The economic burden of Chagas disease: A systematic review.

BACKGROUND: Chagas disease (CD) is a neglected disease affecting millions worldwide, yet little is known about its economic burden. This systematic review is part of RAISE project, a broader study that aims to estimate the global prevalence, mortality, and health and economic burden attributable to chronic CD and Chronic Chagas cardiomyopathy. The objective of this study was to assess the main costs associated with the treatment of CD in both endemic and non-endemic countries. METHODS: An electronic search of the Medline, Lilacs, and Embase databases was conducted until 31st, 2022, to identify and select economic studies that evaluated treatment costs of CD. No restrictions on place or language were made. Complete or partial economic analyses were included. RESULTS: Fifteen studies were included, with two-thirds referring to endemic countries. The most commonly investigated cost components were inpatient care, exams, surgeries, consultation, drugs, and pacemakers. However, significant heterogeneity in the estimation methods and presentation of data was observed, highlighting the absence of standardization in the measurement methods and cost components. The most common component analyzed using the same metric was hospitalization. The mean annual hospital cost per patient ranges from $25.47 purchasing power parity US dollars (PPP-USD) to $18,823.74 PPP-USD, and the median value was $324.44 PPP-USD. The lifetime hospital cost per patient varies from $209,44 PPP-USD for general care to $14,351.68 PPP-USD for patients with heart failure. DISCUSSION: Despite the limitations of the included studies, this study is the first systematic review of the costs of CD treatment. The findings underscore the importance of standardizing the measurement methods and cost components for estimating the economic burden of CD and improving the comparability of cost components magnitude and cost composition analysis. Finally, assessing the economic burden is essential for public policies designed to eliminate CD, given the continued neglect of this disease.

Changes in malaria patterns in Brazil over 28 years (1990-2017): results from the Global Burden of Disease Study 2017.

BACKGROUND: This study presents the malaria burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), by analyzing disease burden indicators in federated units of the Legal Amazon and Extra-Amazon regions, as well as describing malaria cases according to Plasmodium species occurring in the country. METHODS: We used estimates from the GBD 2017 to report years of life lost due to premature death (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for malaria in Brazil, grouped by gender, age group, and Brazilian federated unit, from 1990 to 2017. Results are presented as absolute numbers and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UI). RESULTS: At the national level, the age-standardized DALYs rate due to malaria decreased by 92.0%, from 42.5 DALYs per 100,000 inhabitants (95% UI 16.6-56.9) in 1990 to 3.4 DALYs per 100,000 inhabitants (95% UI 2.7-4.7) in 2017. The YLLs were the main component of the total DALYs rate for malaria in 1990 (67.3%), and the YLDs were the main component of the metric in 2017 (61.8%). In 2017, the highest sex-age DALYs rate was found among females in the "< 1-year-old" age group, with a 6.4 DALYs per 100,000 inhabitants (95% UI 1.8-14.7) and among males in the age group of "20 to 24 years old", with a 4.7 DALYs per 100,000 inhabitants (95% UI 3.3-9.9). Within the Brazilian Amazon region, the three federated units with the highest age-standardized DALYs rates in 2017 were Acre [28.4 (95% UI 14.2-39.1)], Roraima [28.3 (95% UI 13.5-40.2)], and Rondônia [24.7 (95% UI 11.4-34.8)]. Concerning the parasite species that caused malaria, 73.5% of the total of cases registered in the period had Plasmodium vivax as the etiological agent. CONCLUSIONS: The results of the GBD 2017 show that despite the considerable reduction in the DALYs rates between 1990 and 2017, malaria remains a relevant and preventable disease, which in recent years has generated more years of life lost due to disability than deaths. The states endemic for malaria in the Amazon region require constant evaluation of preventive and control measures. The present study will contribute to the direction of current health policies aimed at reducing the burden of malaria in Brazil, as knowing the geographical and temporal distribution of the risk of death and disability of this disease can facilitate the planning, implementation, and improvement of control strategies aimed at eliminating the disease.

The burden of tuberculosis and attributable risk factors in Brazil, 1990-2017: results from the Global Burden of Disease Study 2017.

