Skip to main content

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

Abstract

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.

Résumé

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Availability of Data and Material

The data is available upon request.

Code Availability

Available upon request.

References

  1. Akerman, M., Stephens, C., Campanario, P., & Maia, P. B. (1994). Saúde e meio ambiente: Uma análise de diferenciais intra-urbanos enfocando o Município de São Paulo Brasil. Revista De Saúde Pública, 28(4), 320–325.

    Article  Google Scholar 

  2. Alai, D. H., Arnold, S., & Sherris, M. (2014). Modelling cause-of-death mortality and the impact of cause-elimination. Annals of Actuarial Science, 9(1), 167–186.

    Article  Google Scholar 

  3. Almeida, M. C. S., Gomes, C. M. S., & Nascimento, L. F. C. (2014). Spatial analysis of neonatal mortality in the state of São Paulo, 2006–2010. Revista Paulista de Pediatria, 32(4).

  4. Antunes, J. L. F., Toporcov, T. N., Biazevic, M. G. H., Boing, A. F., & Bastos, J. L. (2013). Gender and racial inequalities in trends of oral cancer mortality in São Paulo Brazil. Revista De Saúde Pública, 47(3), 470–478. https://doi.org/10.1590/S0034-8910.2013047003724

    Article  Google Scholar 

  5. Assunção, R. M., Schmertmann, C. P., Potter, J. E., & Cavenaghi, S. M. (2005). Empirical Bayes estimation of demographic schedules for small areas. Demograhy, 42, 537–558.

    Article  Google Scholar 

  6. Atun, R., Andrade, L. O. M., Almeida, G., Cotlear, D., Dmytraczenko, T., Frenz, P., Garcia, P., Gómez-Dantés, O., Knaul, F. M., Muntaner, C., de Paula, J. B., Rígoli, F., Serrate, P.C.-F., & Wagstaff, A. (2015). Health-system reform and universal health coverage in Latin America. The Lancet, 385(9974), P1230-1247.

    Article  Google Scholar 

  7. Baptista, E. A., & Queiroz, B. L. (2019). Spatial analysis of mortality by cardiovascular disease in the adult population: A study for Brazilian micro-regions between 1996 and 2015. Spatial Demography, 7(1), 83–101.

    Article  Google Scholar 

  8. Baptista, E. A., Queiroz, B. L., & Rigotti, J. I. R. (2018). Decomposition of mortality rates from cardiovascular disease in the adult population: A study for Brazilian micro-regions between 1996 and 2015. Revista Brasileira De Estudos De População, 35(2), e00050.

    Article  Google Scholar 

  9. Besag, J., York, Y., & Mollie, A. (1991). Bayesian image restoration with two applications in spatial statistics (with discussion). Annals of the Institute of Statistical Mathematics, 43, 1–59.

    Article  Google Scholar 

  10. Bobadilla, J. L., & Possas, C. (1993). Health policy issues in three Latin American countries: Implications of the epidemiological transition. In J. N. Gribble & S. H. Preston (Eds.), The epidemiological transition policy and planning implications for developing countries. The National Academies Press.

  11. Borges, G. M. (2017). Health transition in Brazil: Regional variations and divergence/convergence in mortality. Cadernos De Saúde Pública, 33(8), e00080316.

    Article  Google Scholar 

  12. Brant, L. C. C., Nascimento, B. R., Passos, V. M. A., Duncan, B. B., Bensenõr, I. J. M., Malta, D. C., Souza, M., & d. F. M. d., Ishitani, L. H., FrançaI, E., OliveiraI, M. S., Mooney, M., Naghavi, M., Roth, G., & RibeiroI, A. L. P. . (2017). Variations and particularities in cardiovascular disease mortality in Brazil and Brazilian states in 1990 and 2015: Estimates from the Global Burden of Disease. Revista Brasileira De Epidemiologia, 20(Suppl 1), 116–128.

    Article  Google Scholar 

  13. Buchalla, C. M., Waldman, E. A., & Laurenti, R. (2003). A Mortalidade Por Doenças Infecciosas No Início e No Final Do Século XX No Município De São Paulo. Revista Brasileira De Epidemiologia, 6(4), 335–344.

    Article  Google Scholar 

  14. Conceição, M. B. M., Boing, A. F., & Peres, K. G. (2014). Time trends in prostate cancer mortality according to major geographic regions of Brazil: An analysis of three decades. Cadernos De Saúde Pública, 30(3), 559–566.

    Article  Google Scholar 

  15. Costa, F. A. M. M., Trindade, R. F. C., & Santos, C. B. (2014). Deaths from homicides: A historical series. Revista Latino-Americana De Enfermagem, 22(6), 1017–1025.

