Mortality Information System Research Articles

Ethnic disparities in breast cancer patterns in Brazil: examining findings from population-based registries.

To investigate breast cancer (BC) incidence and mortality rates among specific racial groups in Brazil. BC incidence was evaluated from 2010 to 2015, using Brazilian Population-Based Cancer Registries, incorporating crude ratios and annual average percentage change (AAPC). Clinical and sociodemographic data from 2000 to 2019 were obtained from Hospital-Based Cancer Registries. Mortality data from 2000 to 2020 were sourced from the National Mortality Information System, comparing White women and Black women. Across 13 Brazilian registries, 70,896 new BC cases were reported from 2010 to 2015. The median BC incidence rate was notably higher for White women (101.3 per 100,000) compared to Black women (59.7 per 100,000). In the general population, non-significant decrease in annual BC incidence was observed (AAPC = - 1.2; p = 0.474). Black women were more likely to live in underdeveloped areas, have lower education levels, live without a partner, and have higher alcohol consumption as compared to White women. A higher proportion of Black women received advanced-stage diagnoses (60.1% versus 50.6%, p < 0.001). BC-related mortality analysis showed 271,002 recorded deaths, with significant increase in BC-specific mortality rates in both racial groups. Black women displayed an AAPC of 2.3% (p < 0.001), while White women demonstrated a moderately elevated AAPC of 0.6% (p < 0.001). This study underscores the need for targeted policies to address disparities in access to early detection and proper treatment, particularly for Black women in underprivileged regions, aiming to improve the survival rates of Brazilian women grappling with BC.

Assessment of the impact of Uber system implementation on mortality from traffic injuries in Brazilian capital cities.

The rapid expansion of Uber Technologies, Inc.'s ride-sharing, courier service, and food delivery system and e-hailing applications has been transforming the logistics network and urban mobility around the world. We aimed to evaluate the impact of the Uber system on traffic injury (TI) mortality during its implementation in Brazilian capital cities. A quasiexperimental design of interrupted time series was used. The monthly mortality rates for TI standardized by age were analyzed. The date of availability of the Uber app, specific to each capital, was considered the start date. Data from the Brazilian Mortality Information System and the Brazilian Institute of Geography and Statistics were used. For the data analysis, from an interrupted time-series design, autoregressive integrated moving average (ARIMA) models with a transfer function were fitted. In 92.6% (n=25) of Brazilian capitals, there was no impact of Uber system implementation, 12 months after the start of its activities, on TI mortality. A reduction in mortality from this cause was observed after the system was implemented in Belo Horizonte and Rio de Janeiro. The impact on TI mortality was progressive and continuous in both. More studies are needed to establish the factors associated with the inequalities observed in the impact of Uber system implementation between different locations and the heterogeneity of effects.

Suicide mortality in Paraíba (Brazil) between 2010 and 2021 and the impact of the Covid-19 pandemic: an ecological study

This study aims to analyze the rates of suicide mortality in the State of Paraíba (Brazil) between 2010 and 2021, describing the impact of the COVID-19 pandemic on the suicide rates in 2020 and 2021. We here proposed a mixed longitudinal - ecological study that employed secondary data provided by the Mortality Information System regarding deaths from self-harm in 2010 - 2021 in the state of Paraíba. It also included cases of death from intentional self-inflicted injuries, coded X60-X84 according to the 10th International Classification of Diseases (ICD-10). A linear regression was used to evaluate the relationship between the mortality rates and the years analyzed and also to calculate the predicted values for 2020 and 2021 based on findings from previous years. Although the suicide rates observed in 2020 and 2021 were higher than expected (6.387 and 6.789, respectively), they were still within the confidence interval. The present study found a constant increase in the suicide mortality during the period studied, even if without a significant difference between the expected trends according to previous years and those observed during the COVID-19 pandemic.

Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region.

To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program. A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system. 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction &lt;40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death. Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

Quantifying gaps in the tuberculosis care cascade in Brazil: A mathematical model study using national program data.

