Abstract
Using five cause-specific mortality data sourced by the Brazilian Ministry of Health, and over 17 years period, we applied Bayesian spatio-temporal models on 644 municipalities of the state of São Paulo, using logistic model to the binary outcome that specifies whether or not the death was from a specific cause. We modeled the temporal mortality effects using B-splines, while the spatial components were considered through Gaussian and Markov random field, and inference was based on Markov chain Monte Carlo simulation. The results demonstrate consistent downward trend in mortality from infectious and parasitic diseases and external causes, while those from neoplasms and respiratory are rising. Cardiovascular is the only cause-specific death that is kept constant in time. All the causes of death considered show heterogeneous spatial and temporal variations among the municipalities, which sometimes change considerably within successive years. Mortality from infectious diseases clustered around the Northwestern municipalities in 2000, but changes to the Southeastern part in 2016, a similar development as external death causes. The study identifies areas with increased and decreased odds mortality and could be useful in disease monitoring, especially if we consider small spatial units.
Highlights
Patterns of morbidity and mortality among societies are usually reflections of health care systems, personal lifestyle behavior and the general living conditions of the people, which often vary from one locality to another
As addressed by other studies[20], we examined the changes in death profiles, from five ICD-10 chapters, that mainly affect the country namely: infectious and parasitic diseases, cardiovascular diseases, neoplasms, respiratory infections, and external causes, using yearly data from 2000 to 2016
Mortality due to infectious diseases and external causes reduced drastically over the years, though a slight rise is seen in the case of external causes between year 2000 and 2001, and 2010 and 2011
Summary
Patterns of morbidity and mortality among societies are usually reflections of health care systems, personal lifestyle behavior and the general living conditions of the people, which often vary from one locality to another. The contributions of environmental and geographical settings to the survival chances of people are often enormous[1]. The effects of these factors are accumulated over time and they impact disproportionately on the well-being of people of neighboring locations. These effects, in turn, lead to spatial heterogeneity in risks of morbidity and mortality. Brazil has undergone structural and economic changes leading to health care reforms that birthed the Brazilian Universal Health System (SUS). A second Law No 8,142, from the same year, established that the community may participate in SUS management, and it regulated the intergovernmental transfers of financial resources in the social area[2]
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