COVID-19, Excess Deaths, and Mortality: Evidence from a Municipality in Brazil

We evaluated the hypothesis of an association between excess mortality and political partisanship in Brazil using municipal death certificates registered in the Brazilian Ministry of Health database and first-round electoral results of Presidential elections in 2018 and 2022. Considering the former Brazilian President's stance of discrediting and neglecting the severity of the pandemic, we expect a possible relationship between excessive mortality rates during the COVID-19 health crisis and the number of municipal votes for Bolsonaro. Our results showed that, in both elections, the first-round percentage of municipal votes for Bolsonaro was positively associated with the peaks of excess deaths across Brazilian municipalities in 2020 and 2021. Despite the excess mortality during the pandemic, the political loyalty to Bolsonaro remained the same during the electoral period of 2022. A possible explanation for this is linked to the Brazilian political scenario, which presents an environment of tribal politics and affective polarization.

Correction to: COVID-19, Excess Deaths, and Mortality: Evidence from a Municipality in Brazil

The importance for tuberculosis of mitigating economic crises

Economic recession might worsen health in low-income and middle-income countries with precarious job markets and weak social protection systems. Between 2014-16, a major economic crisis occurred in Brazil. We aimed to assess the association between economic recession and adult mortality in Brazil and to ascertain whether health and social welfare programmes in the country had a protective effect against the negative impact of this recession. In this longitudinal analysis, we obtained data from the Brazilian Ministry of Health, the Brazilian Institute for Geography and Statistics, the Ministry of Social Development and Fight Against Hunger, and the Information System for the Public Budget in Health to assess changes in state unemployment level and mortality among adults (aged ≥15 years) in Brazil between 2012 and 2017. Outcomes were municipal all-cause and cause-specific mortality rates for all adults and across population subgroups stratified by age, sex, and race. We used fixed-effect panel regression models with quarterly timepoints to assess the association between recession and changes in mortality. Mortality and unemployment rates were detrended using Hodrick-Prescott filters to assess cyclical variation and control for underlying trends. We tested interactions between unemployment and terciles of municipal social protection and health-care expenditure to assess whether the relationship between unemployment and mortality varied. Between 2012 and 2017, 7 069 242 deaths were recorded among adults (aged ≥15 years) in 5565 municipalities in Brazil. During this time period, the mean crude municipal adult mortality rate increased by 8·0% from 143·1 deaths per 100 000 in 2012 to 154·5 deaths per 100 000 in 2017. An increase in unemployment rate of 1 percentage-point was associated with a 0·50 increase per 100 000 population per rter (95% CI 0·09-0·91) in all-cause mortality, mainly due to cancer and cardiovascular disease. Between 2012 and 2017, higher unemployment accounted for 31 415 excess deaths (95% CI 29 698-33 132). All-cause mortality increased among black or mixed race (pardo) Brazilians (a 0·46 increase [95% CI 0·15-0·80]), men (0·67 [0·22-1·13]), and individuals aged 30-59 years (0·43 [0·16-0·69] per 1 percentage-point increase in the unemployment rate. No significant association was identified between unemployment and all-cause mortality for white Brazilian, women, adolescents (aged 15-29 years), or older and retired individuals (aged ≥60 years). In municipalities with high expenditure on health and social protection programmes, no significant increases in recession-related mortality were observed. The Brazilian recession contributed to increases in mortality. However, health and social protection expenditure seemed to mitigate detrimental health effects, especially among vulnerable populations. This evidence provides support for stronger health and social protection systems globally. None.

The study of fine particles (PM2.5) and its relationship with health has not been much explored in Brazil. Only with Resolution CONAMA 491/2018 that PM2.5 was nationally considered a pollutant of interest, while the World Health Organization brings guidelines for its environmental concentration since 2006. PM2.5 monitoring in Brazil is still restricted to few Southeast municipalities. From Brazilian time series epidemiological studies that studied PM2.5 and its relationship with health, mainly due to respiratory causes, air quality modeling was mostly employed. This paper aims to survey epidemiological studies already carried out for PM2.5 in Brazil, discussing the use of monitored and modeled data for this purpose. The use of relative risks to estimate excess mortality and morbidity is also evidenced as a direct measure to quantify the benefits associated with air quality improvement, and an estimate for Brazilian municipalities is performed. Finally, the importance of well-designed emission control strategies is emphasized so that the health benefits of improving air quality are indeed significant.

SummaryBackgroundThe world is currently experiencing multiple economic crises due to the COVID-19 pandemic, war in Ukraine, and inflation surge, which disproportionately affect children, especially in low- and middle-income countries (LMICs). We evaluated if the expansion of Social Assistance, represented by Social Pensions (SP) and Conditional Cash Transfers (CCT), could reduce infant and child mortality, and mitigate excess deaths among children in Brazil, one of the LMICs most affected by these economic crises.MethodsWe conducted a retrospective impact evaluation in a cohort of Brazilian municipalities from 2004 to 2019 using multivariable fixed-effects negative binomial models, adjusted for relevant demographic, social, and economic factors, to estimate the effects of the SP and CCT on infant and child mortality. To verify the robustness of the results, we conducted several sensitivity and triangulation analyses, including difference-in-difference with propensity-score matching. These results were incorporated into dynamic microsimulation models to generate projections to 2030 of various economic crises and Social Assistance scenarios.FindingsConsolidated coverage of SP was associated with significant reductions in infant and child mortality rates, with a rate ratio (RR) of 0.843 (95% CI: 0.826–0.861) and 0.840 (95% CI: 0.824–0.856), respectively. Similarly, CCT consolidated coverages showed RRs of 0.868 (95% CI: 0.842–0.849) and 0.874 (95% CI: 0.850–0.899) for infant and child mortality, respectively. The higher the degree of poverty in the municipalities, the stronger the impact of CCT on reducing child mortality. Given the current economic crisis, a mitigation strategy that will increase the coverage of SP and CCT could avert 148,736 (95% CI: 127,148–170,706) child deaths up to 2030, compared with fiscal austerity measures.InterpretationSP and CCT programs could strongly reduce child mortality in LMICs, and their expansion should be considered as an effective strategy to mitigate the impact of the current multiple global economic crises.Funding10.13039/100000865Bill & Melinda Gates Foundation, Grant_Number:INV-027961. 10.13039/501100000265Medical Research Council(MRC-UKRI),Grant_Number:MC_PC_MR/T023678/1.