In Brazil, many individuals with tuberculosis (TB) do not receive appropriate care due to delayed or missed diagnosis, ineffective treatment regimens, or loss-to-follow-up. This study aimed to estimate the health losses and TB program costs attributable to each gap in the care cascade for TB disease in Brazil. We constructed a Markov model simulating the TB care cascade and lifetime health outcomes (e.g., death, cure, postinfectious sequelae) for individuals developing TB disease in Brazil. We stratified the model by age, human immunodeficiency virus (HIV) status, drug resistance, state of residence, and disease severity, and developed a parallel model for individuals without TB that receive a false-positive TB diagnosis. Models were fit to data (adult and pediatric) from Brazil's Notifiable Diseases Information System (SINAN) and Mortality Information System (SIM) for 2018. Using these models, we assessed current program performance and simulated hypothetical scenarios that eliminated specific gaps in the care cascade, in order to quantify incremental health losses and TB diagnosis and treatment costs along the care cascade. TB-attributable disability-adjusted life years (DALYs) were calculated by comparing changes in survival and nonfatal disability to a no-TB counterfactual scenario. We estimated that 90.0% (95% uncertainty interval [UI]: 85.2 to 93.4) of individuals with TB disease initiated treatment and 10.0% (95% UI: 7.6 to 12.5) died with TB. The average number of TB-attributable DALYs per incident TB case varied across Brazil, ranging from 2.9 (95% UI: 2.3 to 3.6) DALYs in Acre to 4.0 (95% UI: 3.3 to 4.7) DALYs in Rio Grande do Sul (national average 3.5 [95% UI: 2.8 to 4.1]). Delayed diagnosis contributed the largest health losses along the care cascade, followed by post-TB sequelae and loss to follow up from TB treatment, with TB DALYs reduced by 71% (95% UI: 65 to 76), 41% (95% UI: 36 to 49), and 10% (95% UI: 7 to 16), respectively, when these factors were eliminated. Total health system costs were largely unaffected by improvements in the care cascade, with elimination of treatment failure reducing attributable costs by 3.1% (95% UI: 1.5 to 5.4). TB diagnosis and treatment of false-positive individuals accounted for 10.2% (95% UI: 3.9 to 21.7) of total programmatic costs but contributed minimally to health losses. Several assumptions were required to interpret programmatic data for the analysis, and we were unable to estimate the contribution of social factors to care cascade outcomes. In this study, we observed that delays to diagnosis, post-disease sequelae and treatment loss to follow-up were primary contributors to the TB burden of disease in Brazil. Reducing delays to diagnosis, improving healthcare after TB cure, and reducing treatment loss to follow-up should be prioritized to improve the burden of TB disease in Brazil.

Incomplete recording of race/colour in health information systems in Brazil: time trend, 2009-2018.

This ecological study of time trends and multiple groups evaluated incompleteness in the race/colour field of Brazilian health information system records and the related time trend, 2009-2018, for the diseases and disorders most prevalent in the black population. The Romero and Cunha (2006) classification was applied in order to examine incompleteness using secondary data from Brazil's National Notifiable Diseases System, Hospital Information System and Mortality Information System, by administrative regions of Brazil, while percentage underreporting and time trend were calculated using simple linear regression models with Prais-Winsten correction (p-value<0.05). All records scored poorly except those for mortality from external causes (excellent), tuberculosis (good) and infant mortality (fair). An overall downward trend was observed in percentage incompleteness. Analysis by region found highest mean incompleteness in the North (30.5%), Northeast (33.3%) and Midwest (33.0%) regions. The Southeast and Northeast regions showed the strongest downward trends. The findings intended to increase visibility on the implications of the race/color field for health equity.

Mortality due to cervical cancer in a capital of the brazilian Amazon

Objective: To analyze mortality from cervical cancer in the city of Belém-Pará-Brazil. Methods: Epidemiological, cross-sectional, descriptive study with data on mortality from cervical cancer for the period 2013-2020, obtained from the Mortality Information System and made available by the Pará State Department of Public Health. All reported deaths of women living in the municipality of Belém were included. Data were obtained in June 2022. A descriptive analysis of the socio-epidemiological profile was carried out; mortality rates were calculated according to the year of occurrence; and trend analysis was performed using simple linear regression. Results: A total of 695 deaths were analyzed, with the highest proportion identified in women aged between 50 and 69 years old (43%; n=149), housewives (59%; n=410), single women (39.9%; n=277) and low education, proportionally. The rates were high and tended to increase in the series studied. The period 2015-2017 stands out as the most significant indices. Conclusion: The evidence obtained points to a higher proportion of deaths from CC among women with low education, housewives, single women, aged between 50 and 69 years old. The findings suggest improving actions to promote women's health and prevent cervical cancer, with improvements in screening actions for the disease.