    Article  Google Scholar 

  16. Dean, W. (1969). The industrialization of São Paulo, 1880–1945.

  17. Dedecca, C. S. (2009). Por dentro do estado de São Paulo. Novos Estudos CEBRAP, 84, 127–150.

    Article  Google Scholar 

  18. Duncan, C., Jones, K., & Moon, G. (1996). Health-related behaviour in context: A multilevel modelling approach. Social Science and Medicine, 42(6), 817–830.

    Article  Google Scholar 

  19. Eberstein, I. W., Nam, C. B., & Hummer, R. A. (1990). Infant mortality by cause of death: Main and interaction effects. Demograhy, 27(3), 413–430.

    Article  Google Scholar 

  20. Fadel, S. A., Boschi-Pinto, C., Yu, S., Reynales-Shigematsu, L. M., Menon, G. R., Newcombe, L., Strong, K. L., Wang, Q., & Jha, P. (2019). Trends in cause-specific mortality among children aged 5–14 years from 2005 to 2016 in India, China, Brazil, and Mexico: An analysis of nationally representative mortality studies. The Lancet, 393(10176), 1119–1127.

    Article  Google Scholar 

  21. Filho, A. M. S., Souza, M. F. M., Gazal-Carvalho, C., Malta, D. C., Alencar, A. P., Silva, M. M. A., & Neto, O. L. M. (2007). Analysis of homicide mortality in Brazil. Epidemiologia e Serviços De Saúde, 16(1), 7–18.

    Google Scholar 

  22. França, E. B., Lansky, S., Rego, M. A. S., Malta, D. C., França, J. S., Teixeira, R., Porto, D., Almeida, M. F. d., Souza, M. d. F. M. d., Szwarcwald, C. L., Mooney, M., Naghavi, M., & Vasconcelos, A. M. N. (2017a). Leading causes of child mortality in Brazil, in 1990 and 2015: Estimates from the Global Burden of Disease study. Revista Brasileira de Epidemiologia, 20(Supl 1), 46–60.

  23. França, E. B., Passos, V. M. d. A., Malta, D. C., Duncan, B. B., Ribeiro, A. L. P., Guimarães, M. D. C., Abreu, D. M. X., Vasconcelos, A. M. N., Carneiro, M., Teixeira, R., Camargos, P., Melo, A. P. S., Queiroz, B. L., Schmidt, M. I., Ishitani, L., Ladeira, R. M., Morais-Neto, O. L., Bustamante-Teixeira, M. T., Guerra, M. R., Bensenor, I., Lotufo, P., Mooney, M., & Naghavi, M. (2017b). Cause-specific mortality for 249 causes in Brazil and states during 1990–2015: A systematic analysis for the global burden of disease study 2015. Population Health Metrics, 15(39).

  24. Gawryszewski, V. P., & Jorge, M. H. P. M. (2000). Mortalidade violenta no Município de São Paulo nos últimos 40 anos. Revista Brasileira De Epidemiologia, 3(1–3), 50–69.

    Article  Google Scholar 

  25. Gelfand, A. E., Diggle, P. J., Fuentes, M., & Guttorp, P. (2010). Handbook of spatial statistics. Chapman & Hall/CRC.

  26. Ghosn, W., Menvielle, G., Rican, S., & Rey, G. (2017). Associations of cause-specific mortality with area level deprivation and travel time to health care in France from 1990 to 2007, a multilevel analysis. BMC Public Health, 18(86).

  27. Gonzaga, M. R., & Schmertmann, C. P. (2016). Estimating age- and sex-specific mortality rates for small areas with TOPALS regression: An application to Brazil in 2010. Revista Brasileira De Estudos De População, 33(3), 629–652.

    Article  Google Scholar 

  28. Guerra, M. R., Bustamante-Teixeira, M. T., Corrêa, C. S. L., Abreu, D. M. X., Curado, M. P., Mooney, M., Naghavi, M., Teixeira, R., França, E. B., & Malta, D. C. (2017). Magnitude and variation of the burden of cancer mortality in Brazil and Federation Units, 1990 and 2015. Revista Brasileira De Epidemiologia, 20, 102–115.

    Article  Google Scholar 

  29. Heligman, L., & Pollard, J. H. (1980). The age pattern of mortality. Journal of the Institute of Actuaries, 107(1), 49–80.

    Article  Google Scholar 

  30. Hernandez, A. V., Pasupuleti, V., Deshpande, A., Bernabe-Ortiz, A., & Miranda, J. J. (2012). Effect of rural-to-urban within-country migration on cardiovascular risk factors in low- and middle-income countries: A systematic review. Hearth, 98, 185–194.

    Article  Google Scholar 

  31. IBGE. (2010). Sistema IBGE de Recuperação Automática: Sidra. Retrieved 1 October from https://sidra.ibge.gov.br/pesquisa/censo-demografico/demografico-2010/inicial.

