Relationship between social development indicators and mortality due to Diabetes <i>Mellitus</i> in Brazil: a space-time analysis

Garces, Thiago Santos; Damasceno, Lara Lídia Ventura; Sousa, George Jó Bezerra; Cestari, Virna Ribeiro Feitosa; Pereira, Maria Lúcia Duarte; Moreira, Thereza Maria Magalhães

doi:10.1590/1518-8345.6592.3972

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 31 • 2023 • https://doi.org/10.1590/1518-8345.6592.3972 copy

Relationship between social development indicators and mortality due to Diabetes Mellitus in Brazil: a space-time analysis^* * Paper extracted from doctoral dissertation “Mortalidade por diabetes mellitus e efeito da doença na gravidade e óbito por covid-19: subsídios ao monitoramento epidemiológico”, presented to Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde do Centro de Ciências da Saúde da Universidade Estadual do Ceará, Fortaleza, CE, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to identify the space-time pattern of mortality due to Diabetes Mellitus in Brazil, as well as its relationship with social development indicators.

Method:

an ecological and time series nationwide study based on secondary data from the Unified Health System Informatics Department, with space-time analysis and inclusion of indicators in non-spatial and spatial regression models. The following was performed: overall mortality rate calculation; characterization of the sociodemographic and regional profiles of the death cases by means of descriptive and time analysis; and elaboration of thematic maps.

Results:

a total of 601,521 deaths related to Diabetes Mellitus were recorded in Brazil, representing a mean mortality rate of 29.5/100,000 inhabitants. The states of Rio Grande do Norte, Paraíba, Pernambuco, Alagoas and Sergipe, Rio de Janeiro, Paraná and Rio Grande do Sul presented high-high clusters. By using regression models, it was verified that the Gini index (β=11.7) and the Family Health Strategy coverage (β=3.9) were the indicators that most influenced mortality due to Diabetes Mellitus in Brazil.

Conclusion:

in Brazil, mortality due to Diabetes presents an overall increasing trend, revealing itself as strongly associated with places that have worse social indicators.

Descriptors:
Diabetes Mellitus; Mortality; Social Indicators; Ecological Studies; Spatial Analysis; Time Series Studies

Highlights:

(1) The time-space pattern of mortality due to Diabetes presents an increasing trend.

(2) The Northeast and South regions present high rates of mortality due to Diabetes.

(3) Mortality due to Diabetes is associated with worse sociodemographic indicators.

(4) A relationship is observed between income, access to health and mortality due to Diabetes.

Variable	Total deaths (%)	Mortality rate*
	601,521 (100%)	29.8
Gender
Female	331,150 (55.0%)	32.1
Male	270,553 (45.0%)	26.9
Age (years old)
10-19	1,088 (0.1%)	0.32
20-29	3,976 (0.6%)	1.15
30-39	9,342 (1.5%)	2.87
40-49	26,887 (4.4%)	10.00
50-59	72,854 (12.1%)	34.49
60-69	136,522 (22.6%)	99.61
70-79	170,140 (28.2%)	230.82
>80	180,416 (29.9%)	508.46
Race/Skin color
White	295,588 (49.1%)	31.85
Black	54,662 (9.0%)	33.00
Brown	218,790 (36.3%)	36.16
Asian	3,617 (0.6%)	24.26
Indigenous	1,149 (0.1%)	15.55
Schooling (years)
0-3	291,229 (48.3%)	59.53
4-7	106,068 (17.6%)	23.78
8-11	59,248 (9.8%)	19.98
>12	20,207 (3.3%)	3.15

