Health transition in Brazil: regional variations and divergence/convergence in mortality.

Gabriel Mendes Borges

doi:10.1590/0102-311x00080316

Abstract

This study analyzes the main characteristics of the health transition in Brazil and its five major regions, using a framework that accounts for regional inequalities in mortality trends. The regional mortality divergence/convergence process is described and discussed by considering the specific contributions of age groups and causes of death in life expectancy variations. Results show that mortality change in Brazil has follow the epidemiologic transition theory to some extent during the period under analysis - for instance, the sharp decline in infant mortality in all regions (first from infectious and parasitic diseases and then from causes associated with the perinatal period) and the increase in the participation of chronic and degenerative diseases as the main cause of death. However, some features of Brazilian transition have not followed the linear and unidirectional pattern proposed by the epidemiologic transition theory, which helps to understand the periods of regional divergence in life expectancy, despite the long-term trends showing reducing regional inequalities. The emergence of HIV/AIDS, the persistence of relatively high levels of other infections and parasitic diseases, the regional differences in the unexpected mortality improvements from cardiovascular diseases, and the rapid and strong variations in mortality from external causes are some of the examples.

Highlights

Epidemiologic transition is a concept first used by Omran 1 to explore the complex change in patterns of health and disease
These life tables were constructed using the information of deaths from the Civil Registration System, vital statistics from the Brazilian Ministry of Health (Brazilian Mortality Information System – SIM), and census population counts for the corresponding years
Life expectancy at birth is often taken as an index of overall mortality, but gives a poor idea of lifespan, since it is heavily affected by infant mortality 29

Summary

Introduction

Epidemiologic transition is a concept first used by Omran 1 to explore the complex change in patterns of health and disease This theory is based on the idea that degenerative and the so-called “man-made” diseases replaced infectious diseases as the primary causes of morbidity and mortality, following these three successive stages: (i) the “Age of Pestilence and Famine”, when mortality is high and fluctuating; (ii) the “Age of Receding Pandemics”, when mortality declines progressively; and (iii) the “Age of Degenerative and Man-Made Diseases”, when mortality continues to decline and eventually approaches stability at a relatively low level. This concept includes a rapid decline in mortality, concentrated mostly at advanced ages and caused by the postponement of mortality from degenerative diseases 2,3

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