  32. IBGE. (2014). Estimativas da população residente no Brasil e Unidades da Federação com data de referência em 1º de julho de 2014. Instituto Brasileiro de Geografia e Estatística. Retrieved 05 September from ftp://ftp.ibge.gov.br/Estimativas_de_Populacao/Estimativas_2014/nota_metodologica_2014.pdf.

  33. IBGE. (2019). Em 2017, São Paulo (SP) tinha o maior PIB e Paulínia (SP), o maior PIB per capita do país. Retrieved 1 October from https://agenciadenoticias.ibge.gov.br/agencia-sala-de-imprensa/2013-agencia-de-noticias/releases/26396-em-2017-sao-paulo-sp-tinha-o-maior-pib-e-paulinia-sp-o-maior-pib-per-capita-do-pais.

  34. Johnson, H. L., Liu, L., Fischer-Walker, C., & Black, R. E. (2010). Estimating the distribution of causes of death among children age 1–59 months in high mortality countries with incomplete death certification. International Journal of Epidemiology, 39, 1103–1114.

    Article  Google Scholar 

  35. Lawn, J. E., Wilczynska-Ketende, K., & Cousens, S. N. (2006). Estimating the causes of 4 million neonatal deaths in the year 2000. International Journal of Epidemiology, 35, 706–718.

    Article  Google Scholar 

  36. Levi, F., Lucchini, F., Negri, E., & Vecchia, C. L. (2002). Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world. Hearth, 88, 119–124.

    Article  Google Scholar 

  37. Lima, E. E. C., Queiroz, B. L., Trifon, M., & Lenart, A. (2016). Methods to estimate mortality curves in small areas: An application to municipality data in Brazil. (Ed.),^(Eds.). Annual Meeting of the Popualation Association of America.

  38. Limaa, J. C., Mingarelli, A. M., Segri, N. J., Zavala, A. A. Z., & Takano, O. A. (2017). Population-based study on infant mortality. Ciência & Saúde Coletiva, 22(3), 931–939.

    Article  Google Scholar 

  39. Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behaviour, Extral Issue, 80–94.

  40. Mansur, A. P., & Favarato, D. (2016). Trends in mortality rate from cardiovascular disease in Brazil, 1980–2012. Arquivos Brasileiros De Cardiologia, 107(1), 20–25. https://doi.org/10.5935/abc.20160077

    Article  Google Scholar 

  41. Martins, R. S., Eduardo, M. B. P., & Nascimento, A. d. F. (2016). Tendência temporal da mortalidade por doenças infecciosas intestinais em crianças menores de cinco anos de idade, no estado de São Paulo, 2000–2012. Epidemiologia e Serviços de Saúde, 25(3), 541–552. https://doi.org/10.5123/s1679-49742016000300010.

  42. Martins, W. A., Rosa, M. L. G., Matos, R. C., Silva, W. D. S., Souza Filho, E. M., Jorge, A. J. L., Ribeiro, M. L., & Silva, E. N. (2020). Trends in mortality rates from cardiovascular disease and cancer between 2000 and 2015 in the most populous capital cities of the five regions of Brazil. Arquivos Brasileiros De Cardiologia, 114(2), 199–206. https://doi.org/10.36660/abc.20180304

    Article  Google Scholar 

  43. Martins-Melo, F. R., Ramos, A. N., Alencar, C. H., Lange, W., & Heukelbach, J. (2012). Mortality of Chagas’ disease in Brazil: Spatial patterns and definition of high-risk areas. Tropical Medicine and International Health, 17(9), 1066–1075.

    Article  Google Scholar 

  44. Martins-Melo, F. R., NovaesRamos, A., Alencar, C. H., & Heukelbach, J. (2016). Trends and spatial patterns of mortality related to neglected tropical diseases in Brazil. Parasite Epidemiology and Control, 1(2), 56–65.

    Article  Google Scholar 

  45. Milanesi, M. L., & Laurenti, R. (1967). Mortalidade infantil no município de São Paulo. Análise do seu comportamento nos últimos 15 anos. Revista De Saúde Pública, 1(1), 44–50.

    Article  Google Scholar 

  46. Moura, E. C., Santos, W., Neves, A. C. M., Schwarz, E., & Gomes, R. (2016). Mortality in Brazil according to gender perspective, years 2000 and 2010. Revista Brasileira De Epidemiologia, 19(2), 326–338.

    Article  Google Scholar 

  47. Murray, J. L., & Chen, L. C. (1993). In search of a contemporary theory for understanding mortality change. Social Science and Medicine, 36, 143–155.

    Article  Google Scholar 

  48. Neiderud, C.-J. (2015). How urbanization affects the epidemiology of emerging infectious diseases. Infection Ecology & Epidemiology, 5(1), 27060. https://doi.org/10.3402/iee.v5.27060

    Article  Google Scholar 

  49. Nepomuceno, M., & Turra, C. (2020). Assessing the quality of education reporting in Brazilian censuses. Demographic Research, 42(15), 441–460.

