Original article • Epidemiol. Serv. Saúde 31 (3) 202202 Dec 2022 • https://doi.org/10.1590/S2237-96222022000300017   copy

Characteristics and temporal trends of mortality rates in children and adolescents in Mato Grosso and Brazil, 2009-2020

Mônia Maia de Lima Alexsandra Rodrigues de Mendonça Favacho Reinaldo Souza-Santos Silvana Granado Nogueira da Gama About the authors

Abstract

Objective:

to analyze the characteristics and temporal trend of mortality rates in the population aged 5 to 14 years in Mato Grosso state and in Brazil, from 2009 to 2020.

Methods:

this was an ecological time-series study, based on data taken from the Mortality Information System. Descriptive and trend analyses were performed, using the joinpoint regression model and calculating the average annual percentage change (AAPC).

Results:

in Brazil and in Mato Grosso state, deaths were predominantly male, preventable and due to external causes. A falling trend was identified for Brazil (5-9 years AAPC: -2.9; 95%CI -4.3;-1.6 and 10-14 years AAPC: -2.5; 95%CI -3.3;-1.8), while a stationary trend was found in Mato Grosso (5-9 years AAPC: -2.0; 95%CI -5.6;1.7 and 10-14 years AAPC: -0.1; 95%CI -5.9;6.1).

Conclusion:

the stable trend of mortality at high levels demands urgent interventions to reduce it.

Keywords:
Mortality; Time Series Studies; Causes of Death; External Causes; Transport Accidents

Study contributionsMain results

The magnitude of male deaths, preventable deaths and deaths from external causes was high in Mato Grosso state and in Brazil as a whole. In Mato Grosso, the mortality trend in the 5 to 9 and 10 to 14 age groups was stable, while for Brazil as a whole the trend was falling.

Implications for services

Morbidity and mortality related to external causes overburden emergency and rehabilitation services. Deaths from these causes, considered preventable, lead to years of potential life lost, with epidemiological, social, and economic consequences.

Perspectives

Multifactorial interventions to reduce risk factors are essential. Prevention policies, especially for traffic accidents, cannot be delayed and are capable of provoking important changes in the mortality trend.

Introduction

The inclusion of mortality among children under 5 years of age, referred to as child mortality, as part of the Millennium Development Goals (MDGs) for the period 1990-2015, and as part of the Sustainable Development Goals (SDGs) to be met by 2030, points to its relevance as an indicator of the population’s health population. Monitoring child mortality guides the development of strategies to reduce illness and death in this age group.11. França EB, Lansky S, Rego MAS, Malta DC, França JS, Teixeira R, et al. Principais causas da mortalidade na infância no Brasil, em 1990 e 2015: estimativas do estudo de Carga Global de Doença. Rev Bras Epidemiol. 2017;20(supl 1):46-60. doi: 10.1590/1980-5497201700050005
https://doi.org/10.1590/1980-54972017000...

In addition to the efforts directed towards reducing the child mortality rate, mortality in the population between 5 and 14 years of age also deserves to be highlighted, since it includes deaths that are for the greater part preventable.22. Fadel SA, Boschi-Pinto C, Yu S, Reynales-Shigematsu LM, Menon GR, Newcombe L, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet. 2019;393(10176):1119-27. doi:10.1016/s0140-6736(19)30220-x
https://doi.org/10.1016/s0140-6736(19)30... ,33. Masquelier B, Hug L, Sharrow D, You D, Hogan D, Hill K, et al. Global, regional, and national mortality trends in older children and young adolescents (5-14 years) from 1990 to 2016: an analysis of empirical data. Lancet Glob Health. 2018;6(10): e1087-e1099. doi:10.1016/s2214-109x(18)30353-x
https://doi.org/10.1016/s2214-109x(18)30... ,44. Hill K, Zimmerman L, Jamison DT. Mortality risks in children aged 5-14 years in low-income and middle-income countries: a systematic empirical analysis. Lancet Glob Health. 2015;3(10):e609-e616. doi:10.1016/s2214-109x(15)00044-3
https://doi.org/10.1016/s2214-109x(15)00... Between 1990 and 2016, the risk of death for those in the 5-14 age group fell by 51% worldwide, although the trend slowed in the 2000s. During this period, the reduction in deaths of those aged 5-9 was greater than that among those in the 10-14 age group.33. Masquelier B, Hug L, Sharrow D, You D, Hogan D, Hill K, et al. Global, regional, and national mortality trends in older children and young adolescents (5-14 years) from 1990 to 2016: an analysis of empirical data. Lancet Glob Health. 2018;6(10): e1087-e1099. doi:10.1016/s2214-109x(18)30353-x
https://doi.org/10.1016/s2214-109x(18)30...

External causes, especially road traffic accidents, were the leading cause of deaths in the 5-14 age group in Europe from 1990 to 2016.55. Kyu HH, Stein CE, Pinto CB, Rakovac I, Weber MW, Purnat DT, et al. Causes of death among children aged 5-14 years in the WHO European Region: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Child Adolescent Health. 2018;2(5):321-37. doi: 10.1016/s2352-4642(18)30095-6
https://doi.org/10.1016/s2352-4642(18)30... In low- and middle-income countries, besides external causes, cancer, respiratory, neurological and infectious diseases have stood out as causes of death in this age group.22. Fadel SA, Boschi-Pinto C, Yu S, Reynales-Shigematsu LM, Menon GR, Newcombe L, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet. 2019;393(10176):1119-27. doi:10.1016/s0140-6736(19)30220-x
https://doi.org/10.1016/s0140-6736(19)30...