State	*APC1 (95% IC** ^§ )	JP ^†	*APC2 (95% IC** ^§ )	AAPC ^‡ (95% IC ^§ )
North Region
Rondônia	1.3 (-1.1; 3.7)			1.3 (-1.1; 3.7)
Acre	1.9 (-1.0; 5.0)			1.9 (-1.0; 5.0)
Amazonas	5.8^\|\| (4.3; 7.3)			5.8^\|\| (4.3; 7.3)
Roraima	6.1^\|\| (4.4; 7.9)	2017	-9.4 (-1.3; 0.5)	2.5^\|\| (0.4; 4.5)
Pará	3.3^\|\| (2.1; 4.4)			3.3^\|\| (2.1; 4.4)
Amapá	6.1^\|\| (3.3; 8.9)			6.1^\|\| (3.3; 8.9)
Tocantins	4.1^\|\| (1.8; 6.5)			4.1^\|\| (1.8; 6.5)
Northeast Region
Maranhão	2.6^\|\| (1.5; 3.7)			2.6^\|\| (1.5; 3.7)
Piauí	1.5^\|\| (0.0; 2.9)			1.5^\|\| (0.0; 2.9)
Ceará	-2.2^\|\| (-3.8; -0.6)			-2.2^\|\| (-3.8; -0.6)
Rio Grande do Norte	0.2 (-1.2; 1.6)			0.2 (-1.2; 1.6)
Paraíba	-0.8 (-1.8; 0.2)			-0.8 (-1.8; 0.2)
Pernambuco	-0.2 (-1.5; 1.2)			-0.2 (-1.5; 1.2)
Alagoas	2.2^\|\| (0.9; 3.5)			2.2^\|\| (0.9; 3.5)
Sergipe	-0.6 (-2.4; 1.2)			-0.6 (-2.4; 1.2)
Bahia	1.9^\|\| (1.1; 2.6)			1.9^\|\| (1.1; 2.6)
Southeast Region
Minas Gerais	-0.4 (-1.8; 1.1)	2015	4.0^\|\| (2.0; 6.1)	1.6^\|\| (0.6; 2.5)
Espírito Santo	0.0 (-1.8; 1.8)
Rio de Janeiro	-4.6^\|\| (-6.2; -2.9)	2014	1.5^\|\| (-0.2; 2.8)	-1.3^\|\| (-2.1; -0.5)
São Paulo	-1.9 (-4.1; 0.4)	2014	2.2^\|\| (0.6; 3.8)	0.4 (-0.7; 1.4)
South Region
Paraná	0.4 (-1.1; 2.0)			0.4 (-1.1; 2.0)
Santa Catarina	1.3^\|\| (0.5; 2.1)
Rio Grande do Sul	0.1 (-2.8; 3.0)	2015	9.0^\|\| (5.1; 13.1)	3.9^\|\| (2.1; 5.8)
Midwest Region
Mato Grosso do Sul	1.5 (-0.3; 3.4)			1.5 (-0.3; 3.4)
Mato Grosso	2.9^\|\| (1.1; 4.7)
Goiás	2.4^\|\| (1.6; 3.3)			2.4^\|\| (1.6; 3.3)
Distrito Federal	-5.4^\|\| (-9.2; -1.4)	2015	6.4^\|\| (0.7; 12.4)	-0.3^\|\| (-2.8; 2.3)

	Univariate OLS*			Multivariate OLS*			GWR^†
	Coefficient	Standard Error	p-value ^‡	Coefficient	Standard Error	p-value ^‡	Mean β ^§	Standard Deviation
Illiteracy in individuals >18 years old	0.01	0.002	<0.001		0.56	0.04	<0.001	0.20	0.68
Gini	-1.66	0.30	<0.001		2.54	4.00	0.525	11.67	36.81
Per capita income	-0.0002	0.00008	0.01		0.001	0.002	0.444	0.01	0.03
Formalization degree in individuals >18 years old	-0.001	0.001	0.065		0.02	0.02	0.358	-0.07	0.17
% of houses with a bathroom and running water	0.008	0.0009	<0.001		0.23	0.02	<0.001	0.24	0.25
% of houses with density >2	-0.18	0.001	<0.001		-0.18	0.03	<0.001	-0.31	0.41
MHDI^\|\|	-0.10	0.27	0.705
FHS^¶ coverage	0.64	0.08	<0.001		2.32	0.83	0.005	3.89	9.44
Social Vulnerability Index	-0.42	0.15	0.005		6.79	3.92	0.083	9.05	31.13
Bolsa Família transfer	0.0001	0.0002	0.521
Percentage of people registered in CADÚnico^** receiving Bolsa Família	-0.0009	0.001	0.371
CONSTANT				1.66		3.29	0.615	7.48	32.70

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[1] Corresponding author:
George Jó Bezerra Sousa E-mail: georgejobs@hotmail.com https://orcid.org/0000-0003-0291-6613