Neurocysticercosis-related mortality in Brazil, 2000–2011: Epidemiology of a neglected neurologic cause of death

Abstract

Neurocysticercosis (NCC) is an important cause of severe neurological disease mainly in low- and middle-income countries, but data on NCC mortality from endemic areas are scarce. Here we analysed the epidemiological patterns of NCC-related mortality in Brazil. We included all deaths recorded in Brazil between 2000 and 2011, in which NCC was mentioned on death certificates, either as underlying or as associated cause of death. NCC was identified in 1829/12,491,280 deaths (0.015%), 1130 (61.8%) as underlying cause, and 699 (38.2%) as associated cause. Overall age-adjusted mortality rate for the period was 0.97 deaths/1,000,000 inhabitants (95% confidence interval [CI]: 0.83-1.12). The highest NCC-related mortality rates were found in males, elderly, white race/colour and residents in endemic states/regions. Age-adjusted mortality rates at national level decreased significantly over time (annual percent change [APC]: -4.7; 95% CI: -6.0 to -3.3), with a decrease in the Southeast, South and Central-West regions, and a non-significant increasing trend in the North and Northeast regions. We identified spatial and spatiotemporal high-risk mortality clusters located mainly in NCC-endemic areas. Conditions related to the nervous system were the most commonly associated causes of death when NCC was mentioned as an underlying cause, and HIV/AIDS was the main underlying cause when NCC was an associated cause. NCC is a neglected and preventable cause of severe neurologic disease and death with high public health impact in Brazil. There is a clear need to strengthen nationwide epidemiological surveillance and control for the taeniasis/cysticercosis complex.

Mapping the residual incidence of taeniasis and cysticercosis in Colombia, 2009–2013, using geographical information systems: Implications for public health and travel medicine

“…Regarding mortality, a study undertaken in Brazil reported that cysticercosis was identified in 0.016% of all deaths during 2000–2011, and NCC was reported in 91.1% of those deaths due to cysticercosis [46]. The number of deaths due to NCC in our country is unknown, but it supports the idea that we are in risk of death, given the number of cases reported during the study period.…”

The burden of Neglected Tropical Diseases in Brazil, 1990-2016: A subnational analysis from the Global Burden of Disease Study 2016

“…The observed findings indicate gender-specific patterns of infectious disease exposure, as the relationship between gender and risk of infection is often conditioned by different socioeconomic, environmental, occupational, and behavioral factors, as well as access to healthcare services [ 10 , 36 , 37 , 40 ]. In fact, healthcare seeking behavior in Brazilian males is more often retarded, with increased morbidity and severity for some diseases [ 39 , 41 ].…”

Trends and spatial patterns of mortality related to neglected tropical diseases in Brazil

“…Due to the impact of control measures implemented in recent decades, other NTDs with high mortality impact, such as schistosomiasis and leprosy, also presented decreasing trends, as shown previously ( Martins-Melo et al, 2015a , Martins-Melo et al, 2014a , Amaral et al, 2006 ). Other factors not related to specific control programmes may have contributed to the decline in morbidity and mortality, such as increased urbanization, general improvements in housing, socioeconomic and sanitary conditions, and improved access to healthcare services ( Martins-Melo et al, 2012a , Martins-Melo et al, 2014a , Martins-Melo et al, 2016b ).…”

“…While the analysis of underlying causes of death is usually applied as standard, an analysis of multiple causes of death (i.e. underlying and associated causes of death) will facilitate trend and spatial analyses, besides the inclusion of information on NTDs that are usually not selected as an underlying cause of death ( Martins-Melo et al, 2012a , Martins-Melo et al, 2015a , Martins-Melo et al, 2014a , Martins-Melo et al, 2016b ). Knowledge of the geographical distribution and trends of NTD-related deaths in endemic countries is essential for monitoring and evaluation of the impact of disease prevention and control intervention strategies, and the effectiveness of disease-specific control measures ( Martins-Melo et al, 2012a , Martins-Melo et al, 2014a , Martins-Melo et al, 2014b ).…”