A study conducted in India, China, Mexico and Brazil, which analyzed characteristics and trends in mortality in those aged 5-14 between 2005 and 2016, showed similarities of these deaths in terms of the underlying basic causes and the proportion of deaths due to ill-defined causes. However, variations were found between the order and proportion of causes of death, the 5-9 age group compared to the 10-14 age group, as well as between the sexes and the countries included in the study.22. Fadel SA, Boschi-Pinto C, Yu S, Reynales-Shigematsu LM, Menon GR, Newcombe L, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet. 2019;393(10176):1119-27. doi:10.1016/s0140-6736(19)30220-x
https://doi.org/10.1016/s0140-6736(19)30...

Between 2009 and 2020, 867,548 Brazilians under the age of 20 lost their lives. Despite accounting for some 12% of all deaths in the population, the 5-14 age group corresponds to around 100,000 deaths, mostly classified as preventable, according to the Brazilian National Health System (Sistema Único de Saúde do Brasil - SUS) List of Causes of Deaths Preventable through Interventions (5-74 age group).66. Ministério da Saúde (BR). Departamento de Informática do Sistema Único de Saúde. Banco de dados do Sistema Único de Saúde-DATASUS [Internet]. Brasília: Ministério da Saúde; 2022. Disponível em: https://datasus.saude.gov.br/informacoes-de-saude-tabnet
https://datasus.saude.gov.br/informacoes... ,77. Malta DC, França E, Abreu DX, Oliveira H, Monteiro RA, Sardinha LMV, et al. Atualização da lista de causas de mortes evitáveis (5 a 74 anos de idade) por intervenções do Sistema Único de Saúde do Brasil. Epidemiol Serv Saude. 2011; 20(3):409-12. doi:10.5123/S1679-49742011000300016
https://doi.org/10.5123/S1679-4974201100...

Still in relation to the period between 2009 and 2020, analysis of mortality rates for 5-9 years old and 10-14 years old in Brazil indicates that the Northern region led the national ranking, with higher values (357.1/100,000 inhab. - 5-9 years; 432.9/100,000 inhab. - 10-14 years), followed by the Midwest region (298.0/100,000 inhab. - 5-9 years; 394.8/100,000 inhab. - 10-14 years). The state of Mato Grosso, located in the Midwest region, had the highest values in that region in both age groups (321.9/100,000 inhab. - 5-9 years; 430.0/100,000 inhab. - 10-14 years), surpasssing some states in the Northern region and all the national rates.66. Ministério da Saúde (BR). Departamento de Informática do Sistema Único de Saúde. Banco de dados do Sistema Único de Saúde-DATASUS [Internet]. Brasília: Ministério da Saúde; 2022. Disponível em: https://datasus.saude.gov.br/informacoes-de-saude-tabnet
https://datasus.saude.gov.br/informacoes...

In Mato Grosso, around 70% of deaths of people under 20 years of age occurring between 2009 and 2020 were due to preventable causes: accidents, assault and communicable diseases.66. Ministério da Saúde (BR). Departamento de Informática do Sistema Único de Saúde. Banco de dados do Sistema Único de Saúde-DATASUS [Internet]. Brasília: Ministério da Saúde; 2022. Disponível em: https://datasus.saude.gov.br/informacoes-de-saude-tabnet
https://datasus.saude.gov.br/informacoes... Preventable deaths, in general, are the result of failures in the prevention, diagnosis and treatment of conditions that determine their occurrence, as well as reflecting unsatisfactory levels of health and life contexts.88. Bonatti AF, Silva AMC, Muraro AP. Mortalidade infantil em Mato Grosso, Brasil: tendência entre 2007 e 2016 e causas de morte. Cienc Saude Colet. 2020; 25(7):2821-30. doi:10.1590/1413-81232020257.28562018
https://doi.org/10.1590/1413-81232020257... The objective of this study was to analyze the characteristics and temporal trend of mortality rates in the population aged 5 to 14 years in Mato Grosso state and in Brazil, from 2009 to 2020.

Methods

Design

This was an ecological time-series study, which used data taken from the Mortality Information System (Sistema de Informação sobre Mortalidade - SIM), covering a 12-year period (2009 to 2020), having as its units of analysis both Brazil and the state of Mato Grosso.

Background

The SIM system aggregates information regarding the characteristics of deaths certified on death certificates throughout the national territory. The database made available by the SUS Department of Information Technology (DATASUS) is freely accessible and enables countless data cross-referencing. Mortality statistics are an important tool in identifying the population’s health problems and for informing public health policy planning and management.99. Messias KLM, Bispo Júnior JP, Pegado MFQ, Oliveira LC, Peixoto TG, Sales MAC, et al. Qualidade da informação dos óbitos por causas externas em Fortaleza, Ceará, Brasil. Cienc Saude Colet. 2016;21(7):2319. doi: 10.1590/1413-81232015217.14362016
https://doi.org/10.1590/1413-81232015217... ,1010. Daniel VM, Macadar MA, Pereira GV. O Sistema de Informação sobre Mortalidade e seu Apoio à Gestão e ao Planejamento do Sistema Único de Saúde (SUS). Rev Gestão em Sistemas de Saúde. 2013;2(2):148-73. doi: 10.5585/rgss.v2i2.76
https://doi.org/10.5585/rgss.v2i2.76...

Participants

We analyzed the data on the deaths of children and adolescents aged 5 to 14 years old living in both the state of Mato Grosso and also in Brazil as a whole that occurred between 2009 and 2020.

