Cause-specific mortality for 249 causes in Brazil and states during 1990–2015: a systematic analysis for the global burden of disease study 2015

Elisabeth B. França, Valéria Maria de Azeredo Passos, Deborah Carvalho Malta, Bruce B. Duncan, Antonio Luiz P. Ribeiro, Mark D. C. Guimarães, Daisy M.X. Abreu, Ana Maria N. Vasconcelos, Mariângela Carneiro, Renato Teixeira, Paulo Camargos, Ana Paula S. Melo, Bernardo L. Queiroz, Maria Inês Schmidt, Lenice Ishitani, Roberto Marini Ladeira, Otaliba L. Morais-Neto, Maria Tereza Bustamante-Teixeira, Maximiliano R. Guerra, Isabela Bensenor, Paulo Lotufo, Meghan Mooney, Mohsen Naghavi

Reliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015. We describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states. There was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country's Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI. A widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly.