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Objectives: The aim of this study was to analyse the burden of disease due to noncommunicable diseases (NCDs) between 1990 and 2021 in Brazil. In addition, this study compared mortality from NCDs with mortality from all causes and COVID-19, analysed NCD mortality trends and projections for 2030, and analysed NCD mortality rates and risk factors attributed to these deaths among the 27 states of Brazil., Study Design: Ecological studies., Methods: This study used the Global Burden of Disease study (GBD) database from 1990 to 2021. Premature deaths from four NCDs (neoplasms, cardiovascular disease, chronic respiratory diseases and diabetes mellitus) were analysed. The following metrics were used to analyse the burden of NCDs in Brazil: absolute number of deaths, proportional mortality, mortality rate, years of life lost due to premature death (YLL), years lived with disabilities (YLD) and disability-adjusted years of life lost due to premature death (DALY). For comparison between the years studied and states, age-standardised rates were used., Results: Finding from this study showed that there was increase in the proportion of premature deaths due to NCDs between 1990 and 2019 (29.4 % in 1990, 30.8 % in 2019), and a reduction in 2021 (24.7 %). The mortality rates, DALY and YLL from NCDs declined between 1990 and 2019 (-37.7 %, -34.5 % and -38.3 %, respectively); however, a stability in mortality rates, DALY, YLD, YLL was observed between 2019 and 2021 (-0.1 %, 0.7 %, -0.1 % and 0.8 %, respectively). Between 1990 and 2021, there was a decline in mortality rates, DALY and YLL for most states and an increase in YLD rates. However, results suggest that the Sustainable Development Goal (SDG) for the reduction in mortality from NCDs by one-third by 2030 will not be achieved. The main risk factors associated with premature death from NCDs in 2021 were high blood pressure, tobacco use, dietary risks, high body mass index (BMI) and high blood glucose levels. The correlation between sociodemographic index and percentage change in mortality rates was significant for the following total NCDs, cardiovascular disease, chronic respiratory disease, diabetes and neoplasms., Conclusions: The current study highlights the importance of deaths from NCDs in Brazil and the worsening of mortality rates since 2016, as a result of austerity measures and the COVID-19 pandemic, which compromises the achievement of the SDG reduced mortality targets for NCDs. There was a reduction in risk factors for NCDs, mainly behavioural, although metabolic risk factors are of great concern and require new strategies to promote health, prevention and comprehensive care., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: To analyze the occurrence of leprosy in Brazil and its states between 1990 and 2019, according to Global Burden of Disease (GBD) estimates, and its correlation with development status., Study Design: A descriptive and analytical ecological epidemiological study., Methods: Rates of incidence, prevalence, and years lived with disability (YLD) due to leprosy, standardized by age, per 100,000 inhabitants, were analyzed. The trend analysis consisted of the joinpoint regression model and the average annual percentage change. The correlation between the incidence rate and the sociodemographic index (SDI) was investigated (Spearman test) at a 5% significance level. Incidence, prevalence and YLD rates were presented by country's states, sex, and age., Results: There was an average percentage decrease of -1.1% per year (P < 0.001) in the incidence rate in the country and, between 1990 and 2019, a decline from 4.8 to 3.5 per 100,000 inhabitants; prevalence from 26.1 to 22.2, and YLD from 1.1 to 1.0. The incidence rate was higher among men and the elderly. Maranhão (7.0 in 1990; 4.2 in 2019), Alagoas (6.6 in 1990; 4.1 in 2019), Acre (6.1 in 1990; 4.0 in 2019), Mato Grosso (5.2 in 1990 and 3.7 in 2019), and Mato Grosso do Sul (4.8 in 1990 and 3.7 in 2019) presented the highest incidence rates. A negative correlation was observed between SDI levels and leprosy incidence rates in 1990 (R = -0.71; P < 0.0001) and 2019 (R = -0.81; P < 0.0001)., Conclusions: Despite the decrease in the rates of leprosy incidence, prevalence, and YLDs over the analyzed period, Brazil has a long way towards achieving its eradication. The greater burden of the disease in males stands out. The estimated risk of the disease was higher in the states with the lowest SDI levels. Therefore, interventions must consider the heterogeneity of the disease burden geographically and between sociodemographic groups., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: In the American regions, Brazil accounts for 97% of visceral leishmaniasis (VL) cases, with a case fatality rate of approximately 10%. This study aimed