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Spatial Disparity and Associated Factors of Cause-Specific Mortality in Small Areas of Brazil


This study examines the possible clustering in the residual spatial variations of five mortality causes, classified by the tenth ICD, among 644 municipalities of the Brazilian state of São Paulo, after accounting for individuals' demographic characteristics and place of death. Mortality data by cause of death for 2014–2016 were sourced from the Brazilian Sistema de Informações sobre Mortalidade. We applied a Bayesian model that assumes a multinomial distribution for the polytomous outcome, classifying the causes of death into six categories, namely, infectious diseases, neoplasm, respiratory, cardiovascular, external, and other causes, and simultaneously estimates the spatial patterns, accounting for explanatory variables for the first five causes, taking the other causes as reference. The results show that, relative to the causes in the reference group, there is clustering of high relative risks among the municipalities for all the causes of mortality. The relative risks of death from neoplasms and cardiovascular diseases were lower among men relative to women but much higher for external causes. The identified spatial clustering can be useful in identifying appropriate cost-effective strategies suitable for addressing issues of human well-being in the specific municipalities of the state.


Cette étude examine la possibilité de regroupement dans les variations spatiales résiduelles de cinq causes de mortalité, classées par la 10e CIM, parmi 644 municipalités de l'État brésilien de São Paulo, après avoir pris en compte certaines caractéristiques démographiques des individus et le lieu du décès. Les données de mortalité par cause de décès pour 2014–2016 proviennent du Sistema de Informações sobre Mortalidade brésilien. Nous avons appliqué un modèle bayésien qui suppose une distribution multinomiale pour la variable dépendante, qui corresponde aux classement de causes de décès en six catégories (maladies infectieuses, néoplasmes, maladies respiratoires, maladies cardiovasculaires, causes externes, et autres causes) et fait une estimation simultanée variables pour les cinq premières causes, en prenant les autres causes comme référence. Les résultats montrent que par rapport aux causes du groupe de référence, il existe un regroupement de risques relatifs élevés parmi les municipalités pour toutes les causes de mortalité. Les risques relatifs de décès par néoplasmes et maladies cardiovasculaires étaient plus faibles chez les hommes que chez les femmes, mais beaucoup plus élevés pour les causes externes. Le regroupement spatial identifié peut être utile pour identifier des stratégies appropriées pour traiter les problèmes de bien-être dans certaines municipalités.

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The authors are grateful for the financial support from the São Paulo Research Foundation (FAPESP), grant 2018/18649-7.

This article is also part of the project (421183/2018-7), financed by the National Council for Scientific and Technological Development.


The study was sponsored by the São Paulo Research Foundation (FAPESP), grant 2018/18649–7.

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Correspondence to Ezra Gayawan.

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Gayawan, E., Lima, E.E.C. Spatial Disparity and Associated Factors of Cause-Specific Mortality in Small Areas of Brazil. Can. Stud. Popul. (2021).

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  • Causes of death
  • Small areas
  • São Paulo
  • Socioeconomic differentials
  • Brazil


  • Causes de décès
  • Petites zones
  • São Paulo
  • Différentiels socio-économiques
  • Brésil