Mental health and collective health: an epidemiological analysis of suicides in Brazil

To analyze the temporal behavior of suicides. Cross-sectional, ecological study on suicide registered in the mortality information system. Kernel analysis was used in Quantum Geographic Information System (QGIS), TerraView and the Chi-Square test in R software. In twenty years there were 195,046 suicides, with a mortality rate of 4.94, mainly in the southeast, among males with significant growth, low education, single, aged 20-29, white and by hanging. In the kernel map, the south, southeast and northeast regions concentrate the largest clusters. In part of the South and in the interior of the Southeast there was a reduction in mortality. This study provides information about the worrying scenario of suicide in Brazil over twenty years, identifying the areas and characteristics with the greatest risks. To reduce this suicide scenario, effective public actions and a quality health care network that provides comprehensive, equitable and universal assistance to the mental health of individuals are essential, creating conditions to meet the needs of the social body.

Alzheimer’s disease in Brazil: the influence of sex on the mortality profile

Alzheimer’s disease (AD) is the most common cause of dementia in the elderly, and a leading cause of mortality in developed countries. It is essential that healthcare professionals know in more detail the mortality profile of this dementia so that they can offer a better quality of life to patients. The general objective of this study was to evaluate the AD mortality profile in Brazil, from 2010 to 2019, and the influence of sex and gender on this profile. This study is descriptive in nature with a quantitative approach, using secondary data, and during the presentation of this data, information reproduced by scientific articles on the topic will also be presented. The data were collected from the Mortality Information System (SIM), created by the Information Technology Department of the Unified Health System (DATASUS). The bibliographic survey was carried out in the Scielo and Pubmed databases. We conclude that females present more accelerated cognitive decline compared to males, and there is also a genotypic issue involved. In this way, we can affirm that sex and gender influence the clinical progression of AD, providing opportunities for measures to be taken early regarding these data, such as public health policies to combat AD.

Gender and homicides in Paraná: a descriptive analysis from an ecological perspective (2018-2021)

Violence is considered a public health issue as it is one of the main causes of premature mortality in the world, resulting in several impacts that affect the population. This is an ecological time series study on homicides between 2018 and 2021 carried out in the State of Paraná. Data were extracted from the Mortality Information System (SIM) by categories: gender, age, race/color, marital status, place of occurrence and IDC (X85 to Y09 and Y35 to Y36). Data analysis shows that 9,169 violent deaths occurred in the state during the period, 91.2% (8,365) of which were male and 8.7% (801) were female. Considering only the age group, the majority of homicides are between the ages of 20 and 29, totaling 3,349 deaths in the last 4 years, 93.3% (3,123) of male gender and 6.7% (226) of female gender. In this same age group, there is the largest percentage difference between genders. A greater similarity was observed between 5 and 9 years old, with the percentage of both genders equal to 50% (7). The data shows that the highest rate of female homicides, 36.1% (289) occurred at home, while 42.7% (3,572) of male deaths occurred on public roads. Firearm discharge (ICD: X93, X94 and X95) is the main cause of death for both genders, with males accounting for 61.5% (5,142) and females 43.6% (349) of the cases. Better understanding the categories that lead to homicide is a fundamental step towards creating more effective public policies to minimize homicides in Brazil and around the world.

Levantamento de dados sobre os métodos diagnósticos de câncer de mama no Brasil em mulheres de 40 a 59 anos

The present study aimed to analyze the diagnostic methods provided by the SUS that are carried out in Brazil for the BC and to explain the relevance of these approaches in the early detection of this pathology. This was a longitudinal, retrospective and quantitative study, where data was collected through the SUS Information and Informatics Department (DATASUS), through the Tabnet platform, on the use of diagnostic tests for breast cancer and mammogram results positive for breast injury in the period 2017 to 2021. In addition, data were obtained from the Mortality Information System (SIM) on the breast cancer mortality rate from 2015 to 2019. The study chose the age group of 40 to 59 years for data analysis, as they are the most susceptible ages for the development of MC. In relation to exams carried out between 2017 and 2021, mammography (MMG) is the most used exam with 8,109,591, followed by breast histology with 73,008 in total, and cytology with a lower number of 38, 945. mortality by BC of the female population aged 40 to 59 years, from 2015 to 2019, with 32,561 deaths. The conclusion of this study is that mammography is the exam most used by the Brazilian population for the early diagnosis of MC, but there is a need for new methods to aid in its detection. Another observation identified was the increase in the number of deaths in Brazil over the years.

