Trends of chronic kidney disease mortality rates and pesticide expenditure in Brazil from 1996-2015.

Abstract

Background/Aim: Emerging evidence suggests that exposure to pesticides may be contributing to the burden of chronic kidney disease (CKD) epidemic among agricultural communities. We investigated the association of pesticide expenditure with trends in CKD mortality rates in Southern and Southeastern Brazil from 1996-2015. Methods: We calculated CKD mortality rates between 1996-2015 for all Brazilian counties of the Southeast and South regions. We divided the total number of deaths due to CKD (ICD10: N18) by the total resident population between 1996-2015 and multiplied per 100,000. Temporal trend analyses and average annual percentage change (AAPC) were obtained for age (20-39, 40-59, and ≥60), sex, region (South and Southeast), place of residence (urban and rural counties) and tertiles of per capita pesticide expenditure (1996) using the joinpoint regression model. Results: The overall trend of CKD mortality rates maintained constant between 1996-2015 (AAPC: 0.1; 95%CI: -0.9-1.1), while a slight increase in rural (AAPC:1.1; 95%CI: -0.2-2.4) and a decrease in urban (AAPC: -0.8; 95%CI: 1.7-0.0) counties was observed. The increase in rural counties was higher among women (AAPC: 1.9; 95%CI: 1.3-2.5) compared to men ages 60 and older (AAPC: 1.4; 95%CI: 0.8-2.0). Furthermore, the trend in CKD mortality rates increased by tertiles of pesticides expenditure (AAPCT1:0.3; 95%CI: -1.2-1,8, AAPCT2: 1.9; 95%CI: 0.7-3.2 and AAPCT3: 2.8; 95%CI: 0.6-5.0). This trend was similar when limited to the older population (AAPCT1: 1.2; 95%CI: 0.4-1.9; AAPCT2: 1.7; 95%CI: 1.0-2.5 and AAPCT3: 2.2; 95%CI: 1.7-2.7). Sensitivity analysis confirmed a different behavior for diseases unrelated to pesticide exposure. Conclusions: Against a background of rising CKD mortality rates, the overall trend of CKD mortality rates remained constant over the study period in Southern and Southeastern Brazil. However, pesticide expenses and age stratifications suggest that pesticides use may be related to CKD mortality trends.