Related mortality will hansenÃase and its association of diabetes mellitus and systemic arterial hypertension in Brazilian population 1999-2007 / Mortalidade relacionada à hansenÃase e sua associaÃÃo com diabetes mellitus e hipertensÃo arterial sistÃmica na populaÃÃo brasileira, 1999-2007

AUTOR(ES)
FONTE

IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia

DATA DE PUBLICAÇÃO

30/03/2011

RESUMO

Leprosy is still a public health problem in several countries. The low case fatality rate from leprosy may be responsible for an increased importance of chronic non-communicable diseases (NCD) in this context. The objective of the present study was to characterize patterns of mortality related to leprosy, and the association of leprosy-related deaths with diabetes mellitus (DM) and systemic arterial hypertension (SAH) in Brazil. A quantitative study was performed, based on official data from death certificates registered by the national Mortality Information System (Sistema de InformaÃÃo de Mortalidade). We analyzed all deaths due to leprosy as underlying, contributing and multiple causes, 1999-2007. The study consisted of four analytical blocks: 1) general description of deaths according to cause of death and their spatial distribution; 2) analysis of deaths according to demographic and clinical variables, and calculation of disease-specific mortality rates (DSM, per 100,000 inhabitants) and proportional mortality (PM) from leprosy as underlying, contributing and multiple causes of death; 3) description of contributing causes of death associated with leprosy as underlying cause of death; 4) identification of the interaction between chronic NCD, DM and SAH in those who died from leprosy as underlying cause. Of a total of 8,942,217 deaths in the study period, leprosy was present in 5,729 (0.06%) death certificates as multiple causes, and in 2,242 (39.1%) as underlying cause of death. The distribution of deaths (multiple causes) in Brazilâs regions was: Southeast (38.6%), Northeast (25.9%), Central-West (14.4%), South (10.7%) and North (10.4%). The majority occurred in males (70.5%), individuals >70 years age (40.7%), residents of capital cities (78%) and in patients with lepromatous leprosy (64.9%). Temporal trends (1999-2007) of PM and DSM as underlying/multiple causes were stable, with values of 0.03/0.06 and 0.14/0.36, respectively. The highest DSM from leprosy as multiple causes of death were observed in individuals >70 years (3.94), males (0.51), residents from Central-West (0.75) and those living in capital cities (0.37). In logistic regression analysis, demographic variables significantly associated with death from leprosy as underlying cause in relation to all deaths were: male sex (adjusted OR 1.92; 95% CI 1.75-2.11); resident in a capital city (adjusted OR 1.39; 95% CI 1.25-1.54); and age in years (adjusted OR 1.01; 95% CI: 1.00-1.01); all p<0.001. The South and Southeast regions were associated with lower chance of death from leprosy (adjusted OR 0.41; 95% CI 0.38-0.45; p<0.001). The following contributing causes of death were significant risk factors for death from leprosy as an underlying cause: adverse events to drugs (RR 208.5; 95% CI 126.3-344.1), toxic liver disease (RR 79.3; 95% CI 52.6-119.6); lower limb ulcers (RR 33.9; 95% CI 23.5-48.7); renal failure (RR 2.2; 95% CI 1.9-2.5); and septicemia (RR 2.1; 95% CI: 2.0-2.3); all p<0.001. Of the immediate, intermediate and contributing causes of death, two chapters of ICD-10 were prominent, XVIII/I, I/IX e I/IX. In the analysis of interaction between NCD, DM and SAH in those who died from leprosy as underlying cause, only septicemia showed higher occurrence of DM-related deaths (RR 1.67; 95% CI 1.26-2.20, p<0.001). Septicemia (RR 0.14; 95% CI 0.05-0.36, p<0.01) and pneumonia (RR 0.16; 95% CI 0.04-0.62, p<0.01) were significantly less frequent in deaths related to SAH. The data show that in the context of demographic and epidemiologic transition, leprosy should be considered a chronic disease. In addition, the data reflect the successful measures done by the state and national leprosy control programs to control the endemic. On the other hand, areas for improvement are emphasized. Leprosy continues being a neglected disease associated with poverty, with considerable regional differences in Brazil

ASSUNTO(S)

saude publica hansenÃase brasil epidemiologia morbidade mortalidade

ACESSO AO ARTIGO

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