Mortality trend due to chronic kidney disease in Brazil: an ecological study

This was a time series study having deaths as its unit of analysis, based on Mortality Information System data. The mortality rate was standardized using the direct method and the temporal trend was analyzed using the Prais-Winsten method.

Results:

There was a rising trend in chronic kidney disease mortality, ranging from 2.82, in 2009, to 3.24 in 2020 (average annual increase 1.29%; 95%CI 0.73;1.85), with a greater increase in males (1.14% per year; 95%CI 0.52;1.76), those aged 75 years and over (2.23% per year; 95%CI 1.87; 2.60) and in the Northern Region (3.86% per year; 95%CI 1.86;5.90) and Northeast Region (3.36% per year; 95%CI 2.24;4.50).

Conclusion:

Chronic kidney disease mortality showed a rising trend in the period, with sociodemographic disparities.

Keywords:
Chronic Kidney Disease; Mortality; Time Series Studies; Epidemiology

Study contributions

Main results

A rising mortality trend was found for both sexes, with a greater increase in males, those aged over 75 years and in the North and Northeast regions of Brazil; mortality was highest in the Midwest region throughout the entire period.

Implications for services

The results point to the need to implement public policies with guidelines for addressing chronic kidney disease, focused on strengthening Primary Health Care (PHC).

Perspectives

Expanding access to health services, health education and integration between PHC, health surveillance and specialized care are strategies that would possibly prove to be efficient in managing this chronic health condition.

Year of death	2009		2010		2011		2012		2013		2014		2015		2016		2017		2018		2019		2020		Total
Year of death	n	%	N	%	n	%	n	%	n	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%	N	%
Sex
Male	3,045	58.0	3,222	57.3	3,458	57.9	3,352	57.6	3,483	56.4	3,592	56.7	3,931	57.1	4,123	57.6	4,277	57.3	4,61	56.7	4,916	58.2	4,485	57.8	46,494	57.4
Female	2,2	42.0	2,4	42.7	2,518	42.1	2,472	42.4	2,695	43.6	2,743	43.3	2,954	42.9	3,04	42.4	3,191	42.7	3,514	43.2	3,526	41.8	3,278	42.2	34,531	42.6
Unknown	1	-	-	-	-	-	-	-	-	-	3	-	-	-	1	-	2	-	2	-	-	-	-	-	9	-
Age group (in years)
< 1	4	0.1	10	0.2	4	0.1	3	0.1	2	-	3	-	5	0.1	2	-	4	0.1	10	0.1	8	0.1	2	-	57	0.1
01-04	9	0.2	10	0.2	5	0.1	12	0.2	9	0.1	8	0.1	9	0.1	11	0.2	6	0.1	10	0.1	8	0.1	5	0.1	102	0.1
05-14	26	0.5	17	0.3	24	0.4	24	0.4	13	0.2	9	0.1	22	0.3	25	0.3	20	0.3	10	0.1	13	0.2	17	0.2	220	0.3
15-24	74	1.4	76	1.4	77	1.3	71	1.2	57	0.9	80	1.3	62	0.9	70	1.0	61	0.8	81	1.0	70	0.8	81	1.0	860	1.1
25-34	156	3.0	184	3.3	144	2.4	133	2.3	149	2.4	140	2.2	147	2.1	151	2.1	165	2.2	154	1.9	133	1.6	157	2.0	1,813	2.2
35-44	299	5.7	284	5.1	317	5.3	297	5.1	300	4.9	320	5.0	311	4.5	340	4.7	336	4.5	312	3.8	328	3.9	343	4.4	3,787	4.7
45-54	602	11.5	674	12.0	659	11.0	640	11.0	624	10.1	580	9.2	631	9.2	714	10.0	633	8.5	675	8.3	679	8.0	666	8.6	7,777	9.6
55-64	909	17.3	985	17.5	1,067	17.9	982	16.9	1,054	17.1	1,037	16.4	1,093	15.9	1,112	15.5	1,224	16.4	1,338	16.5	1,359	16.1	1,27	16.4	13,43	16.6
65-74	1,145	21.8	1,166	20.7	1,275	21.3	1,26	21.6	1,32	21.4	1,428	22.5	1,524	22.1	1,604	22.4	1,674	22.4	1,921	23.6	1,933	22.9	1,756	22.6	18,006	22.2
≥ 75	2,015	38.4	2,212	39.3	2,402	40.2	2,4	41.2	2,645	42.8	2,732	43.1	3,08	44.7	3,128	43.7	3,345	44.8	3,611	44.4	3,911	46.3	3,466	44.6	34,947	43.1
Age unknown	7	0.1	4	0.1	2	-	2	-	5	0.1	1	-	1	-	7	0.1	2	-	4	-	-	-	-	-	35	0.0
Region of residence
North	310	5.9	312	5.5	363	6.1	345	5.9	331	5.4	383	6.0	409	5.9	470	6.6	552	7.4	584	7.2	659	7.8	591	7.6	5,309	6.6
Northeast	1,051	20.0	1,087	19.3	1,336	22.4	1,276	21.9	1,409	22.8	1,493	23.6	1,633	23.7	1,794	25.0	1,831	24.5	1,91	23.5	2,042	24.2	1,825	23.5	18,687	23.1
Southeast	2,608	49.7	2,891	51.4	2,903	48.6	2,904	49.9	3,045	49.3	3,048	48.1	3,304	48.0	3,389	47.3	3,518	47.1	3,765	46.3	3,763	44.6	3,382	43.6	38,52	47.5
South	868	16.5	908	16.2	959	16.0	867	14.9	994	16.1	920	14.5	1,032	15.0	1,087	15.2	1,099	14.7	1,351	16.6	1,328	15.7	1,389	17.9	12,802	15.8
Midwest	409	7.8	424	7.5	415	6.9	432	7.4	399	6.5	494	7.8	507	7.4	424	5.9	470	6.3	516	6.3	650	7.7	576	7.4	5,716	7.1
TOTAL	5,246	100.0	5,622	100.0	5,976	100.0	5,824	100.0	6,178	100.0	6,338	100.0	6,885	100.0	7,164	100.0	7,47	100.0	8,126	100.0	8,442	100.0	7,763	100.0	81,034	100.0