BACKGROUND: Tuberculosis (TB) continues to be an important cause of fatal and non-fatal burden in Brazil. In this study, we present estimates for TB burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017). METHODS: This descriptive study used GBD 2017 findings to report years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of TB in Brazil by sex, age group, HIV status, and Brazilian states, from 1990 to 2017. We also present the TB burden attributable to independent risk factors such as smoking, alcohol use, and diabetes. Results are reported in absolute number and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UIs). RESULTS: In 2017, the number of DALYs due to TB (HIV-negative and HIV-positive combined) in Brazil was 284,323 (95% UI: 240,269-349,265). Among HIV-negative individuals, the number of DALYs was 196,366 (95% UI: 189,645-202,394), while 87,957 DALYs (95% UI: 50,624-146,870) were estimated among HIV-positive individuals. Between 1990 and 2017, the absolute number and age-standardized rates of DALYs due to TB at the national level decreased by 47.0% and 68.5%, respectively. In 2017, the sex-age-specific TB burden was highest among males and in children under-1 year and the age groups 45-59 years. The Brazilian states with the highest age-standardized DALY rates in 2017 were Rio de Janeiro, Pernambuco, and Amazonas. Age-standardized DALY rates decreased for all 27 Brazilian states between 1990 and 2017. Alcohol use accounted for 47.5% of national DALYs due to TB among HIV-negative individuals in 2017, smoking for 17.9%, and diabetes for 7.7%. CONCLUSIONS: GBD 2017 results show that, despite the remarkable progress in reducing the DALY rates during the period, TB remains as an important and preventable cause of health lost to due premature death and disability in Brazil. The findings reinforce the importance of strengthening TB control strategies in Brazil through integrated and multisectoral actions that enable the access to prevention, early diagnosis, and timely treatment, with emphasis on high-risk groups and populations most vulnerable to the disease in the country.

Burden of Chagas disease in Brazil, 1990-2016: findings from the Global Burden of Disease Study 2016.

Chagas disease continues to be an important cause of morbidity, mortality and disability in several Latin American countries, including Brazil. Using findings from the Global Burden of Disease Study 2016 (GBD, 2016), we present years of life lost, years lived with disability, and disability-adjusted life years due to Chagas disease in Brazil, by sex, age group, and Brazilian states, from 1990 to 2016. Results are reported in absolute numbers and age-standardized rates (per 100,000 population) with 95% uncertainty intervals. In 2016, 141,640 disability-adjusted life years (95% uncertainty intervals: 129,065-155,941) due to Chagas disease were estimated in Brazil, with a relative reduction of 36.7% compared with 1990 (223,879 disability-adjusted life years (95% uncertainty intervals: 209,372-238,591)). Age-standardized disability-adjusted life year rates declined at the national level (-69.7%) and in all Brazilian states between 1990 and 2016, but with different regional patterns. The decrease in the disability-adjusted life year rates was driven primarily by a consistent reduction in the years of life lost rates, the main component of total disability-adjusted life years for Chagas disease. The highest fatal and non-fatal burden due to Chagas disease was observed among males, the elderly, and in those Brazilian states encompassing important endemic areas for vector transmission in the past. Despite the consistent reduction in its burden during the period, Chagas disease is still an important and neglected cause of health lost due to premature mortality and disability in Brazil. Efforts should be made to maintain the political interest and sustainability of surveillance and control actions for Chagas disease, prevent the risk of re-emergence of vector transmission in endemic areas, and provide health care to chronically infected individuals, including early diagnosis and treatment interventions.

Burden of leishmaniasis in Brazil and federated units, 1990-2016: Findings from Global Burden of Disease Study 2016.