to investigate the VL mortality distribution in Brazil and identify high-priority and high-risk areas for intervention strategies., Study Design: This was an ecological study that analysed the spatial-temporal patterns of VL mortality in Brazilian municipalities., Methods: Age-standardised VL mortality rates from the Global Burden of Disease study from 2001 to 2018 were used. The distribution of mortality in the municipalities was assessed, and subsequently the Local Index of Spatial Autocorrelation (LISA) analysis was conducted to identify contiguous areas with high mortality rates. Scan analysis identified clusters of high spatial-temporal risks., Results: The highest mortality rates and clusters were in municipalities located in the Northeast region and in the states of Tocantins and Roraima (North region), Mato Grosso do Sul (Central-West region), and Minas Gerais (Southeast region). According to LISA, there was an increase in the number of municipalities classified as high priority from the first 3-year period (n = 434) to the last 3-year period (n = 644). The spatio-temporal analysis identified 21 high-risk clusters for VL mortality., Conclusion: Areas with a high risk of VL mortality should prioritise preventing transmission, invest in early diagnosis and treatment, and promote the training of healthcare professionals., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objective: This article aims to analyse the evolution of 40 Sustainable Development Goals' (SDGs) health-related indicators in Brazil and Ecuador from 1990 to 2019., Study Design: Epidemiological study of long-term trends in 40 SDGs' health-related indicators for Brazil and Ecuador from 1990 to 2019, using estimates from the Global Burden of Disease Study., Methods: Forty SDGs' health-related indicators and an index from 1990 to 2017 for Brazil and Ecuador, and their projections up to 2030 were extracted from the Institute for Health Metrics and Evaluation's Global Burden of Disease website and analysed. The percent annual change (PC) between 1990 and 2019 was calculated for both countries., Results: Both countries have made progress on child stunting (Brazil: PC = -38%; Ecuador: PC = -43%) and child wasting prevalences (Brazil: PC = -42%; Ecuador: PC = -41%), percent of vaccine coverage (Brazil: PC = +215%; Ecuador: PC = +175%), under-5 (Brazil: PC = -75%; Ecuador: PC = -60%) and neonatal mortality rates (Brazil: PC = -69%; Ecuador: PC = -51%), health worker density per 1000 population (Brazil: PC = +153%; Ecuador: PC = +175%), reduction of neglected diseases prevalences (Brazil: PC = -40%; Ecuador: PC = -58%), tuberculosis (Brazil: PC = -27%; Ecuador: PC = -55%) and malaria incidences (Brazil: PC = -97%; Ecuador: PC = -100%), water, sanitation and hygiene mortality rates (Brazil and Ecuador: PC = -89%). However, both countries did not show sufficient improvement in maternal mortality ratio to meet SDGs targets (Brazil: PC = -37%; Ecuador: PC = -40%). Worsening of indicators were found for violence, such as non-intimate partner violence for both countries (Brazil: PC = +26%; Ecuador: PC = +18%) and suicide mortality rate for Ecuador (PC = +66%), child overweight indicator for Brazil (PC = -67%), disaster mortality rates (Brazil: PC = +100%; Ecuador: PC = +325%) and alcohol consumption (Brazil: PC = +46%; Ecuador: PC = +35%)., Conclusions: Significant improvements are necessary in both countries requiring the strengthening of health and other policies, particularly concerning the prevention and management of violence and alcohol consumption, and preparedness for dealing with environmental disasters., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objectives: The objective of this study was to analyse the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019., Study Design: This is an epidemiological time-series study., Methods: This study analysed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardised mortality rate, and disability-adjusted life years (DALYs). This study also analysed the correlation between the percentage variation of mortality rates and SDI., Results: A decrease in the number of deaths (-75 %), mortality rate (-75.1 %), and DALYS (-72 %) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6 %); however, the mortality rate (-9.7) and DALYs (-6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI., Conclusion: Our study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objectives: The aim of this study was to analyse the trends of avoidable mortality in Brazil from 1990 to 2019 and its correlation with sociodemographic indexes (SDIs)., Study Design: Epidemiological mortality trends., Methods: This study analysed data from the Global Burden of Disease database. The list of causes of avoidable death, as proposed by Nolte and McKee, was applied and included 32 causes. The current study used