Variables

Apart from the “death” outcome, we extracted the aggregate data on the following variables:

  1. Sex (male; female);

  2. Age group (5-9 years; 10-14 years);

  3. Race/skin color (White; Black; mixed race; Indigenous; Asian; unknown; other);

  4. Underlying cause of death, according to the most recurrent chapters of the International Statistical Classification on Diseases and Related Health Problems - ICD-10 (Certain infectious and parasitic diseases - A00-B99; Neoplasms - C00-D48; Diseases of the nervous system - G00-G99; Diseases of the respiratory system - J00-J99; External causes - V01-Y98); and

  5. Classification of the preventability of death, according to groups of causes, as per the SUS List of Causes of Deaths Preventable through Interventions (5-74 age group), the ICD listed description of which can be consulted in Malta et al. (2018), namely:77. Malta DC, França E, Abreu DX, Oliveira H, Monteiro RA, Sardinha LMV, et al. Atualização da lista de causas de mortes evitáveis (5 a 74 anos de idade) por intervenções do Sistema Único de Saúde do Brasil. Epidemiol Serv Saude. 2011; 20(3):409-12. doi:10.5123/S1679-49742011000300016
    https://doi.org/10.5123/S1679-4974201100...     deaths reducible by vaccination actions; deaths reducible by health promotion, communicable disease prevention, control and adequate care actions; deaths reducible by health promotion, non-communicable disease prevention, control and adequate care actions; deaths reducible by maternal causes prevention, control and adequate care actions; deaths reducible by intersectoral and health promotion, external causes prevention and care actions; ill-defined causes; other causes (not clearly preventable).

Data collection

The mortality data were extracted from DATASUS, taking the underlying causes of death according to the ICD-10 chapters. We considered the five chapters which occurred most frequently. Our analysis of preventability was based on the updated SUS List of Causes of Deaths Preventable through Interventions (5-74 age group).77. Malta DC, França E, Abreu DX, Oliveira H, Monteiro RA, Sardinha LMV, et al. Atualização da lista de causas de mortes evitáveis (5 a 74 anos de idade) por intervenções do Sistema Único de Saúde do Brasil. Epidemiol Serv Saude. 2011; 20(3):409-12. doi:10.5123/S1679-49742011000300016
https://doi.org/10.5123/S1679-4974201100...

The population data were extracted from the website of the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE), which provides the 2010 Census data as well as population estimates up to the year 2021.

Data analysis

The data were tabulated using the Health Information Tabulator (Tabulador de Informações em Saúde - TabNet) before being exported to Excel® spreadsheets. Deaths were stratified by age group and sex.

The raw annual mortality rates per 100,000 inhabitants for each age group were calculated both for Brazil as a whole and also for Mato Grosso state, as well as the total rate for the period analyzed. The following formula was used for this calculation:

Mortality rate = (number of deaths/population) x 100,000

We also calculated the standardized rates by age group, using the direct method, taking the reference to be the age structure of the Brazilian population estimated by the IBGE for each year of analysis. Standardization was necessary in order for the mortality rates to be comparable between each other and throughout the period studied.

After standardization, the mean value for each age group was calculated, as well as the standard deviation and the difference between the rates at the beginning and end of the period.

Descriptive analysis of the mortality data at the study sites was performed. Besides the mortality rates, the absolute frequencies of deaths and their distribution by race/skin color and underlying cause were presented, both for the comparison between Brazil and Mato Grosso, and for comparison between age groups in Mato Grosso.

When analyzing race/skin color, we grouped together the “Black” and “Indegenous” categories, due to the small number of cases and because they are more vulnerable groups, and we also grouped together the “unknown” and “other” categories.

We performed temporal trend analyses for Brazil as a whole and for Mato Grosso state, comparing the resulting annual percentage change (APC) and average annual percentage change (AAPC).

Statistical methods

We applied the chi-square test (X2), using R software to test the homogeneity of the proportions obtained through the descriptive analysis.

When analyzing the mortality rate temporal trends, we used the JoinPoint Regression Program, version 4.9.1.0, dated April 2022 (Statistical Research and Applications Branch, National Cancer Institute), which, based on the Monte Carlo permutation method, estimated APC and AAPC, taking a 95% confidence interval (95%CI) and a 5% significance level.

The changes in the mortality rate values, both in terms of increase and reduction, are the basis for identifying jointpoints. Following the pattern of the method, the number of jointpoints varies according to the number of points (in this case, years) in the database analyzed. Taking the slope of the regression line, it is possible to identify these points, which allows the temporal trend to be classified as stationary (p-value > 0.05), rising (p-value < 0.05 and positive regression coefficient) or falling (p-value < 0.05 and negative regression coefficient).1111. Marinho CSR, Flor TBM, Pinheiro JMF, Ferreira MAF. Objetivos de Desenvolvimento do Milênio: impacto de ações assistenciais e mudanças socioeconômicas e sanitárias na mortalidade de crianças. Cad Saude Publica. 2020; 36(10):e00191219. doi: 10.1590/0102-311X00191219
https://doi.org/10.1590/0102-311X0019121... ,1212. Souza CDF, Albuquerque AR, Cunha EJO, Silva Junior LCF, Silva JVM, Santos FGB, et al. Novo século, velho problema: tendência da mortalidade infantil e seus componentes no Nordeste brasileiro. Cad Saude Colet. 2021;29(1):133-42. doi:10.1590/1414-462X202129010340
https://doi.org/10.1590/1414-462X2021290... ,1313. Aragão CMC, Mascarenhas MDM. Tendência temporal das notificações de lesão autoprovocada em adolescentes no ambiente escolar, Brasil, 2011-2018. Epidemiol Serv Saude. 2022;31(1):e202820. doi:10.1590/S1679-49742022000100028
https://doi.org/10.1590/S1679-4974202200... The jointpoint regression model was applied for both age groups and for the national and state scenarios.

