Mortalidade por asma em crianças e adolescentes no Brasil ao longo de 20 anos (1996-2015)

Abstract

PURPOSE: To evaluate asthma deaths and the temporal trend of asthma-specific mortality rate, according to gender, age group, geographical region of the country and place of occurrence of asthma death in children and adolescents up to 19 years of age in Brazil. METHODS: This is an ecological time-series study of asthma deaths occurred in Brazil, in the population up to 19 years of age, between 1996 and 2015. Data were collected from the Department of Informatics of the Brazilian Unified Health System (DATASUS), an agency of Brazilian Ministry of Health. The main variable studied was the specific asthma mortality rate (SAMR) and its temporal trend analyzed by the linear regression test. The intervening variables were age, sex, place of death (hospital or out-of-hospital) and geographic region of the country. RESULTS: there have been 5014 deaths during the 20 years evaluated, with the majority, 68.1%, being registered in children under 5 years of age. There was a significant reduction of temporal trend with coefficient = -0.018 (CI 95% -0.021; 0.016) in Simple Linear Regression. The SMRA ranged from 0.57 / 100,000 in 1997 to 0.21 / 100,000 in 2014. It was generally higher in the Northeast than in other regions. Considering p<0,05, in children under one year of age and in those between 5 and 9 years old, there was a predominance of deaths in males, 59.1% and 53.9%, respectively. In adolescents, between 10 and 19 years old, the predominance was in the female sex (53.7%). Regarding the place of death, 79.4% occurred in the hospital setting. Deaths out-of- hospital were significantly more frequent among adolescents, 26.4%, when compared with other age groups. There was no difference on trend between the sexes and no significant decrease in out-of-hospital deaths. CONCLUSIONS: We observed a reduction of temporal trend of asthma over 20 years in children and adolescents in Brazil. Mortality rates varied across the geographic regions of the country and were higher in the Northeast, probably reflecting social, economic and health inequalities. The majority of deaths occurred in children under 5 years of age, and even if the difficulties of determining the diagnosis of asthma at this age are taken into account, this fact probably is associated with a sad reality, especially in low income countries, where this vulnerable group represents a larger proportion of mortality childhood, indicating needs for attention and concentration of health efforts. In adolescence, although the deaths are less frequent, it is worth noting the higher occurrence of out-of-hospital deaths, signaling the possibility of under- diagnosis and under-treatment. Asthma deaths are considered rare but unacceptable events, considering the treatable nature of the disease and the presence of avoidable factors in most of fatal outcomes. The knowledge about asthma mortality temporal trend and its characteristics are a life instrument and contribute to early detection of death epidemics and to public health planning and policies in order to improve the quality of care provided to patients.