age-standardised mortality rates and the rates of change, in addition to a correlation analysis between avoidable death and the SDI., Results: Mortality rates decreased from 343.90/100,000 inhabitants in 1990 to 155.80/100,000 inhabitants in 2019. Infectious diseases showed the largest decline in mortality rates, but notable decreases were also found for diarrhoeal diseases (-94.9%), maternal conditions (-66.5%) and neonatal conditions (-60.5%). Mortality rates for non-communicable diseases (NCDs) also decreased (-48%) but maintained a similar absolute number of deaths in 2019 compared with 1990. Decreased mortality rates were also found for ischaemic heart disease (-49.1%), stroke (-61.4%) and deaths due to adverse effects caused by medical treatments (-26.2%). Avoidable mortality rates declined in all of the 27 Brazilian states, and a high correlation was found between deaths and SDI (R = -0.74; P < 0.000001)., Conclusions: A reduction in avoidable deaths was found throughout Brazil over the study period, although major regional inequalities were revealed. Richer states presented the best overall reduction in mortality rates. The biggest decreases in mortality were seen in maternal and paediatric infectious diseases in the poorest states due to the expansion of the Primary Health System and improvements in sanitation. Today, NCDs predominate and efforts should be made to formulate public policies for the prevention and control of NCDs., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objectives: The aims of this article were to analyse the burden of NCDs and their RFs in the Mercosur countries between 1990 and 2019 and to project mortality trends for 2030., Study Design: Epidemiological study of time series., Methods: The present study used data from the Global Burden of Disease study. The absolute number of deaths, mortality rates, disability-adjusted life years, years of life lost, years lived with disability and the burden of premature mortality by NCD attributable to the RFs were evaluated. Projections were made up to 2030. Age-standardised rates were used to draw comparisons by years and by countries. The analysis was conducted using the RStudio software., Results: Between 1990 and 2019, a decrease was found in the premature mortality rates caused by NCDs in all the countries, except for Paraguay, which remained stable. When analysing premature mortality rates due to NCDs up to 2030, it was predicted that none of the countries would achieve the sustainable development goal of a one-third reduction in premature mortality by NCDs. Regarding the impacts of the RFs for NCDs, smoking, dietary risks, high blood pressure (BP) and high body mass index (BMI) were the main risks attributable to premature deaths due to NCDs., Conclusions: The results showed that mortality rates are declining in Mercosur countries; however, none of the countries are predicted to achieve the sustainable development goal of a one-third reduction in mortality due to NCDs by 2030. In addition to access to adequate treatment, progress is required in public regulation actions to reduce RFs, such as smoking, dietary risks, high BP and high BMI., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objectives: This study aimed to investigate patterns of mortality by road transport injury (RTI) in Brazilian municipalities, focused on deaths of motorcyclists, between 2000 and 2018, and their relation with population size and economic status., Study Design: This was an ecological epidemiological study with a descriptive and analytical nature., Methods: The age-standardized RTI mortality rates were calculated for the Brazilian municipalities, referring to the 3-year periods of 2000/2002 (T1), 2009/2011 (T2), and 2016/2018 (T3). The rates were stratified according to macroregion and population size and were compared in terms of percentage variation from one 3-year period to another. The Moran Global and Local indices were used in the spatial point-pattern analysis of the rates. To verify the association with the gross domestic product (GDP) per capita, the Spearman correlation coefficient was applied., Results: A decline in RTI mortality rates was found between 2000 and 2018, with the most significant declines observed in municipalities from the South and Southeast regions of Brazil. However, increases were observed among motorcyclists. Clusters of municipalities were detected, which presented high mortality rates among the motorcyclists in the Northeast region and in some states of the North and Midwest regions. The mortality rates showed a negative correlation with the GDP per capita of the Brazilian municipalities., Conclusions: Although there were decreases in RTI mortality rates between 1990 and 2018, there was a significant increase in deaths among motorcyclists, especially in the Northeast, North, and Midwest regions of the