BACKGROUND: The study presents estimates for the burden of visceral leishmaniasis (VL) and cutaneous and mucocutaneous leishmaniasis (CML) in Brazil and its 27 federated units using data from the Global Burden of Disease Study (GBD) 2016. METHODOLOGY: We report the incidence, years of life lost (YLL), years lived with disability (YLD), and disability-adjusted life years (DALY) for leishmaniasis in Brazil from 1990 to 2016. The metrics are presented as age-standardized rates per 100,000 inhabitants with their respective uncertainty intervals (95%UI) and relative percentages of change. PRINCIPAL FINDINGS: The age-standardized incidence rate of leishmaniasis decreased 48.5% from 1990 (71.0, 95%UI 24.3-150.7) to 2016 (36.5, 95%UI 24.7-50.9), whereas the age-standardized DALY increased 83.6% over the studied period from 12.2 (95%UI 7.9-18.8) to 22.4 (95%UI 13.3-36.2). The age-standardized incidence rate and YLL for VL increased by 52.9% and 108% from 1990 to 2016, respectively. Considering CML, the age-standardized incidence rate and YLD decreased by 51% and 31.8% respectively for the same period. For VL, similar profiles for male and female were observed, with YLL and DALY increasing over time; with males presenting slightly higher values. The highest YLL rates were among "under 1-year old" children, which increased 131.2% from 1990 to 2016. Regarding CML, the highest values of YLD and DALY were verified among males, and YLD values showed a similar profile, with rates increasing with age. The VL burden increased in some states in the Northeast and Southeast regions and decreased for CML in some Northern states. CONCLUSION: The increase of VL burden over the study period might be associated with the difficulties in controlling the disease spread. Information regarding the weight of VL and CML, including the death and disability tolls that they cause, highlights the impact of these neglected diseases on public health and the importance of effective prevention and treatment.

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

BACKGROUND: Neglected Tropical Diseases (NTDs) are important causes of morbidity, disability, and mortality among poor and vulnerable populations in several countries worldwide, including Brazil. We present the burden of NTDs in Brazil from 1990 to 2016 based on findings from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016). METHODOLOGY: We extracted data from GBD 2016 to assess years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for NTDs by sex, age group, causes, and Brazilian states, from 1990 to 2016. We included all NTDs that were part of the priority list of the World Health Organization (WHO) in 2016 and that are endemic/autochthonous in Brazil. YLDs were calculated by multiplying the prevalence of sequelae multiplied by its disability weight. YLLs were estimated by multiplying each death by the reference life expectancy at each age. DALYs were computed as the sum of YLDs and YLLs. PRINCIPAL FINDINGS: In 2016, there were 475,410 DALYs (95% uncertainty interval [UI]: 337,334-679,482; age-standardized rate of 232.0 DALYs/100,000 population) from the 12 selected NTDs, accounting for 0.8% of national all-cause DALYs. Chagas disease was the leading cause of DALYs among all NTDs, followed by schistosomiasis and dengue. The sex-age-specific NTD burden was higher among males and in the youngest and eldest (children <1 year and those aged ≥70 years). The highest age-standardized DALY rates due to all NTDs combined at the state level were observed in Goiás (614.4 DALYs/100,000), Minas Gerais (433.7 DALYs/100,000), and Distrito Federal (430.0 DALYs/100,000). Between 1990 and 2016, the national age-standardized DALY rates from all NTDs decreased by 45.7%, with different patterns among NTD causes and Brazilian states. Most NTDs decreased in the period, with more pronounced reduction in DALY rates for onchocerciasis, lymphatic filariasis, and rabies. By contrast, age-standardized DALY rates due to dengue, visceral leishmaniasis, and trichuriasis increased substantially. Age-standardized DALY rates decreased for most Brazilian states, increasing only in the states of Amapá, Ceará, Rio Grande do Norte, and Sergipe. CONCLUSIONS/SIGNIFICANCE: GBD 2016 findings show that, despite the reduction in disease burden, NTDs are still important and preventable causes of disability and premature death in Brazil. The data call for renewed and comprehensive efforts to control and prevent the NTD burden in Brazil through evidence-informed and efficient and affordable interventions. Multi-sectoral and integrated control and surveillance measures should be prioritized, considering the population groups and geographic areas with the greatest morbidity, disability, and most premature deaths due to NTDs in the country.

Oral health conditions in leprosy cases in hyperendemic area of the Brazilian Amazon.

