Variações e diferenciais da mortalidade por causas evitáveis por atenção à saúde no Brasil

Abstract

Objective: To analyze the variations and differentials in avoidable mortality in Brazil. This paper is presented as a series of scientific articles according to the specific objectives: review of literature on avoidable mortality in Latin America (Article 1); analysis of the relationship between the occurrence of deaths avoidable through adequate health care and the reorganization of the Brazilian health care system between 1983 and 2002 (Article 2); identification of sex differentials in mortality rates by avoidable causes during the period 1983 to 2005 (Article 3).Methods: The review focuses on literature published in peer-reviewed journals on Latin American empirical studies on avoidable mortality. The main sources were MEDLINE - PubMed and LILACS. In the study on avoidable mortality in Brazil, deaths arising from avoidable causes were analyzed in 117 municipalities, using the Mortality Information System (SIM) of Ministry of Health as a source. The causes of avoidable death through adequate health care were divided into three groups: (1) those avoidable through early diagnosis and treatment, (2) those avoidable with improvements in the quality of treatment and medical care, and (3) ischemic heart disease. Mortality rates had been standardized by ageusing the Brazilian population of 1991 as age distribution standard. A negative binomial regression model that controlled sex, age, geographic region, and socioeconomic conditions was used for the analysis. The magnitude of the incidence of different groups of avoidable causes of death on life expectancy for men and women was evaluated by means ofcompetitive risks. Results: The review of Latin American studies was enough to justify the importance of the analysis of trends and variations of avoidable mortality in this region. The results indicated that, for all three groups of avoidable causes, the risk of avoidable mortality was higher in the 19831992 subperiod than in the 19932002 subperiod, after control of social, economic and demographic variables. Men presented a higher risk for all the three groups of avoidable causes according to the multivariate analysis. Conclusions: The results suggest that in Brazil the decrease in avoidable mortality between 1983 and 2002 was partially due to changes in the availability of and access to health services brought about by the reorganization of the Brazilian health care system since the 1990s. The analysis of the sex differentials of avoidable mortality represents a useful tool for monitoring the health situation for both sexes. The avoidable mortality approach can help in the analysis of organization, quality of and access to health services in Latin American countries.Furthermore the analysis of causes of death avoidable through adequate health care can contribute to identify and propose actions for health that would have to be prioritized, aimed at improving life conditions.