00151513
Rocha NFF, Ferreira J. A escolha da via de parto e a autonomia das mulheres no Brasil: uma revisão integrativa. Saude Debate. 2020;44(125):556-68. https://doi.org/10.1590/0103-1104202012521
Dias MAB, Domingues RMSM, Schilithz AOC, Nakamura-Pereira M, Diniz CSG, Brum IR, et al. Incidence of maternal near miss in hospital childbirth and postpartum: data from the Birth in Brazil study. Cad Saude Publica. 2014;30(Suppl 1):S1-12. https://doi.org/10.1590/0102-311x00154213
Souza MFM, Malta DC, França EB, Barreto ML. Transição da saúde e da doença no Brasil e nas Unidades Federadas durante os 30 anos do Sistema Único de Saúde. Cienc Saude Coletiva. 2018;23(6):1737-50. https://doi.org/10.1590/1413-81232018236.04822018
Malta DC, Minayo MCS, Cardoso LSM, Veloso GA, Teixeira RA, Pinto IV, et al. Mortalidade de adolescentes e adultos jovens brasileiros entre 1990 e 2019: uma análise do estudo Carga Global de Doença. Cienc Saude Coletiva. 2021;26(9):4069-86. https://doi.org/10.1590/1413-81232021269.12122021
Cerqueira D, Ferreira H, Bueno S, Alves PP, Lima RS, Marques D, et al. Atlas da violência 2021. São Paulo: FBSP, 2021.