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Background In the last 20 years, Brazil has undergone dramatic changes in terms of socioeconomic development and health care. In the first decade of the 2000s, the Ministry of Health (MoH) developed a series of programs focused on reducing infant mortality, including the Family Health Program as a national policy for primary care. In this paper, we propose a method to correct underreporting of deaths and live births. After vital statistics are corrected, infant mortality trends are analyzed for the period 2000-2010 by macro-geographical region. Methods A proactive search of live births and deaths was carried out in the Amazon and Northeast regions in 2010 to find vital events that occurred in 2008 and were not reported to the Ministry of Health. The probabilistic sample of 133 municipalities was stratified by adequacy of vital information reporting. For each municipality, the adequacy analysis was based on the reported age-standardized mortality rate per 1,000 population and the ratio between reported and estimated live births. Correction factors were estimated by strata based on additional vital events found in the proactive search. The procedure was generalized to correct municipal vital statistics for the period 2000-2010. Results In the proactive search, 35% of non-reported deaths were found within the health system (hospitals and other health establishments), but 28% were found in non-official sources, like illegal cemeteries. In areas of extreme poverty and unreliable vital information, the estimated completeness of infant death reporting was only 33%. After correction of vital information, the estimated infant mortality rate decreased from 26.1 in 2000 to 16.0 in 2010, with an annual rate of decrease of 4.7%, greater than the required rate to achieve the Millennium Development Goal. Among Brazilian regions, the Northeast showed the largest decrease, from 38.4 to 20.1 per 1,000 live births. Conclusions The proactive search for vital events was shown to be a good strategy both in terms of understanding local irregularities and for correcting vital statistics. The methodology could be applied in other countries to routinely assess the pattern and extent of birth and death under-registration in order to improve the utility of these data to inform health policies. [ABSTRACT FROM AUTHOR]

Background: Estimates of completeness of death registration are crucial to produce estimates of life tables and population projections and to estimate the burden of disease. They are an important step in assessing the quality of data. In the case of subnational data analysis in Brazil, it is important to consider spatial and temporal variation in the quality of mortality data. There are two main sources of data quality evaluation in Brazil, but there are few comparative studies and how they evolve over time. The aim of the paper is to compare and discuss alternative estimates of completeness of death registration, adult mortality (45q15) and life expectancy estimates produced by the National Statistics Office (IBGE), Institute for Health Metrics and Evaluation (IHME), and estimates presented in Queiroz et al. (2017) and Schmertmann and Gonzaga (2018), for 1980 and 2010. Methods: We provide a descriptive and comparative analysis of aforementioned estimates from four (4) sources of estimates at subnational level (26 states and one Federal District) in Brazil from two different points in time. Results: We found significant differences in estimates that affect both levels and trends of completeness of adult mortality in Brazil and states. IHME and Queiroz et al. (2017) estimates converge by 2010, but there are large differences when compared to estimates from the National Statistics Office (IBGE). Larger differences are observed for less developed states. We have showed that the quality of mortality data in Brazil has improved steadily overtime, but with large regional variations. However, we have observed that IBGE estimates show the lowest levels of completeness for the Northern of the country compared to other estimates. Choice of methods and approaches might lead to very unexpected results. Conclusion: We produced a detailed comparative analysis of estimates of completeness of death registration from different sources and discuss the main results and possible explanations for these differences. We have also showed that new improved methods are still needed to study adult mortality in less developed countries and at a subnational level. More comparative studies are important in order to improve quality of estimates in Brazil. [ABSTRACT FROM AUTHOR]

Background: Brazil leads the world in number of firearm deaths and ranks sixth by country in rate of firearm deaths per 100,000 people. This study aims to analyze trends in and burden of mortality by firearms, according to age and sex, for Brazil, and the association between these deaths and indicators of possession and carrying of weapons using data from the global burden of diseases, injuries, and risk factors study (GBD) 2017. Methods: We used GBD 2017 estimates of mortality due to physical violence and self-harm from firearms for Brazil to analyze the association between deaths by firearms and explanatory variables. Results: Deaths from firearms increased in Brazil from 25,819 in 1990 to 48,493 in 2017. Firearm mortality rates were higher among men and in the 20–24 age group; the rate was 20 times higher than for women in the same age group. Homicide rates increased during the study period, while mortality rates for suicides and accidental deaths decreased. The group of Brazilian federation units with the highest firearm collection rate (median = 7.5) showed reductions in the rate of total violent deaths by firearms. In contrast, the group with the lowest firearm collection rate (median = 2.0) showed an increase in firearm deaths from 2000 to 2017. An increase in the rate of voluntary return of firearms was associated with a reduction in mortality rates of unintentional firearm deaths (r = −0.364, p < 0.001). An increase in socio-demographic index (SDI) was associated with a reduction in all firearm death rates (r = −0.266, p = 0.008). An increase in the composite index of firearms seized or collected was associated with a reduction in rates of deaths by firearm in the subgroup of females, children, and the elderly (r = −0.269, p = 0.005). Conclusions: There was a change in the trend of firearms deaths after the beginning of the collection of weapons in 2004. Federation units that collected more guns have reduced rates of violent firearm deaths. [ABSTRACT FROM AUTHOR]

Background: Brazil is the world's fifth most populous nation, and is currently experimenting a fast demographic aging process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. Methods: The estimates were derived from data obtained through the collaboration between the Brazilian Ministry of Health and the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60+ years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), from 2000 to 2017. Results: LE at birth significantly increased from 71.3 years (95% UI to 70.9-71.8) to 75.2 years (95% UI 74.7-75.7). There was a trend of increasing HALE, from 62.2 years (95% UI 59.54-64.5) to 65.5 years (95% UI 62.6-68.0). The proportion of DALYs among older adults increased from 7.3 to 10.3%. Chronic noncommunicable diseases are the leading cause of death among middle aged and older adults, while Alzheimer's disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain, and hearing or vision losses are among the leading causes of disability. Conclusions: The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil. [ABSTRACT FROM AUTHOR]