country. Such differences can be explained by unequal growth in the size of the motorcycle fleet in those regions, by less law enforcement capability, and by the implementation of educational actions., (Copyright © 2023 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The present study analyzed trends in premature mortality from Noncommunicable diseases (NCDs) between 1990 and 2019, the projections up to 2030, and the risk factors (RFs) attributable to these diseases in the Community of Portuguese Language Countries (CPLP). Estimates from the Global Burden of Disease (GBD) study and the analysis of the burden of premature mortality due to NCDs were used for nine CPLP countries, applying age-standardized rates, using RStudio. Portugal, Brazil, Equatorial Guinea, Angola, and Guinea Bissau showed declining premature mortality rates caused by NCDs, while East Timor, Cape Verde, São Tomé and Príncipe, and Mozambique showed an increase in rates. Projections indicate that none of the countries is expected to achieve the goals of reducing premature mortality due to NCDs by one third by 2030. The attributable burden of disease showed that the most important RFs in 2019 were: high systolic blood pressure (SBP), tobacco, dietary risks, high body mass index (BMI), and air pollution. It can therefore be concluded that there are profound differences in the burden of NCDs among the countries, with better results in Portugal and Brazil, and that no CPLP country is likely to reach the NCD reduction target by 2030.

Objective: To describe the patterns of overall mortality and mortality from external causes and the temporal evolution in the municipalities of the Paraopeba River Basin, before the socio-environmental disaster of the Brumadinho dam and, additionally, to investigate the correlation between mortality and socioeconomic deprivation in these municipalities., Methods: Global Burden of Disease Study mortality estimates for 26 municipalities in the state of Minas Gerais, Brazil, were analyzed. Rates of overall mortality and mortality from external causes were estimated in the triennia (T) T1 (2000 to 2002), T2 (2009 to 2011), and T3 (2016 to 2018). Pearson's correlation coefficient measured the association between mortality rates and socioeconomic deprivation, according to the Brazilian Deprivation Index (IBP)., Results: There was a decrease in overall mortality in the Paraopeba River Basin from 717.7/100 thousand to 572.6/100 thousand inhabitants, and in most municipalities between T1-T3. Mortality from external causes increased from 73.3/100 thousand to 82.1/100 thousand, and it was higher in these municipalities compared with the mean for Brazil and Minas Gerais. Deaths from suicide and interpersonal violence increased from 29.6/100 thousand to 43.2/100 thousand in most of the 26 municipalities. Death rates due to unintentional injuries decreased during the period, and those due to transport injuries, increased. There was a positive correlation between socioeconomic deprivation and the percent change in mortality rates., Conclusion: Despite the strong presence of mining activity in the region, such did not reflect in the improvement of the sanitary situation. Death rates due to external causes increased in the period, associated with inequalities, which must be considered in the planning for the recovery of the disaster areas.

Background: The impact of risk factors (RF) on morbidity and mortality from cardiovascular disease (CVD) for most Portuguese-speaking countries (PSC) is little known., Objectives: We aimed to analyze the morbidity and mortality from CVD attributable to RF and its variation, from 1990 to 2019, in PSC, based on estimates from the Global Burden of Disease (GBD) 2019 study., Methods: We evaluated changes in cardiovascular RF, mortality rates and age-standardized disability-adjusted life years (DALYs) between 1990 and 2019. The correlation between percentage changes in mortality rates and the sociodemographic index (SDI) of each PSC was evaluated by the Spearman method. A p-value <0.05 was considered statistically significant., Results: Elevated systolic blood pressure (SBP) was the main RF for mortality and DALYs for CVD for all PSC. Mortality from CVD showed a downward trend in 2019, more accentuated in Portugal (-66.6%, 95%CI -71.0 - -61.2) and in Brazil (-49.8%, 95%CI -52.5 - -47.1). There was a trend towards an inverse correlation between SDI and the percent change in mortality, which was significant for dietary risks (r=-0.70, p=0.036), high LDL cholesterol (r=-0.77, p=0.015) and high SBP (r=-0.74, p=0.023)., Conclusions: In addition to SBP, dietary and metabolic RF justified a greater variation in the burden of CVD correlated with SDI in the PSC, suggesting the need to adopt health policies adapted to the reality of each country, aiming to reduce their impact on population.