    Article  Google Scholar 

  50. Oliveira, C. M. d., Bonfim, C. V. d., Guimarães, M. J. B., Frias, P. G., & Medeiros, Z. M. (2016). Infant mortality: Temporal trend and contribution of death surveillance. Acta Paulista de Enfermagem, 29(3), 282-290.

  51. Paes, N. A., & Silva, L. A. A. (1999). Doenças infecciosas e parasitárias no Brasil: Uma década de transiçao. Revisita Panamericana de Salud Publica, 6(2).

  52. Park, Y., Choi, J. W., & Lee, D.-H. (2006). A parametric approach for measuring the effect of the 10th revision of the international classification of diseases. Journal of the Royal Statistical Society (series C, Applied Statistics), 55(5), 677–697.

    Article  Google Scholar 

  53. Perea, L. M. E., Peres, M. A., Boing, A. F., & Antunes, J. L. F. (2018). Trend of oral and pharyngeal cancer mortality in Brazil in the period of 2002 to 2013. Revista de Saúde Pública, 53(10).

  54. Powles, J. (1992). Changes in disease patterns and related social trends. Social Science and Medicine, 35, 377–387.

    Article  Google Scholar 

  55. Prata, P. R. (1992). A transição epidemiológica no Brasil. Cadernos De Saúde Pública, 8(2), 168–175.

    Article  Google Scholar 

  56. Queiroz, A. A. R., Berra, T. Z., Garcia, M. C. d. C., Popolin, M. P., Belchior, A. d. S., Yamamura, M., Santos, D. T. d., Arroyo, L. H., & Arcêncio, R. A. (2018). Spatial pattern and temporal trend of mortality due to tuberculosis. Revista Latino-Americana de Enfermagem, 26, e2992.

  57. Ramos, L. R. (2003). Fatores determinantes do envelhecimento saudável em idosos residentes em centro urbano: Projeto Epidoso São Paulo. Cadernos De Saúde Pública, 19(3), 793–797.

    Article  Google Scholar 

  58. Reid, A., & van den Boomen, N. (2015). The faces of death: Regional differentiation in cause-specific mortality in the past. The History of the Family, 20(3), 309–319.

    Article  Google Scholar 

  59. Reyes, R., Ahn, R., Thurber, K., & Burke, T. F. (2013). Urbanization and infectious diseases: General principles, historical perspectives, and contemporary challenges. In I. W. Fong (Ed.), Challenges in Infectious Diseases. Springer.

  60. Rue, H., & Held, L. (2005). Gaussian Markov random fields. Theory and applications.

  61. Santos, S. S., Melo, L. R., Koifman, R. J., & Koifman, S. (2013). Cancer incidence, hospital morbidity, and mortality in young adults in Brazil. Cadernos De Saúde Pública, 29(5), 1029–1040.

    Article  Google Scholar 

  62. SEADE. (2019). Mortalidade infantil no estado de São Paulo. Retrieved 1 October from https://www.seade.gov.br/produtos/midia/2019/12/SeadeInforma_demografia_16dez.pdf.

  63. Siviero, P. C. L., Souza, L. G., & Machado, C. J. (2019). Diferenciais de mortalidade por sexo no município de São Paulo em 2005 e 2016: contribuição dos grupos etários e das principais causas de óbito. Revista Brasileira De Estudos De População, 36, e0099.

    Google Scholar 

  64. Sorenson, S. B. (2011). Gender disparities in injury mortality: Consistent, persistent, and larger than you’d think. American Journal of Public Health, 102(Suppl 1), S353–S358. https://doi.org/10.2105/AJPH.2010.300029

    Article  Google Scholar 

  65. Souza, A., Hill, K., & Dal Poz, M. (2017). Sub-national assessment of inequality trends in neonatal and child mortality in Brazil. International Journal of Equity in Health, 9(21).

  66. Stephens, C., Timaeus, I., Akerman, M., Avie, S., Maia, P. B., Campanario, P., Doe, B., Lush, L., & Tetteh, D. (1994). Environment and health in developing countries: An analysis of intra-urban mortality differentials using existing data in Accra (Ghana) and Sao Paulo (Brazil) and analysis of urban data of four demographic and health surveys.

  67. Waiselfisz, J. J. (2013). Mapa da violência 2013: Homicídios e juventude no Brasil.

Download references

Acknowledgements

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.

Funding

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

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ezra Gayawan.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gayawan, E., Lima, E.E.C. Spatial Disparity and Associated Factors of Cause-Specific Mortality in Small Areas of Brazil. Can. Stud. Popul. (2021). https://doi.org/10.1007/s42650-021-00045-z

Download citation

Keywords

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

Mots-clé

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