Leprosy is a hyperendemic chronic condition in the Rondônia State . Despite the significant impact of oral health on the quality of life and clinical evolution of leprosy patients, systematic evaluation of oral health status has been neglected. To analyze the dental-clinical profile, self-perceived oral health and dental health service access of leprosy cases in the municipality of Cacoal in Rondônia State , North Brazil, from 2001 to 2012. A descriptive, cross-sectional study design was performed based on dental evaluation and standardized structured instruments. We investigated clinically assessed and self-perceived oral health status, as well as dental health service access. A total of 303 leprosy cases were included; 41.6% rated their oral health as good, and 42.6% reported being satisfied with their oral health. Self-reported loss of upper teeth was 45.5%. The clinical evaluation revealed that 54.5% had active caries. Most (97.7%) cases reported having been to the dentist at least once in their life and 23.1% used public health services. The poor standard of oral health in this population may increase the risk for leprosy reactions, consequently reducing quality of life. Low access to public health dental services and poor self-perceived oral health reinforce the need to achieve comprehensive health care in this population.

Social determinants of leprosy in a hyperendemic State in North Brazil.

OBJECTIVE: To identify the socioeconomic, demographic, operational, and health service-related factors associated with the occurrence of leprosy in a hyperendemic State in North Brazil. METHODS: This is an ecological study based on secondary data from the Sistema de Informações de Agravos de Notificação in municipalities of the State of Tocantins from 2001 to 2012. Units of analysis were the 139 municipalities of the State. Negative binomial log linear regression models were used to estimate incidence rate ratios. RESULTS: In bivariate analysis, the incidence rate ratios were significantly higher for municipalities with higher income ratio of the poorest 20.0% (1.47; 95%CI 1.19-1.81) and better Municipal Human Development Index (1.53; 95%CI 1.14-2.06). In multivariate analysis, the incidence rate ratios were significantly higher in municipalities with higher proportion of immigrants (1.31; 95%CI 1.11-1.55) and higher proportion of households with waste collection (1.37; 95%CI 1.11-1.69). There was a significant reduction in the incidence rate ratio with increased coverage of the Bolsa Família Program (0.98; 95%CI 0.96-0.99). CONCLUSIONS: Control programs need to focus on activities in municipalities of greater social vulnerability with intersectoral investment for the improvement of the living conditions of the population. OBJETIVO: Identificar fatores socioeconômicos, demográficos, operacionais e de serviços de saúde associados à ocorrência da hanseníase em um estado hiperendêmico do norte do Brasil. MÉTODOS: Estudo ecológico com dados secundários do Sistema de Informações de Agravos de Notificação em municípios do estado do Tocantins de 2001 a 2012. As unidades de análise foram os 139 municípios do estado. Modelos de regressão log linear binomial negativa foram utilizados para estimar as razões de taxas de incidência. RESULTADOS: Na análise bivariada, a razão de taxa de incidência foi significativamente maior para os municípios com maior razão de renda dos 20,0% mais pobres (1,47; IC95% 1,19-1,81) e melhor Índice de Desenvolvimento Humano Municipal (1,53; IC95% 1,14-2,06). Na múltipla, a razão de taxa de incidência foi significativamente superior em municípios com maior concentração de imigrantes (1,31; IC95% 1,11-1,55) e proporção de domicílios com coleta de lixo (1,37; IC95% 1,11-1,69). Houve redução significativa da razão de taxa de incidência com o aumento da cobertura do programa bolsa família (0,98; IC95% 0,96-0,99). CONCLUSÕES: Os programas de controle precisam focar as atividades em municípios de maior vulnerabilidade social com investimentos intersetoriais para a melhoria das condições de vida da população.

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

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.

[Leprosy trends in Tocantins, a hyperendemic State in the North of Brazil, 2001-2012]. / Tendências da hanseníase no Tocantins, um estado hiperendêmico do Norte do Brasil, 2001-2012.