Disaggregation	Mortality coefficient			Beta^b	p-value	Average annual rate of increase (%)	95%CI^c	Interpretation
Disaggregation	2009	2015	2020	Beta^b	p-value	Average annual rate of increase (%)	95%CI^c	Interpretation
Sex
Male	3.72	3.99	3.98	0.005	0.002	1.14	0.52;1.76	Rising
Female	2.13	2.30	2.23	0.004	0.008	0.82	0.28;1.37	Rising
Age group (in years)
≤ 4	0.08	0.09	0.05	0.002	0.768	0.54	-3.34;4.58	Stationary
5-14	0.08	0.07	0.06	-0.012	0.385	-2.82	-9.32;4.15	Stationary
15-24	0.21	0.18	0.24	0.000	0.888	0.10	-1.46; 1.69	Stationary
25-34	0.47	0.42	0.46	-0.003	0.527	-0.58	-2.50; 1.38	Stationary
35-44	1.12	1.04	1.04	-0.003	0.018	-0.79	-1.40; -0.17	Falling
45-54	2.78	2.58	2.54	-0.004	0.094	-0.95	-2.07; 0.18	Stationary
55-64	6.49	6.21	6.17	-0.001	0.664	-0.23	-1.33;0.89	Stationary
65- 74	13.61	14.66	14.33	0.006	0.001	1.42	0.78;2.06	Rising
≥ 75	37.95	45.85	44.74	0.010	< 0.001	2.23	1.87; 2.60	Rising
Region of residence
North	2.92	3.30	4.07	0.016	0.002	3.86	1.86;5.90	Rising
Northeast	2.12	2.83	2.83	0.014	< 0.001	3.36	2.24;4.50	Rising
Southeast	3.04	3.10	2.77	-0.002	0.187	-0.41	-1.05;0.23	Stationary
South	3.02	2.85	3.28	0.003	0.309	0.76	-0.80;2.35	Stationary
Midwest	7.99	7.47	7.05	-0.004	0.297	-0.92	-2.75;0.93	Stationary
TOTAL	2.82	3.03	3.24	0.006	< 0.001	1.29	0.73;1.85	Rising

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence:
Ellen de Cassia Dutra Pozzetti Gouvêa | ellen.gouvea@saude.gov.br