Racial disparities in breast cancer survival after treatment initiation in Brazil: a nationwide cohort study

Breast cancer is a public health priority in Brazil and ensuring equity in health care is one of the cancer control plan goals. Our aim was to present the first assessment on the influence of race or skin colour on breast cancer survival at the national level. In this nationwide cohort study, data on women who initiated treatment for breast cancer in the public health-care system (Sistema Unico de Saúde), Brazil, were assembled through record linkage of administrative and mortality information systems. The administrative information systems were the Outpatient Information System (data from high complexity procedure authorisations) and the Hospital Information System (data from hospitalisation authorisations). We included women aged 19 years or older who started treatment between Jan 1, 2008, and Nov 30, 2010; self-identified as having White, Black, or Brown race or skin colour; had tumour stage I-IV; and were treated with chemotherapy or radiotherapy, or both. Patients were followed up until Dec 31, 2015. Patients with only hormone therapy records or who underwent only surgery were excluded. The Kaplan-Meier method was used to estimate crude overall survival for race or skin colour by time since treatment initiation, and Cox regression to estimate all-cause mortality hazard ratios (HRs) before and after adjustment for other covariates. We identified 59 811 women treated for stage I-IV breast cancer. 37 318 (62·4%) women identified themselves as White, 18 779 (31·4%) as Brown, and 3714 (6·2%) as Black. 5-year overall survival probability was higher for White women (74% [95% CI 73-74]) than Black women (64% [62-65]; p<0·0001). In adjusted regression models stratified by the absence of hormone therapy, Black women had a 24% (HR 1·24 [95% CI 1·16-1·34]; p<0·0001) higher risk of all-cause death than White women, and in the presence of hormone therapy Black women had a 25% (1·25 [1·14-1·38]; p<0·0001) higher risk of all-cause death than White women. Black skin colour was identified as a statistically significant risk marker for lower 5-year survival probability and higher risk of all-cause death among women treated for breast cancer by the Sistema Unico de Saúde. Actions to understand and mitigate this unfair difference in health results are urgently needed. Conselho Nacional de Desenvolvimento Científico e Tecnológico and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and Pró-Reitoria de Pesquisa da Universidade Federal de Minas Gerais.

Near miss neonatal em capital do Centro-Oeste brasileiro: estudo caso-controle

Abstract We aimed to analyze factors associated with neonatal near-miss in Cuiabá, State of Mato Grosso, Brazil by performing a case-control study of live births in a capital city of central-western Brazil from January 2015 to December 2018 that included 931 cases and 1,862 controls. Data were obtained from the Live Births Information System and the Mortality Information System and variables were organized according to the hierarchical model. Association was analyzed by logistic regression with a 5% significance level. Data were expressed as crude and adjusted odds ratio (OR) and respective confidence intervals (95%CI). The following factors were associated with neonatal near miss: mothers with two (OR = 1.63; 95%CI: 1.01-2.63) or three or more previous pregnancies (OR=1.87; 95%CI: 1.09-3.21), without any live children (OR = 2.57; 95%CI: 1.56-4.24 ) or one live child at birth (OR = 1.53; 95%CI: 1.04-2.26), multiple pregnancy (OR = 4.57; 95%CI: 2.95-7.07), fewer than six prenatal consultations (OR = 2.20; 95%CI: 1.77-2.72), whose deliveries took place in public/university hospitals (OR = 2.25; 95%CI: 1.60-3.15) or philanthropic hospitals (OR = 1.62; 95%CI: 1.16-2.26), with non-cephalic presentation (OR = 2.71 95%CI: 1.87-3.94) and uninduced labor (OR = 1.47; 95%CI: 1.18-1.84).