Leprosy is hyperendemic in the State of Tocantins, Brazil. The aim of the study was to analyze trends in leprosy indicators in Tocantins from 2001 to 2012, based on analysis of data from the Information System for Notifiable Diseases (SINAN), including incident cases living in Tocantins. The study calculated leprosy indicators and analyzed time trends using polynomial regression. There was a significant downward trend in overall case detection (R2 = 0.40; p < 0.05) and proportion of paucibacillary cases (R2 = 0.81). Detection rates remained stable in individuals < 15 years (R2 = 0.48; p > 0.05) and cases with grade 2 physical disability (R2 = 0.37; p > 0.05), as did the proportion of grade 2 cases (R2 = 0.49; p > 0.05). There were significant increases in the proportions of cases with grade 1 disability (R2 = 0.82; p < 0.05) and multibacillary cases (R2 = 0.81; p < 0.05). Tocantins has regions with high transmission and late diagnosis of leprosy, indicating heterogeneous dissemination of the disease in the time trend analysis.

Tendências da hanseníase no Tocantins, um estado hiperendêmico do Norte do Brasil, 2001-2012 / Leprosy trends in Tocantins, a hyperendemic State in the North of Brazil, 2001-2012 / Tendencias de la lepra en Tocantins, un estado hiperendémico del norte de Brasil, 2001-2012

A hanseníase é hiperendêmica no Estado do Tocantins, Brasil. O objetivo do estudo foi analisar as tendências dos indicadores da hanseníase no Tocantins em 2001-2012. Análise de dados advindos do Sistema de Informação de Agravos de Notificação (SINAN). Incluíram-se casos novos de residentes no Tocantins. Calcularam-se os indicadores da hanseníase e analisaram-se as tendências temporais por meio de regressão polinomial. Houve tendência significativa e decrescente para a detecção geral (R2 = 0,40; p < 0,05) e proporção de casos paucibacilares (R2 = 0,81). Foi estável a detecção em < 15 anos (R2 = 0,48; p > 0,05), detecção de casos com grau 2 de incapacidade física (R2 = 0,37; p > 0,05) e proporção de casos com grau 2 (R2 = 0,49; p > 0,05). Houve aumento significativo para a proporção de casos com grau 1 de incapacidade (R2 = 0,82; p < 0,05) e proporção de casos multibacilares (R2 = 0,81; p < 0,05). O Tocantins apresenta regiões com alta transmissão e diagnóstico tardio da hanseníase, apontando a expansão da doença de forma heterogênea na análise temporal.

Leprosy is hyperendemic in the State of Tocantins, Brazil. The aim of the study was to analyze trends in leprosy indicators in Tocantins from 2001 to 2012, based on analysis of data from the Information System for Notifiable Diseases (SINAN), including incident cases living in Tocantins. The study calculated leprosy indicators and analyzed time trends using polynomial regression. There was a significant downward trend in overall case detection (R2 = 0.40; p < 0.05) and proportion of paucibacillary cases (R2 = 0.81). Detection rates remained stable in individuals < 15 years (R2 = 0.48; p > 0.05) and cases with grade 2 physical disability (R2 = 0.37; p > 0.05), as did the proportion of grade 2 cases (R2 = 0.49; p > 0.05). There were significant increases in the proportions of cases with grade 1 disability (R2 = 0.82; p < 0.05) and multibacillary cases (R2 = 0.81; p < 0.05). Tocantins has regions with high transmission and late diagnosis of leprosy, indicating heterogeneous dissemination of the disease in the time trend analysis.

La lepra es hiperendémica en el estado de Tocantins, Brasil. El objetivo del estudio fue analizar las tendencias de los indicadores de la lepra en Tocantins, 2001-2012. El análisis de los datos procedentes de las enfermedades de declaración obligatoria en el Sistema de Información sobre Dolencias Notificables (SINAN) incluía nuevos casos que viven en Tocantins. Se calcularon los indicadores de la lepra y se analizaron las tendencias temporales de regresión polinómica. Hubo una significativa tendencia a la baja, la detección general (R2 = 0,40; p < 0,05) y el número de casos paucibacillar (R2 = 0,81). Fue una detección estable en < 15 años (R2 = 0,48; p > 0,05), la detección de los casos con discapacidad grado 2 (R2 = 0,37; p > 0,05) y la proporción de casos con grado 2 (R2 = 0,49; p > 0,05 ). Hubo un aumento significativo en la proporción de casos con discapacidad grado 1 (R2 = 0,82; p < 0,05) y la proporción de casos multibacilares (R2 = 0,81; p < 0,05).Tocantins cuenta con regiones de alta transmisión y un diagnóstico tardío de la lepra que apunta a la expansión heterogénea de la enfermedad en el análisis temporal.