Ethical aspects

As this study is based on analysis of public domain and free access secondary and grouped data, with no identification of the individuals involved, it received Ethics Waiver Opinion No. 09/2022 from the Escola Nacional de Saúde Pública Research Ethics Committee.

Results

Between 2009 and 2020, 876 deaths of people aged 5-9 years were recorded, and 1,192 in the 10-14 years age group in Mato Grosso, while in Brazil, there were 42,661 deaths of people aged 5-9 years and 60,323 in the 10-14 years age group.

Throughout the time series, from 2009 to 2020, the mortality rate in the 10-14 years age group surpassed that of the younger group, both in Mato Grosso (321.9/100,000 inhab. - 5-9 years; 430.0/100,000 inhab. - 10-14 years) and also in Brazil (268.3/100,000 inhab. - 5-9 years; 360.1/100,000 inhab. - 10-14 years). Male mortality exceeded female mortality, both in Mato Grosso and in Brazil (Mato Grosso: 439.9/100,000 inhab. - male and 312.2/100,000 inhab. - female; Brazil: 369.2/100,000 inhab. - male and 259.3/100,000 inhab. - female). The Mato Grosso state rates were higher than the national rates in all strata.

There was a reduction in mortality rates at the end of the period analyzed in relation to the beginning, for both age groups, both in Mato Grosso (from 32.1 to 26.9/100,000 inhab., for 5-9 years old; from 42.1 to 37.2/100,000 inhab., for 10-14 years old) and also in Brazil as a whole (from 26.0 to 17.6/100,000 inhab., for 5-9 years old; from 33.5 to 24.6/100,000 inhab., for 10-14 years old). A greater reduction was found in the mortality of children aged 5-9 years in Brazil as a whole (-32.3%), as per Figure 1.

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Figure 1
Changes in mortality rates in the 5-9 and 10-14 years age groups, Brazil and Mato Grosso, 2009-2020

The mortality rates in Mato Grosso exceeded the national rates in both age groups analyzed (average in Mato Grosso: 26.8/100,000 inhab., for 5-9 years old, and 35.9/100,000 inhab. for 10-14 years old; average in Brazil: 22.3/100,000 inhab., for 5-9 years old, and 29.9/100,000 inhab. for 10-14 years old). The exceptions were the year 2015, for children aged 5-9 years, and 2011, for children aged 10-14 years. The values fluctuated more in Mato Grosso in both groups, with greater variability in those aged 10-14 years old (Figure 1).

In both Brazil and Mato Grosso, there was a predominance of male deaths in both age groups (Mato Grosso: 58.2%, 5-9 years, and 60.6%, 10-14 years; Brazil: 57.2%, 5-9 years, and 61.5%, 10-14 years) (Table 1).

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Table 1
Number and percentage of deaths by age group (5-9 and 10-14 years), sex, race/skin color, underlying cause and preventable causes, Brazil and Mato Grosso, 2009-2020

The distribution of deaths according to race/skin color and underlying cause reveals similarities between the state and national scenarios, with a predominance of deaths of mixed race individuals (Mato Grosso: 56.6%, for 5-9 years old, and 58.8% for 10-14 years old; Brazil: 48.5%, for 5-9 years old, and 50.9% for 10-14 years old) and for deaths from external causes (Mato Grosso: 35.5%, for 5-9 years old, and 47.1% for 10-14 years old; Brazil: 30.2%, for 5-9 years old, and 42.0% for 10-14 years old) in relation to other causes, as per Table 1.

Table 1 shows the magnitude of preventable deaths in the age groups (Mato Grosso: 59.2%, for 5-9 years old, and 65.7% for 10-14 years old; Brazil: 54.7%, for 5-9 years old, and 62.6% for 10-14 years old), especially deaths that can be reduced by actions related to care of external causes.

In Mato Grosso, the distribution of deaths by the main groups of external causes was similar in both age groups for females, with a predominance of transport accidents (55.8%, for 5-9 years old, and 48.1% for 10-14 years old). Among males, despite the predominance of transport accidents in both age groups, the proportion of deaths from assaults among individuals aged 10-14 years old (20.4%) stood out (Table 2).

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Table 2
Distribution of deaths from external causes among residents, by age group, sex and main ICD-10a groups, Mato Grosso, 2009-2020

In Brazil as a whole, in the 5-9 years age group, there was a joinpoint in 2018, and the temporal trend was classified as falling (AAPC = -2.9; 95%CI -4.3;-1.6); in the 10-14 years age group, there was a joinpoint in 2012, and the temporal trend was also classified as falling (AAPC = -2.5; 95%CI -3.3;-1.8). In Mato Grosso, this trend proved to be stationary in both age groups (5-9 years, AAPC = -2.0; 95%CI -5.6;1.7; and 10-14 years, AAPC = -0.1; 95%CI -5.9;6.1), joinpoints in 2015, in the 5-9 years age group, and in 2018, in the 10-14 years age group (Table 3). In addition to being higher than the national rates, the Mato Grosso rates showed greater oscillation, compared to expected (Figure 2).

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Figure 2
Temporal trend of mortality in the 5-9 age group (A) and the 10-14 age group (B), Brazil and Mato Grosso, 2009-2020

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Table 3
Average percentage change according to joinpoint regression of the 5-14 age group mortality rates, Brazil and Mato Grosso, 2009-2020

Discussion

Between 2009 and 2020, mortality in the 5-14 age group in both Brazil and Mato Grosso was predominantly male, preventable and due to external causes, especially traffic accidents and assaults, being higher among those aged 10-14 years compared to those aged 5-9 years. There was a reduction in mortality rates at the end of the period in relation to the values found at the beginning.