Impact of the improvement of living conditions on tuberculosis mortality in Brazil: an ecological study.

The risk of death due to tuberculosis (TB) in Brazil is high and strongly related to living conditions (LC). However, epidemiological studies investigating changes in LC and their impact on TB are lacking. To evaluate the impact of LC on TB mortality in Brazil. This ecological study, using panel data on spatial and temporal aggregates, was conducted in 1,614 municipalities between 2002 and 2015. Data were collected from the Mortality Information System and the Brazilian Institute of Geography and Statistics. The proxy variable used for LC was the Urban Health Index (UHI). Negative binomial regression models were used to estimate the effect of the UHI on TB mortality rate. Attributable risk (AR) was used as an impact measure. From 2002 to 2015, TB mortality rate decreased by 23.5%, and LC improved. The continuous model analysis resulted in an RR = 0.89 (95%CI = 0.82-0.96), so the AR was -12.3%. The categorized model showed an effect of 0.92 (95%CI = 0.83-0.95) in municipalities with intermediate LC and of 0.83 (95%CI = 0.82-0.91) in those with low LC, representing an AR for TB mortality of -8.7% and -20.5%, respectively. Improved LC impacted TB mortality, even when adjusted for other determinants. This impact was greater in the strata of low-LC municipalities.

Excess mortality during the COVID-19 pandemic and its spatial distribution in the state of Pernambuco, Brazil: an ecological study.

To investigate excess mortality during the COVID-19 pandemic and its spatial distribution in Pernambuco, Brazil. This was an ecological, descriptive and analytical study of deaths, by municipality, recorded on the Mortality Information System, in 2020 and 2021. Excess mortality was measured by comparing observed and expected deaths, the latter estimated by calculating standardized mortality ratio (SMR). SMR and respective confidence intervals (95%CI) were calculated. Spatial analysis was performed by calculating the Global and Local Moran Index. Excess mortality was 20.6% and 27.5%, respectively, in 2020 and 2021, with positive spatial correlation (p-value < 0.05). More populous municipalities (2020: SMR = 1.26; 95%CI 1.24;1.27 and 2021: SMR = 1.34; 95%CI 1.32;1.34), more developed municipalities (2020: SMR = 1.43; 95%CI 1.41;1.44 and 2021: SMR = 1.51;95%CI 1.50;1.53) and municipalities in the Sertão region (2020:SMR = 1.31;95%CI 1.30;1.33 and 2021: SMR = 1.44; 95%CI 1.42;1.46) showed greater excess deaths. Excess mortality coincided with peak periods of COVID-19 transmission.

Near miss neonatal in the capital of the Brazilian Midwest: a case-control study.

We aimed to analyze factors associated with neonatal near-miss in Cuiabá, State of Mato Grosso, Brazil by performing a case-control study of live births in a capital city of central-western Brazil from January 2015 to December 2018 that included 931 cases and 1,862 controls. Data were obtained from the Live Births Information System and the Mortality Information System and variables were organized according to the hierarchical model. Association was analyzed by logistic regression with a 5% significance level. Data were expressed as crude and adjusted odds ratio (OR) and respective confidence intervals (95%CI). The following factors were associated with neonatal near miss: mothers with two (OR = 1.63; 95%CI: 1.01-2.63) or three or more previous pregnancies (OR=1.87; 95%CI: 1.09-3.21), without any live children (OR = 2.57; 95%CI: 1.56-4.24 ) or one live child at birth (OR = 1.53; 95%CI: 1.04-2.26), multiple pregnancy (OR = 4.57; 95%CI: 2.95-7.07), fewer than six prenatal consultations (OR = 2.20; 95%CI: 1.77-2.72), whose deliveries took place in public/university hospitals (OR = 2.25; 95%CI: 1.60-3.15) or philanthropic hospitals (OR = 1.62; 95%CI: 1.16-2.26), with non-cephalic presentation (OR = 2.71 95%CI: 1.87-3.94) and uninduced labor (OR = 1.47; 95%CI: 1.18-1.84).