Introduction: Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states., Methods: This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI)., Results: During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states' rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50)., Conclusions: The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.

Introduction: Brazil ranks 5th in the number of deaths due to road injuries. This study aimed to analyze mortality and disabilities resulting from road injuries in Brazil, and to assess the Sustainable Development Goals (SDG) target of reducing deaths due to road injuries by 50% by 2030., Methods: This descriptive and exploratory study used the estimates from the Global Burden of Disease 2019: indicators of mortality, premature deaths, and disabilities according to sex, age group, and type of transport for 1990, 2015, and 2019. Time trends in mortality rates from 1990 to 2019 were assessed, and a projection for 2030 was calculated, applying a linear regression model., Results: Deaths due to road injuries were 44,236 in 1990, and 44,529 in 2019, representing a 43% reduction in mortality rates. The highest rates were in the North, Northeast, and Midwest regions of Brazil, in males and young adults. A 77% reduction was observed in mortality rates for pedestrians and an increase of 53% for motorcyclists and of 54% for cyclists during the period. In terms of motorcycle road injuries, the mortality rate for men increased from 7.3/100,000 (1990) to 11.7/100,000 inhabitants (2019). The rates of premature deaths and disabilities were also higher for men when compared to women. Amputations, fractures, spinal cord injuries, and head trauma were the main types of road injuries. The projections for 2030 show that Brazil might not reach the SDG target., Conclusions: Despite the decline in mortality rates, the 2030 Agenda's target might not be achieved.

Introduction: To better understand trends in the main cause of death in Brazil, we sought to analyze the burden of cardiovascular risk factors (RF) and cardiovascular diseases (CVD) attributable to specific RFs in Brazil from 1990 to 2019, using the estimates from the GBD 2019 study., Methods: To estimate RF exposure, the Summary Exposure Value (SEV) was used, whereas for disease burden attributed to RF, mortality and disability-adjusted life-years (DALY) due to CVD were used. For comparisons over time and between states, we compared age-standardized rates. The sociodemographic index (SDI) was used as a marker of socioeconomic conditions., Results: In 2019, 83% of CVD mortality in Brazil was attributable to RF. For SEV, there was a reduction in smoking and environmental RF, but an increase in metabolic RF. High systolic blood pressure and dietary risks continue to be the main RF for CVD mortality and DALY. While there was a decline in age-standardized mortality rates attributable to the evaluated RF, there was also a stability or increase in crude mortality rates, with the exception of smoking. It is important to highlight the increase in the risk of death attributable to a high body mass index. Regarding the analysis per state, SEVs and mortality attributable to RF were higher in those states with lower SDIs., Conclusions: Despite the reduction in CVD mortality and DALY rates attributable to RF, the stability or increase in crude rates attributable to metabolic RFs is worrisome, requiring investments and a renewal of health policies.