Unlike Brazil, which maintained a falling trend in both age groups, Mato Grosso showed a stationary trend for both groups. Even though this trend is not statistically significant, when considering the high rate of mortality in the state, it raises an alert with regard to change in the state context.

These results are in line with the reduction in mortality of children and adolescents aged 10-14 years in countries with different income levels between 1955 and 2004. In that period, among people under 24 years of age, the 5-14 age group had the lowest number of deaths, and the reduction in mortality among 5-9 years old was greater than among 10-14 years old.1414. Viner RM, Coffey C, Mathers C, Bloem P, Costello A, Santelli J, et al. 50-year mortality trends in children and young people: a study of 50 low-income, middle-income, and high-income countries. Lancet. 2011;377(9772):1162-74. doi:10.1016/S0140-6736(11)60106-2
https://doi.org/10.1016/S0140-6736(11)60...

The difference in the speed of decline in the rates, between age groups, continued to be seen worldwide from 1990 to 2016.22. Fadel SA, Boschi-Pinto C, Yu S, Reynales-Shigematsu LM, Menon GR, Newcombe L, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet. 2019;393(10176):1119-27. doi:10.1016/s0140-6736(19)30220-x
https://doi.org/10.1016/s0140-6736(19)30... ,33. Masquelier B, Hug L, Sharrow D, You D, Hogan D, Hill K, et al. Global, regional, and national mortality trends in older children and young adolescents (5-14 years) from 1990 to 2016: an analysis of empirical data. Lancet Glob Health. 2018;6(10): e1087-e1099. doi:10.1016/s2214-109x(18)30353-x
https://doi.org/10.1016/s2214-109x(18)30... The greater drop in deaths of 5-9 years old can be attributed to the indirect benefit of public policies aimed at children under 5 years of age, while the causes of death for 10-14 years old are more difficult to prevent, due to the greater frequency of deaths from external causes.44. Hill K, Zimmerman L, Jamison DT. Mortality risks in children aged 5-14 years in low-income and middle-income countries: a systematic empirical analysis. Lancet Glob Health. 2015;3(10):e609-e616. doi:10.1016/s2214-109x(15)00044-3
https://doi.org/10.1016/s2214-109x(15)00...

The mortality profile of children and adolescents in Mato Grosso was similar to that of other Brazilian states,1616. Marchi JA, Wakiuchi J, Sales CA, Mathias TAF, Fernandes CAM. Câncer infanto juvenil: perfil de óbitos. Rev Rene. 2013;14(4):911-19. Disponível em: http://www.periodicos.ufc.br/rene/article/view/3618
http://www.periodicos.ufc.br/rene/articl... ,1717. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Impacto da violência na saúde dos brasileiros. Série B. Textos Básicos de Saúde [Internet]. Brasília: Ministério da Saúde; 2005. 340 p. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/impacto_violencia.pdf
https://bvsms.saude.gov.br/bvs/publicaco... and that of other countries.1818. Dedefo M, Zelalem D, Eskinder B, Assefa N, Ashenaf W, Barak N, et al. Causes of Death among Children Aged 5 to 14 Years Old from 2008 to 2013 in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia. PLoS ONE. 2016;11(6):e0151929 .doi: 10.1371/journal.pone.0151929
https://doi.org/10.1371/journal.pone.015... ,22. Fadel SA, Boschi-Pinto C, Yu S, Reynales-Shigematsu LM, Menon GR, Newcombe L, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet. 2019;393(10176):1119-27. doi:10.1016/s0140-6736(19)30220-x
https://doi.org/10.1016/s0140-6736(19)30... ,33. Masquelier B, Hug L, Sharrow D, You D, Hogan D, Hill K, et al. Global, regional, and national mortality trends in older children and young adolescents (5-14 years) from 1990 to 2016: an analysis of empirical data. Lancet Glob Health. 2018;6(10): e1087-e1099. doi:10.1016/s2214-109x(18)30353-x
https://doi.org/10.1016/s2214-109x(18)30... ,55. Kyu HH, Stein CE, Pinto CB, Rakovac I, Weber MW, Purnat DT, et al. Causes of death among children aged 5-14 years in the WHO European Region: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Child Adolescent Health. 2018;2(5):321-37. doi: 10.1016/s2352-4642(18)30095-6
https://doi.org/10.1016/s2352-4642(18)30... Besides external causes, neoplasms, respiratory, neurological and infectious diseases figure in the ranking of causes of death in these age groups, pointing out the crucial role of socioeconomic aspects in the order of occurrence of deaths in each region.22. Fadel SA, Boschi-Pinto C, Yu S, Reynales-Shigematsu LM, Menon GR, Newcombe L, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet. 2019;393(10176):1119-27. doi:10.1016/s0140-6736(19)30220-x
https://doi.org/10.1016/s0140-6736(19)30... ,33. Masquelier B, Hug L, Sharrow D, You D, Hogan D, Hill K, et al. Global, regional, and national mortality trends in older children and young adolescents (5-14 years) from 1990 to 2016: an analysis of empirical data. Lancet Glob Health. 2018;6(10): e1087-e1099. doi:10.1016/s2214-109x(18)30353-x
https://doi.org/10.1016/s2214-109x(18)30... ,55. Kyu HH, Stein CE, Pinto CB, Rakovac I, Weber MW, Purnat DT, et al. Causes of death among children aged 5-14 years in the WHO European Region: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Child Adolescent Health. 2018;2(5):321-37. doi: 10.1016/s2352-4642(18)30095-6
https://doi.org/10.1016/s2352-4642(18)30... ,1515. Malta DC, Saltarelli RMF, Prado RR, Monteiro RA, Almeida MF. Mortes evitáveis no Sistema Único de Saúde na população brasileira, entre 5 e 69 anos, 2000 - 2013. Rev Bras Epidemiol. 2018;21:e180008. doi:10.1590/1980-549720180008
https://doi.org/10.1590/1980-54972018000... ,1616. Marchi JA, Wakiuchi J, Sales CA, Mathias TAF, Fernandes CAM. Câncer infanto juvenil: perfil de óbitos. Rev Rene. 2013;14(4):911-19. Disponível em: http://www.periodicos.ufc.br/rene/article/view/3618
http://www.periodicos.ufc.br/rene/articl... ,1717. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Impacto da violência na saúde dos brasileiros. Série B. Textos Básicos de Saúde [Internet]. Brasília: Ministério da Saúde; 2005. 340 p. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/impacto_violencia.pdf
https://bvsms.saude.gov.br/bvs/publicaco... ,1818. Dedefo M, Zelalem D, Eskinder B, Assefa N, Ashenaf W, Barak N, et al. Causes of Death among Children Aged 5 to 14 Years Old from 2008 to 2013 in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia. PLoS ONE. 2016;11(6):e0151929 .doi: 10.1371/journal.pone.0151929
https://doi.org/10.1371/journal.pone.015... ,1919. Cunningham RM, Walton MA, Carter PM. The Major Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2018;379(25):2468-75. doi:10.1056/nejmsr1804754
https://doi.org/10.1056/nejmsr1804754...

