Investigação das causas de mortalidade de mulheres indígenas brasileiras em idade reprodutiva: uma análise de séries temporais

Abstract

Literature suggests the occurrence of indigenous excess mortality among Brazilian adults (in relation to the general population) for both sexes. However, the scarcity of studies addressing the aetiology of deaths of indigenous women in the country compromises the understanding of how their cause-specific mortality rates are affected by systematic racial discrimination, especially at reproductive age. This study aims to compare indigenous and white women in terms of specific mortality rates by cause of death in this age group, and their trends over a decade, to suggest possible inequities in health. We carried out an extensive review of the relevant literature about Indigenous Health in Brazil, focusing on recent quantitative studies on causes of mortality. Subsequently, a survey of data in the Mortality Information System of the Ministry of Health suggested disproportionate mortality rates by groups of causes. From this, we carried out an ecological study using secondary mortality data, and a census-based population projection model, covering the decade between January 2010 and December 2019. We calculated annual mortality rates (specific to groups of causes), standardized by age, for indigenous and white women. Time series trends were estimated using Prais-Winsten regression, and the results were expressed as annual percentage change and 95%CI. The results allowed us a greater reflection on the already produced knowledge, also questioning about still little addressed indigenous health determinants. We analyzed 3,185 Indigenous deaths and 274,393 White deaths. There was a growing trend in mortality rates from neoplasms and endocrine, metabolic, and nutritional diseases among indigenous and white people, with greater magnitudes for the first group. Among indigenous people, there was also a growing tendency for circulatory, respiratory, and digestive causes. Mortality rates from external and infectious-parasitic causes were stationary among indigenous women, with a tendency to decrease among whites. The trend of mortality rates related to pregnancy, childbirth, and the puerperium, and signs, symptoms, and abnormal findings are stationary in both groups surveyed. This study made it possible to observe, quantitatively, how the growth in mortality rates due to chronic diseases among Brazilian indigenous women of reproductive age occurs without the overcome of high mortality rates due to infectious, parasitic, maternal, and external causes. This excess of mortality suggests weaknesses in the articulation between policies aimed at women's and indigenous populations' health, as well as problems with access to basic health services, such as vaccination, disease prevention, nutritional assessment, and prenatal care. There is still a need for further studies on specific causes of mortality, for a better definition of public policies, and for the structuring of a more adequate Health System to the demands of this part of the Brazilian population.