Tuberculosis mortality trends and the correlation with the socio-demographic index in Brazil between 2010 and 2019

The scope of this article is to analyze the trend of the standardized mortality rate (SMR) for tuberculosis and its correlation with the developmental status in Brazil. An ecological time series study was conducted to analyze data of deaths from tuberculosis reported between 2005 and 2019 in all states. Data were extracted from the Mortality Information System, the Brazilian Institute of Geography and Statistics, and the Global Burden of Disease study. The temporal trend was analyzed using Prais-Winsten regression. Spearman's correlation analysis between SMR and Socio-Demographic Index (SDI) was also performed. From 2005 to 2019, 68,879 deaths from tuberculosis were recorded in Brazil. The average mortality rate was 2.3 deaths per 100,000 inhabitants. The decreasing trend of SMR due to tuberculosis was observed in Brazil and in all regions. There was a significant negative correlation between SDI and TMP. TMP due to tuberculosis revealed a decreasing trend in Brazil and in all regions. Most states showed a decreasing trend and none of them had an increasing trend. An inverse relationship was found between developmental status and mortality due to tuberculosis.

Tendência temporal da mortalidade por homicídios femininos por arma de fogo nos estados da região Nordeste do Brasil no período 2000-2019

Abstract This article aims to analyze temporal trends in female firearm homicides in the Northeast of Brazil during the period 2000-2019. We conducted an ecological study using data on firearm homicides of women aged 10 years and over obtained from the Mortality Information System. The population data were taken from the 2010 Census. Homicide rates were calculated after correcting the data to account for differences in the quality and coverage of death records. Trends were assessed using negative binomial regression and described using relative risk and p values. Average annual percentage changes in homicide rates were also calculated. The regional firearm homicide rate during the study period was 4.40 per 100,000 women. Rates were highest in the state of Alagoas (5.40), the 15-19 age group (5.84) and in public thoroughfares (1.58). Trends were upward across all states except Pernambuco, where they were downward, and Alagoas, where rates were stationary. The place of occurrence with the highest percentage increase in firearm homicides over the study period was public thoroughfares. Female firearm homicides showed an upward trend across most northeastern states.

Racial iniquity in mortality from cervical cancer in Brazil: a time trend study from 2002 to 2021.

This ecological study examined time series, from 2002 to 20121, of age-adjusted coefficients of cervical cancer mortality, in Brazil, in women aged 20 years or more, by race. The information sources were Brazil's mortality information system (Sistema de Informação sobre Mortalidade - SIM) and the official bureau of statistics (Instituto Brasileiro de Geografia e Estatística - IBGE). Annual changes in age-adjusted mortality rates were calculated using the Prais-Winsten linear regression method. Black women die more and the rate is decreasing less. Racial inequality has increased over the years. In 2002, there were 0.08 more deaths per 100,000 women in the black population than among white women; in 2021, the number was one death. Health policymaking should consider racial differences in the implementation of strategies and goals.

Fatores associados ao óbito pela coinfecção tuberculose/HIV no sistema prisional

Abstract Objective to analyze the factors associated with deaths due to tuberculosis/HIV co-infection in people deprived of their freedom. Methods Retrospective cohort study, carried out in the state of São Paulo from 2008 to 2017. The study population was made up of people with tuberculosis/HIV co-infection in deprivation of their freedom. Data were collected from the TB-WEB Tuberculosis Patient Control System in linkage with the Mortality Information System. The risk of death according to sociodemographic, clinical and treatment variables was established by relative risk and respective 95% confidence intervals. Results 100 deaths from tuberculosis and/or HIV were identified in the period, which were associated with: individuals belonging to the Regional Coordination of Vale do Paraíba/in the coast (relative risk 2.59; 95% confidence interval 1.35-4, 94); age groups 30 to 39 years old (relative risk 2.49; 95% confidence interval 1.04-5.96), 40 to 49 years old (relative risk 7.09; 95% confidence interval 3.06-19, 06) and 50 to 59 years old (relative risk 14.11; 95% confidence interval 5.91-33.69); self-administered treatment (relative risk 1.94; 95% confidence interval 1.16-3.27); and occurrence of hospitalization (relative risk 2.62; 95% confidence interval 1.69-4.07). Conclusion Such factors must be considered when dealing with tuberculosis/HIV co-infection, considering the age of people in prison, the conditions of incarceration and the intensification of directly observed treatment, aiming to avoid conditions that will require hospitalization.