The reduction in mortality from infectious diseases and cancer may reflect improvements in access to and quality of health care services, such as vaccination, early diagnosis methods, timely use of antibiotics, and appropriate surgical treatment.1919. Cunningham RM, Walton MA, Carter PM. The Major Causes of Death in Children and Adolescents in the United States. N Engl J Med. 2018;379(25):2468-75. doi:10.1056/nejmsr1804754
https://doi.org/10.1056/nejmsr1804754...

The predominance of deaths from external causes, especially those resulting from traffic accidents, is due both to the low frequency of morbidity in this group and also to the greater vulnerability of people who live in high population density areas, with high rates of violence and precarious and unsafe urban and road infrastructure. Added to the natural characteristics of their age (less physical structure, difficulty in identifying risks and dependence on help from others), such factors can be key to the increase of this outcome among children.2020. Martínez P, Contreras D. The effects of Chile's 2005 traffic law reform and in-country socioeconomic differences on road traffic deaths among children aged 0-14 years: A 12-year interrupted time series analysis. Accident Analysis and Prevention. 2020;136(9):105335. doi: 10.1016/j.aap.2019.105335
https://doi.org/10.1016/j.aap.2019.10533...

In Brazil as a whole, the mortality rate for the main preventable underlying causes was similar among the 5-9 and 10-14 age groups for almost all causes. However, despite the general reduction in mortality from preventable causes since the 2000s, in 2013, the mortality rate due to external causes was significantly higher in the older age group.1616. Marchi JA, Wakiuchi J, Sales CA, Mathias TAF, Fernandes CAM. Câncer infanto juvenil: perfil de óbitos. Rev Rene. 2013;14(4):911-19. Disponível em: http://www.periodicos.ufc.br/rene/article/view/3618
http://www.periodicos.ufc.br/rene/articl...

In Cuiabá, the capital of Mato Grosso state, in 2009, fatal victims between 5 and 14 years old accounted for 4.6% of deaths from external causes in people under 24 years of age: the majority resulting from accidents, and, with effect from 10 years of age, showing an expressive predominance of males and an increase in victims of assault.2121. Matos K F, Martins CBG. Perfil epidemiológico da mortalidade por causas externas em crianças, adolescentes e jovens na capital do Estado de Mato Grosso, Brasil, 2009. Epidemiol Serv Saude. 2012;21(1):43-53. doi:10.5123/S1679-49742012000100005
https://doi.org/10.5123/S1679-4974201200...

Considering that traffic accidents are mostly predictable and preventable, monitoring these events is an important tool for the implementation of public prevention and health promotion policies.2222. Souto RMCV, Barufaldi LA, Malta DC, Freitas MG, Pinto IV, Lima CM. et al. Perfil e tendência dos fatores de risco para acidentes de trânsito em escolares nas capitais brasileiras: PeNSE 2009, 2012 e 2015. Rev Bras Epidemiol. 2018;21(supl 1):e180016. doi: 10.1590/1980-549720180016.supl.1
https://doi.org/10.1590/1980-54972018001... The implementation of traffic safety policies - such as the use of seatbelts, helmets and car seats, investing in road safety, encouraging safe driving behavior, and criminalizing drug-impaired driving - has been associated with a reduction in child and adolescent traffic fatalities in Brazil and worldwide.2020. Martínez P, Contreras D. The effects of Chile's 2005 traffic law reform and in-country socioeconomic differences on road traffic deaths among children aged 0-14 years: A 12-year interrupted time series analysis. Accident Analysis and Prevention. 2020;136(9):105335. doi: 10.1016/j.aap.2019.105335
https://doi.org/10.1016/j.aap.2019.10533... ,2121. Matos K F, Martins CBG. Perfil epidemiológico da mortalidade por causas externas em crianças, adolescentes e jovens na capital do Estado de Mato Grosso, Brasil, 2009. Epidemiol Serv Saude. 2012;21(1):43-53. doi:10.5123/S1679-49742012000100005
https://doi.org/10.5123/S1679-4974201200... ,2222. Souto RMCV, Barufaldi LA, Malta DC, Freitas MG, Pinto IV, Lima CM. et al. Perfil e tendência dos fatores de risco para acidentes de trânsito em escolares nas capitais brasileiras: PeNSE 2009, 2012 e 2015. Rev Bras Epidemiol. 2018;21(supl 1):e180016. doi: 10.1590/1980-549720180016.supl.1
https://doi.org/10.1590/1980-54972018001...

