Trends in asthma mortality in the 0- to 4-year and 5- to 34-year age groups in Brazil

Abstract

Objective: To provide an update on trends in asthma mortality in Brazil for two age groups: 0-4 years and 5-34 years.Methods: Data on mortality from asthma, as defined in the International Classification of Diseases, were obtained for the 1980-2014 period from the Mortality Database maintained by the Information Technology Department of the Brazilian Unified Health Care System. To analyze time trends in standardized asthma mortality rates, we conducted an ecological time-series study, using regression models for the 0- to 4-year and 5- to 34-year age groups.Results:There was a linear trend toward a decrease in asthma mortality in both age groups, whereas there was a third-order polynomial fit in the general population.Conclusions: Although asthma mortality showed a consistent, linear decrease in individuals ≤ 34 years of age, the rate of decline was greater in the 0- to 4-year age group. The 5- to 34-year group also showed a linear decline in mortality, and the rate of that decline increased after the year 2004, when treatment with inhaled corticosteroids became more widely available. The linear decrease in asthma mortality found in both age groups contrasts with the nonlinear trend observed in the general population of Brazil. The introduction of inhaled corticosteroid use through public policies to control asthma coincided with a significant decrease in asthma mortality rates in both subsets of individuals over 5 years of age. The causes of this decline in asthma-related mortality in younger age groups continue to constitute a matter of debate.

The paradox of asthma: neglect, burden, and big data

“…The results of the two aforementioned studies 7 , 8 corroborate the volume, veracity, and value of the DATASUS “big data” in epidemiological surveys showing past and present asthma burden and neglect in Brazil. Although asthma-related hospitalizations and deaths have decreased by nearly 70% in children under 5 years of age-which might be due to an overall reduction in child mortality in Brazil-the deaths of 3-5 patients/day (depending on the age bracket) and the 100,000 hospitalizations per year are sufficient cause for concern to warrant social media campaigns such as those launched by the Global Initiative for Asthma in Brazil in order to raise awareness of the problem.…”

“…In the previous and current issues of the JBP, two studies used the DATASUS database (particularly the TabWin program) in order to assess trends in hospital costs and in-hospital morbidity, as well as asthma mortality, in the period between the end of the 20th century and a few years ago in Brazil. Graudenz et al 7 showed a marked (65%) decrease in the asthma mortality rate in the 0- to 34-year age bracket; however, the asthma mortality rate remained at 9-10% in the 5- to 35-year age bracket, with a remarkable decrease in children under 5 years of age (from 3.5 deaths per 100,000 population to 0.5 deaths per 100,000 population). However, the absolute number of deaths in the 0- to 35-year age bracket remained at 2,000-2,500 per year, with a disturbing mean of more than 6 asthma-related deaths per day during the study period.…”

“…There is no doubt that the DATASUS database and other public databases in Brazil are essential resources for generating knowledge and providing the basis for public health policies, as demonstrated in the aforementioned studies. 7 , 8 Analysis of data from the DATASUS database should be encouraged in graduate programs because access to the database is open and free, being less costly than population-based surveys. In a recent ecological study of time trends in all Brazilian municipalities, the authors analyzed data collected from the DATASUS database and found that asthma morbidity and mortality were associated with the proportion of individuals living in urban areas, 11 a finding that allows the planning of household and community strategies to combat asthma.…”

Asthma mortality among Mexican children: Rural and urban comparison and trends, 1999‐2016

“…This is consistent with the findings of a Brazilian study covering the period 1980 to 2014 where asthma mortality decreased in children aged 0 to 4 and in a combined group of children and adults (5‐35 years). Although the reduction in asthma mortality was more prominent in the 0 to 4 group 22 …”

The zero impact of the Vehicle Inspection Program on public health in São Paulo, SP

“…Regarding hospital mortality due to asthma among children under 14 years old, we observed an upward trend from 2011 to 2014. The increase in the number of deaths attributable to asthma may be related to pollutants, but, more often, it reflects the lack of access to appropriate medications and therapies 19 . As we observed no change after inspection suspension, it is more likely a temporal coincidence.…”