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012.

OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women's health, especially to reproductive aspects and attention to pre- and post-abortion processes, are necessary and urgent strategies to be implemented in the country.

Temporal trends and spatial distribution of unsafe abortion in Brazil, 1996-2012 / Tendência temporal e distribuição espacial do aborto inseguro no Brasil, 1996-2012 / Tendência temporal e distribuição espacial do aborto inseguro no Brasil, 1996-2012

OBJECTIVE To analyze temporal trends and distribution patterns of unsafe abortion in Brazil. METHODS Ecological study based on records of hospital admissions of women due to abortion in Brazil between 1996 and 2012, obtained from the Hospital Information System of the Ministry of Health. We estimated the number of unsafe abortions stratified by place of residence, using indirect estimate techniques. The following indicators were calculated: ratio of unsafe abortions/100 live births and rate of unsafe abortion/1,000 women of childbearing age. We analyzed temporal trends through polynomial regression and spatial distribution using municipalities as the unit of analysis. RESULTS In the study period, a total of 4,007,327 hospital admissions due to abortions were recorded in Brazil. We estimated a total of 16,905,911 unsafe abortions in the country, with an annual mean of 994,465 abortions (mean unsafe abortion rate: 17.0 abortions/1,000 women of childbearing age; ratio of unsafe abortions: 33.2/100 live births). Unsafe abortion presented a declining trend at national level (R2: 94.0%, p < 0.001), with unequal patterns between regions. There was a significant reduction of unsafe abortion in the Northeast (R2: 93.0%, p < 0.001), Southeast (R2: 92.0%, p < 0.001) and Central-West regions (R2: 64.0%, p < 0.001), whereas the North (R2: 39.0%, p = 0.030) presented an increase, and the South (R2: 22.0%, p = 0.340) remained stable. Spatial analysis identified the presence of clusters of municipalities with high values for unsafe abortion, located mainly in states of the North, Northeast and Southeast Regions. CONCLUSIONS Unsafe abortion remains a public health problem in Brazil, with marked regional differences, mainly concentrated in the socioeconomically disadvantaged regions of the country. Qualification of attention to women’s health, especially to reproductive aspects and attention to pre- and post-abortion processes, ...

OBJETIVO Analisar tendências temporais e padrões de distribuição espacial do aborto inseguro no Brasil. MÉTODOS Estudo ecológico realizado com base nos registros das internações hospitalares de mulheres por abortamento no Brasil, no período de 1996-2012, obtidos do Sistema de Informações Hospitalares do Ministério da Saúde. Estimou-se o número de abortos inseguros segundo local de residência, utilizando-se técnicas de estimativas indiretas. Foram calculados os indicadores: razão de aborto inseguro por 100 nascidos vivos e coeficiente de aborto inseguro por 1.000 mulheres em idade fértil. As tendências temporais foram analisadas por regressão polinomial e a distribuição espacial utilizando os municípios brasileiros como unidade de análise. RESULTADOS Foram registradas 4.007.327 internações hospitalares por abortamento no Brasil no período. Estimou-se um total de 16.905.911 abortos inseguros, com média anual de 994.465 abortos (coeficiente médio de aborto inseguro de 17,0 abortos/1.000 mulheres em idade fértil e razão de 33,2 abortos inseguros/100 nascidos vivos). O aborto inseguro apresentou tendência de declínio em nível nacional (R2: 94,0%; p < 0,001), com padrões desiguais entre as regiões. As regiões Nordeste (R2: 93,0%; p < 0,001), Sudeste (R2: 92,0%; p < 0,001) e Centro-Oeste (R2: 64,0%; p < 0,001) apresentaram tendência de declínio, enquanto a região Norte (R2: 39,0%; p = 0,030), tendência de aumento, e a região Sul (R2: 22,0%; p = 0,340), de estabilidade. A análise espacial identificou a presença de clusters de municípios com altos valores de abortos inseguros, localizados especialmente em estados das regiões Norte, Nordeste e Sudeste. CONCLUSÕES O aborto inseguro se mantém ...