In Mato Grosso, drowning is an important cause of death among external causes, especially in children 5-9 years old. The climatic and hydrographic aspects of the state favor aquatic leisure activities, increasing exposure, which requires continuous surveillance, greater attention to safety structures in risk areas, and family behavior changes.2323. Martins CBG, Mello-Jorge MHP. Circumstances and factors associated with accidental deaths among children, adolescents and young adults in Cuiabá, Brazil. São Paulo Med J. 2013;131(4):228-37. doi: 10.1590/1516-3180.2013.1314459
https://doi.org/10.1590/1516-3180.2013.1...

In order of importance, assaults are the third leading cause of death in those aged 5-14 years old, indicating a change in the mortality pattern associated with increasing age.66. Ministério da Saúde (BR). Departamento de Informática do Sistema Único de Saúde. Banco de dados do Sistema Único de Saúde-DATASUS [Internet]. Brasília: Ministério da Saúde; 2022. Disponível em: https://datasus.saude.gov.br/informacoes-de-saude-tabnet
https://datasus.saude.gov.br/informacoes... Studies in Brazil and elsewhere1717. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Impacto da violência na saúde dos brasileiros. Série B. Textos Básicos de Saúde [Internet]. Brasília: Ministério da Saúde; 2005. 340 p. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/impacto_violencia.pdf
https://bvsms.saude.gov.br/bvs/publicaco... ,2020. Martínez P, Contreras D. The effects of Chile's 2005 traffic law reform and in-country socioeconomic differences on road traffic deaths among children aged 0-14 years: A 12-year interrupted time series analysis. Accident Analysis and Prevention. 2020;136(9):105335. doi: 10.1016/j.aap.2019.105335
https://doi.org/10.1016/j.aap.2019.10533... ,2424. Sá Neto JA, Silva ACSS, Knupp VMAO, Souza AC, Góes FGB, Silva IR, et al. Diagnóstico situacional de mortalidade entre adolescentes em condição de vulnerabilidade. Rev Enferm UERJ. 2020;28:e.39279. doi:10.12957/reuerj.2020.39279
https://doi.org/10.12957/reuerj.2020.392... have also revealed that in this age group there is increased risk of death due to assault as age increases, especially among males.

Predominance of male mortality, in both age groups, and a high number of preventable deaths have been found by different studies around the world. In recent decades, there has been a predominance of male mortality in the 5-14 age group in countries with different ethnic and socioeconomic characteristics, such as Ethiopia (52%), India (52%), China (57.1%), Brazil (59.4%) and Mexico (63.4%).22. Fadel SA, Boschi-Pinto C, Yu S, Reynales-Shigematsu LM, Menon GR, Newcombe L, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet. 2019;393(10176):1119-27. doi:10.1016/s0140-6736(19)30220-x
https://doi.org/10.1016/s0140-6736(19)30... ,1818. Dedefo M, Zelalem D, Eskinder B, Assefa N, Ashenaf W, Barak N, et al. Causes of Death among Children Aged 5 to 14 Years Old from 2008 to 2013 in Kersa Health and Demographic Surveillance System (Kersa HDSS), Ethiopia. PLoS ONE. 2016;11(6):e0151929 .doi: 10.1371/journal.pone.0151929
https://doi.org/10.1371/journal.pone.015... A similar scenario has been found in different Brazilian states: Minas Gerais (64.3%), Maranhão (53.5%) and Rio Grande do Norte (65%).2525. Romero HSP, Rezende EM, Martins EF. Mortalidade por causas externas em crianças de um a nove anos. Rev Min Enferm. 2016;20:e958. doi: 10.5935/1415-2762.20160027
https://doi.org/10.5935/1415-2762.201600... ,2626. Santos OJ, Santos Júnior OM, Pinto KL, Santos RM, Galvão Júnior AC, Casimiro LM, et al. Mortalidade por causas externas em crianças de 0 a 12 anos: uma análise dos registros de óbitos. Rev Pesq Saúde. 2012;13(3):17-2. doi: 10.18764/
https://doi.org/10.18764/... ,2727. Albuquerque NMG, Cavalcante CAA, Macêdo MLAF, Oliveira JSA, Medeiro SM. Causas externas: características de crianças e adolescentes assistidas em um hospital do Rio Grande do Norte. Rev Bras Pesq Saude. 2014;16(2):7-14. Disponível em: https://periodicos.ufes.br/rbps/article/view/9297
https://periodicos.ufes.br/rbps/article/...

In general, young males are usually exposed to higher risk situations, such as aggressive behavior, urban violence, drug trafficking, alcohol and other drug use, work activities, and dangerous driving, thus being more associated with the external cause mortality profile.1515. Malta DC, Saltarelli RMF, Prado RR, Monteiro RA, Almeida MF. Mortes evitáveis no Sistema Único de Saúde na população brasileira, entre 5 e 69 anos, 2000 - 2013. Rev Bras Epidemiol. 2018;21:e180008. doi:10.1590/1980-549720180008
https://doi.org/10.1590/1980-54972018000...