Introduction: Maternal death continues to be one of the most challenging public health problems that needs to be addressed in low and middle-income countries. The objective of this study was to describe the problem of maternal death in Brazil, using estimates from the Global Burden of Disease Study (GBD)., Methods: This study used data from the GBD 2019 to show the numbers of deaths and the Maternal Mortality Ratio (MMR) - number of deaths/100,000 live births - in Brazil and its 27 Federated Units (FU), for ages 10 to 54 years, from 1990 to 2019. The annual variation of the MMR was estimated in 1990, 2010, and 2019. The MMR were shown for specific causes as well as for five-year age groups. The estimates were presented with 95% uncertainty intervals (UI)., Results: The number of maternal deaths, as well as the MMR showed a 49% reduction from 1990 to 2019. This reduction occurred heterogeneously throughout the country, and the profile of the MMR for specific causes changed between 1990 and 2019: from hypertensive gestation diseases, to indirect maternal deaths, followed by hypertensive gestation diseases. In the extreme age groups, the MMR is higher, with mortality increasing exponentially in direct proportion with age., Conclusions: Maternal deaths in Brazil have decreased substantially since 1990; however, the numbers still fall short of what was established by the World Health Organization (WHO). Indirect causes are the greatest problem in more than 60% of the FU, especially for hypertensive pregnancy diseases.

Introduction: Monitoring trends in risk factors (RFs) and the burden of diseases attributable to exposure to RFs is an important measure to identify public health advances and current inadequate efforts. Objective: Analyze the global burden of disease attributable to exposure RFs in Brazil, and its changes from 1990 to 2019, according to the sex and age group., Methods: This study used data from the Global Burden of Disease study. The Summary Exposure Value, which represents weighted prevalence by risk, was used to estimate exposure to RFs. The mortality and DALYs (Disability Adjusted Life Years) measurements were used to estimate the burden of diseases. For comparisons by year and between Brazilian states, age-standardized rates were used., Results: Arterial hypertension was the factor responsible for most deaths in both sexes. For DALYs, the most important RF was the high body mass index (BMI) for women and alcohol consumption for men. Smoking had a substantial reduction in the attributable burden of deaths in the period. An important reduction was identified in the exposure to RFs related to socioeconomic development, such as unsafe water, lack of sanitation, and child malnutrition. Metabolic RFs, such as high BMI, hypertension, and alcohol consumption showed an increase in the attributable burden., Conclusions: Our findings point to an increase in metabolic RFs, which are the main RFs for mortality and DALYs. These results can help to consolidate and strengthen public policies that promote healthy lifestyles, thus reducing disease and death.

Mortality indicators for Brazilians aged between 10 and 24 years old were analyzed. Data were obtained from the Global Burden of Disease (GBD) 2019 Study, and absolute numbers, proportion of deaths and specific mortality rates from 1990 to 2019 were analyzed, according to age group (10 to 14, 15 to 19 and 20 to 24 years), sex and causes of death for Brazil, regions and Brazilian states. There was a reduction of 11.8% in the mortality rates of individuals aged between 10 and 24 years in the investigated period. In 2019, there were 13,459 deaths among women, corresponding to a reduction of 30.8% in the period. Among men there were 39,362 deaths, a reduction of only 6.2%. There was an increase in mortality rates in the North and Northeast and a reduction in the Southeast and South states. In 2019, the leading cause of death among women was traffic injuries, followed by interpersonal violence, maternal deaths and suicide. For men, interpersonal violence was the leading cause of death, especially in the Northeast, followed by traffic injuries, suicide and drowning. Police executions moved from 77th to 6th place. This study revealed inequalities in the mortality of adolescents and young adults according to sex, causes of death, regions and Brazilian states.

Survival data involving silent events are often subject to interval censoring (the event is known to occur within a time interval) and classification errors if a test with no perfect sensitivity and specificity is applied. Considering the nature of this data plays an important role in estimating the time distribution until the occurrence of the event. In this context, we incorporate validation subsets into the parametric proportional hazard model, and show that this additional data, combined with Bayesian inference, compensate the lack of knowledge about test sensitivity and specificity improving the parameter estimates. The proposed model is evaluated through simulation studies, and Bayesian analysis is conducted within a Gibbs sampling procedure. The posterior estimates obtained under validation subset models present lower bias and standard deviation compared to the scenario with no validation subset or the model that assumes perfect sensitivity and specificity. Finally, we illustrate the usefulness of the new methodology with an analysis of real data about HIV acquisition in female sex workers that have been discussed in the literature., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2020 Informa UK Limited, trading as Taylor & Francis Group.)