02654nas a2200265   4500000000100000008004100001260002400042653002400066653002700090653001700117100001400134700001600148700001500164700001500179700001800194700001700212700001700229700001700246700001600263245009200279856008000371490000700451520190500458022002502363       2022                            d  bFapUNIFESP (SciELO)10aInfectious Diseases10aMicrobiology (medical)10aParasitology1 aSilva BMD1 aFerreira AF1 aSilva JAMD1 aAmorim RGD1 aDomingues ALC1 aPinheiro MCC1 aBezerra FSDM1 aHeukelbach J1 aRamos Jr AN00aHigh schistosomiasis-related mortality in Northeast Brazil: trends and spatial patterns  uhttps://www.scielo.br/j/rsbmt/a/8shjXsZGfVysjzMdJTXLZ9d/?format=pdf&lang=en0 v553 a<h2>Background:</h2>

<p>We analyzed the trends and spatial patterns of schistosomiasis-related mortality in Northeast Brazil in 2000-2019.</p>

<h2>Methods:</h2>

<p>A mixed population-based ecological study was conducted, using information on the underlying or associated causes of death. We used Joinpoint regression analysis to calculate the trends. The spatial analysis included rates, spatial moving averages, and standardized mortality rates. The spatial dependence analysis was based on Getis-Ord's G and Gi* indices (Gi star) and local Moran’s index to check for autocorrelation.</p>

<h2>Results:</h2>

<p>A total of 5,814,268 deaths were recorded, of which 9,276 (0.16%) were schistosomiasis-related; 51.0% (n=4,732, adjusted rate 0.90/100,000 inhabitants [95% confidence interval (CI) 0.88-0.93]) were males; 40.0% (n=3,715, adjusted rate 7.40/100.000 inhabitants [95%CI: 7.16-7.64]) were ≥70 years old; 54.8% (n=5,087, crude rate 0.80/100,000 inhabitants) were of mixed/Pardo-Brazilian ethnicity; and 77.9% (n=7,229, adjusted rate 0.86/100,000 inhabitants [95%CI: 0.84-0.88]) lived outside state capitals. The highest proportion of deaths was in the state of Pernambuco (53.9%, n=4,996, adjusted rate 2.72/100,000 inhabitants [95%CI: 2.64-2.79]). Increasing mortality rate was verified in the state of Sergipe. On the coast of the state of Rio Grande do Norte and Bahia, there was spatial dependence of spatio-temporal risk patterns with clusters. Throughout the study period, we found positive spatial autocorrelation and cluster formation.</p>

<h2>Conclusions:</h2>

<p>In Northeast Brazil, schistosomiasis persists with a high mortality rate, especially in the coastal region, with heterogeneous spatial and temporal patterns. To eliminate schistosomiasis by 2030, it is necessary to strengthen the financing and management of the unified health system (SUS).</p>
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