It was not possible to obtain information on the resident population according to race/skin color in each age group, thereby limiting the analysis of this variable to the description of absolute and relative frequencies only. The categorization used was not sufficient to enable analysis of possible inequities related to the race/skin color of the children and adolescents who died.

Since this study analyzed secondary data, extracted from death certificates, the possibility exists of errors occurring when filling out the original death certificate and inputting the data to the information system. However, the results obtained are in line with those described in the literature and corroborate the need for greater focus on this outcome.22. Fadel SA, Boschi-Pinto C, Yu S, Reynales-Shigematsu LM, Menon GR, Newcombe L, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet. 2019;393(10176):1119-27. doi:10.1016/s0140-6736(19)30220-x
https://doi.org/10.1016/s0140-6736(19)30... ,99. Messias KLM, Bispo Júnior JP, Pegado MFQ, Oliveira LC, Peixoto TG, Sales MAC, et al. Qualidade da informação dos óbitos por causas externas em Fortaleza, Ceará, Brasil. Cienc Saude Colet. 2016;21(7):2319. doi: 10.1590/1413-81232015217.14362016
https://doi.org/10.1590/1413-81232015217... ,1010. Daniel VM, Macadar MA, Pereira GV. O Sistema de Informação sobre Mortalidade e seu Apoio à Gestão e ao Planejamento do Sistema Único de Saúde (SUS). Rev Gestão em Sistemas de Saúde. 2013;2(2):148-73. doi: 10.5585/rgss.v2i2.76
https://doi.org/10.5585/rgss.v2i2.76...

Studies of causes of death, carried out by the World Health Organization (WHO), and studies of the global burden of morbidity reveal that, in several countries, the process of collecting, recording, and making mortality data available needs to be improved, with regard to underestimation of deaths and their causes, especially in the 5-14 age group, due to their lower visibility.22. Fadel SA, Boschi-Pinto C, Yu S, Reynales-Shigematsu LM, Menon GR, Newcombe L, et al. Trends in cause-specific mortality among children aged 5-14 years from 2005 to 2016 in India, China, Brazil, and Mexico: an analysis of nationally representative mortality studies. Lancet. 2019;393(10176):1119-27. doi:10.1016/s0140-6736(19)30220-x
https://doi.org/10.1016/s0140-6736(19)30... Underreporting of deaths interferes with important epidemiological indicators. Improving the quality of socio-demographic and morbidity and mortality information provides input to the decision-making process in public health service management, for the prevention and control of health conditions and problems characteristic of each region.99. Messias KLM, Bispo Júnior JP, Pegado MFQ, Oliveira LC, Peixoto TG, Sales MAC, et al. Qualidade da informação dos óbitos por causas externas em Fortaleza, Ceará, Brasil. Cienc Saude Colet. 2016;21(7):2319. doi: 10.1590/1413-81232015217.14362016
https://doi.org/10.1590/1413-81232015217...

The evolution of studies and evidence related to mortality in the 5-14 age group allows identification of more appropriate interventions intended to reduce these deaths.2828. Bundy DAP, Silva N, Horton S, Patton GC, Schultz L, Jamison DT, et al. Investment in child and adolescent health and development: key messages from Disease Control Priorities. Lancet. 2018;391(10121):687-99. doi: 10.1016/s0140-6736(17)32417-0
https://doi.org/10.1016/s0140-6736(17)32... The occurrence of outcomes of this nature implies, in addition to years of potential life lost, epidemiological, social, and economic consequences and, in each affected family, they can leave immeasurable emotional scars.

The results of the temporal trend analysis may be related to people’s increased social vulnerability. The fiscal austerity measures implemented in Brazil to control the economic crisis that began in 2015 may have negatively impacted social welfare programs and policies, increasing the number of hospitalizations and preventable deaths among children.2929. Rasella D, Basu S, Hone T, Paes-Sousa R, Ocké-Reis CO, Millett C, et al. Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study. Forecasting child mortality associated with austerity measures in Brazil. PLoS Medicine. 2018;15(5):e1002570. doi: 10.1371/journal.pmed.1002570
https://doi.org/10.1371/journal.pmed.100... The threat to the health and socioeconomic progress achieved so far brings signs of worsening indicators with effect from 2016, as well as the resurgence of diseases that had been eradicated.1111. Marinho CSR, Flor TBM, Pinheiro JMF, Ferreira MAF. Objetivos de Desenvolvimento do Milênio: impacto de ações assistenciais e mudanças socioeconômicas e sanitárias na mortalidade de crianças. Cad Saude Publica. 2020; 36(10):e00191219. doi: 10.1590/0102-311X00191219
https://doi.org/10.1590/0102-311X0019121...

The finding regarding the stationary temporal trend, given the high mortality rates identified, with external causes as the main causes of death in children and adolescents, especially traffic accidents, is a cause for alarm and indicates the urgent need for interventions by the various government sectors as well as civil society organizations in the state of Mato Grosso.

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  • Associated academic work

    This article was derived from the doctoral thesis entitled Mortality among children and adolescents aged 5 to 14 in the state of Mato Grosso: An analysis in the light of social determinants, qualified in April 2021 by Mônia Maia de Lima, at the Fundação Oswaldo Cruz (Fiocruz) Postgraduate Program in Epidemiology, Equity and Public Health in Mato Grosso do Sul, and expected to be defended in 2023.

Publication Dates

  • Publication in this collection
    02 Dec 2022
  • Date of issue
    2022

History

  • Received
    05 Aug 2022
  • Accepted
    10 Oct 2022
Creative Common - by 4.0
Este é um artigo publicado em acesso aberto sob uma licença Creative Commons
Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil Brasília - Distrito Federal - Brazil
E-mail: ress.svs@gmail.com
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