Background: In this study, infant mortality rate (IMR) inequalities are analyzed from 1990 to 2015 in different geographic scales. Methods: The Ministry of Health (MoH) IMR estimates by Federative Units (FU) were compared to those obtained by the Global Burden of Disease (GBD) group. In order to measure the inequalities of the IMR by FU, the ratios from highest to lowest from 1990 to 2015 were calculated. Maps were elaborated in 2000, 2010, and 2015 at the municipality level. To analyze the effect of income, IMR inequalities by GDP per capita were analyzed, comparing Brazil and the FU to other same-income level countries in 2015, and the IMR municipal estimates were analyzed by income deciles, in 2000 and 2010. Results: IMR decreased from 47.1 to 13.4 per 1000 live births (LB) from 1990 to 2015, with an annual decrease rate of 4.9%. The decline was less pronounced for the early neonatal annual rate (3.5%). The Northeast region showed the most significant annual decline (6.2%). The IMR estimates carried out by the GBD were about 20% higher than those obtained by the MoH, but in terms of their inequalities, the ratio from the highest to the lowest IMR among the 27 FU decreased from 4 to 2, for both methods. The percentage of municipalities with IMR higher than 40 per 1000 LB decreased from 23% to 2%, between 2000 and 2015. Comparing the IMR distribution by income deciles, all inequality measures of the IMR decreased markedly from 2000 to 2010. Conclusion: The results showed a marked decrease in the IMR inequalities in Brazil, regardless of the geographic breakdown and the calculation method. Despite clear signs of progress in curbing infant mortality, there are still challenges in reducing its level, such as the concentration of deaths in the early neonatal period, and the specific increases of post neonatal mortality in 2016, after the recent cuts in social investments. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) continues to be an important cause of fatal and non-fatal burden in Brazil. In this study, we present estimates for TB burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017). Methods: This descriptive study used GBD 2017 findings to report years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of TB in Brazil by sex, age group, HIV status, and Brazilian states, from 1990 to 2017. We also present the TB burden attributable to independent risk factors such as smoking, alcohol use, and diabetes. Results are reported in absolute number and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UIs). Results: In 2017, the number of DALYs due to TB (HIV-negative and HIV-positive combined) in Brazil was 284,323 (95% UI: 240,269–349,265). Among HIV-negative individuals, the number of DALYs was 196,366 (95% UI: 189,645–202,394), while 87,957 DALYs (95% UI: 50,624–146,870) were estimated among HIV-positive individuals. Between 1990 and 2017, the absolute number and age-standardized rates of DALYs due to TB at the national level decreased by 47.0% and 68.5%, respectively. In 2017, the sex–age-specific TB burden was highest among males and in children under-1 year and the age groups 45–59 years. The Brazilian states with the highest age-standardized DALY rates in 2017 were Rio de Janeiro, Pernambuco, and Amazonas. Age-standardized DALY rates decreased for all 27 Brazilian states between 1990 and 2017. Alcohol use accounted for 47.5% of national DALYs due to TB among HIV-negative individuals in 2017, smoking for 17.9%, and diabetes for 7.7%. Conclusions: GBD 2017 results show that, despite the remarkable progress in reducing the DALY rates during the period, TB remains as an important and preventable cause of health lost to due premature death and disability in Brazil. The findings reinforce the importance of strengthening TB control strategies in Brazil through integrated and multisectoral actions that enable the access to prevention, early diagnosis, and timely treatment, with emphasis on high-risk groups and populations most vulnerable to the disease in the country. [ABSTRACT FROM AUTHOR]

Background: In Brazil, both the Civil Registry (CR) and Ministry of Health (MoH) Mortality Information System (SIM) are sources of routine mortality data, but neither is 100% complete. Deaths from these two sources can be linked to facilitate estimation of completeness of mortality reporting and measurement of adjusted mortality indicators using generalized linear modeling (GLM). Methods: The 2015 and 2016 CR and SIM data were linked using deterministic methods. GLM with covariates of the deceased's sex, age, state of residence, cause of death and place of death, and municipality-level education decile and population density decile, was used to estimate total deaths and completeness nationally, subnationally and by population sub-group, and to identify the characteristics of unreported deaths. The empirical completeness method and Global Burden of Disease (GBD) 2017 estimates were comparators at the national and state level. Results: Completeness was 98% for SIM and 95% for CR. The vast majority of deaths in Brazil were captured by either system and 94% were reported by both sources. For each source, completeness was lowest in the north. SIM completeness was consistently high across all sub-groups while CR completeness was lowest for deaths at younger ages, outside facilities, and in the lowest deciles of municipality education and population density. There was no clear municipality-level relationship in SIM and CR completeness, suggesting minimal dependence between sources. The empirical completeness method model 1 and GBD completeness estimates were each, on average, less than three percentage points different from GLM estimates at the state level. Life expectancy was lowest in the northeast and 7.5 years higher in females than males. Conclusions: GLM using socio-economic and demographic covariates is a valuable tool to accurately estimate completeness from linked data sources. Close scrutiny of the quality of variables used to link deaths, targeted identification of unreported deaths in poorer, northern states, and closer coordination of the two systems will help Brazil achieve 100% death reporting completeness. The results also confirm the validity of the empirical completeness method. [ABSTRACT FROM AUTHOR]