Changes in childhood stroke mortality from 1990 to 2019 in Brazil and its federative units

Abstract

This research analyzed the temporal trend of stroke mortality in children aged 0–14 years, from 1990 to 2019, in Brazil and its federative units. This ecological study used data from the Global Burden of Disease, a study led by the Institute for Health Metrics and Evaluation. Stroke definition considered the International Classification of Diseases according to codes G45, G46, and I60–I69. Age-standardized mortality rates and the mean annual percentage change (APC) in mortality rates were estimated. Stroke mortality trends decreased, with an APC of − 3.9% (95% CI − 4.5; − 3.3; p < 0.001). Reducing trends were found in all but two states, where they were stationary. Maranhão (− 6.5%; 95% CI − 7.6; − 5.4; p < 0.001) had the greatest reduction and Rondônia, the smallest (− 1.2%; 95% CI − 2.3; − 0.1, p = 0.027). Decrease was more important in children < 5 (− 5.8%; 95% CI − 6.3; − 5.2; p < 0.001) compared to 5–14 years old (− 2.1%; 95% CI − 2.9; − 1.3; p < 0.001); additionally, it was greater in girls (− 4.1%; 95% CI − 4.6; − 3.5; p < 0.001) than in boys (− 3.8%; 95% IC − 4.5; − 3.1; p < 0.001). Ischemic stroke had the highest APC (− 6.1%; 95% CI − 6.8; − 5.3; p < 0.001), followed by intracranial hemorrhage (− 5.3%; 95% CI − 6.1; − 4.5; p < 0.001) and subarachnoid hemorrhage (− 2.7%; 95% CI − 3.3; − 2.1; p < 0.001). Largest reductions were seen in states with more vulnerable socioeconomic contexts. The stationary trends and lowest APCs were concentrated in the northern region, which had greater impact of diseases and less favorable outcomes.