Female homicides in the state of Maranhão, Brazil, 2000-2019: an ecological study

Coelho, Sara Ferreira; Conceição, Hayla Nunes da; Rufino, Andréa Cronemberger; Madeiro, Alberto

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 31 (2) • 2022 • https://doi.org/10.1590/S2237-96222022000200007 copy

Female homicides in the state of Maranhão, Brazil, 2000-2019: an ecological study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the profile and temporal trends of female homicides in Maranhão, Brazil, between 2000 and 2019.

Methods:

This was an ecological study using data from the Mortality Information System. The profile of the deaths, mortality rate trends (joinpoint method) and correlation with socioeconomic and health indicators (Pearson correlation) were evaluated.

Results:

1,915 female homicides were reported, with predominance among those between 20-29 years old (29.9%), single (62.0%), with 4-7 years schooling (29.7%), mixed race (71.3%), homicides at home (31.9%) and by firearms (41.1%). The mortality rate showed a rising trend (APC = +8.21; 95%CI 5.18;10.28). There was negative correlation between homicides and per capita income (p-value = 0.031) and positive correlation with the proportion of families headed by women (p-value = 0.001) and with the rate of male mortality due to assault (p-value = 0.001).

Conclusion:

There was an increase in female homicides, related to structural violence in society, poverty and women with greater family authority.

Keywords:
Homicide; Violence Against Women; Mortality; Health Information System; Ecological Studies

Variables	n	%
Age group (in years)^a
≤ 9	76	4.0
10-19	264	13.8
20-29	573	29.9
30-39	475	24.8
40-49	248	12.9
50-59	124	6.5
60-69	67	3.5
≥ 70	76	4.0
Marital status^b
Single	1.187	62.0
Married	290	15.2
Separated	35	1.8
Other	253	13.2
Schooling (in years of study)^c
None	222	11.6
1-3	305	15.9
4-7	569	29.7
8-11	470	24.5
≥ 12	111	5.8
Race/skin color^d
White	280	14.6
Black	219	11.4
Asian	3	0.2
Mixed race	1,366	71.3
Indigenous	14	0.7
Place of occurrence^e
Home	610	31.9
Public thoroughfare	468	24.4
Health facility	520	27.2
Other	297	15.5
Mesoregion of the state
North	761	39.9
West	527	26.5
Center	214	12.8
East	308	15.5
South	105	5.3
Category (ICD-10)^f
Firearm (X93/X94/X95)	788	41.1
Sharp object (X99)	710	37.1
Blunt object (Y00)	127	6.6
Other unspecified means (Y08/Y09)	99	5.2
Hanging/strangulation/suffocation (X91)	94	4.9
Bodily force (Y04)	30	1.6
Crashing of motor vehicle (Y03)	18	0.9
Other maltreatment (Y07)	12	0.6
Smoke/fire/flames (X97)	9	0.5
Drowning/submersion (X92)	10	0.5
Unspecified chemical or noxious substance (X90)	6	0.3
Sexual assault by bodily force (Y05)	6	0.3
Neglect/abandonment (Y06)	3	0.2
Period of death
2000-2004	247	12.9
2005-2009	353	18.4
2010-2014	645	33.7
2015-2019	670	35.0
Total notifications	1,915	100.0

Maranhão and mesoregions of the state	MR^a		APC^b (95%CI)^c	p-value^c	Trend
Maranhão and mesoregions of the state	2000	2019	APC^b (95%CI)^c	p-value^c	Trend
Maranhão	1.53	5.34	8.21 (5.18;10.28)	< 0.001	Rising
North	2.07	5.43	6.92 (4.04;10.32)	< 0.001	Rising
West	1.44	5.48	7.67 (5.15;10.29)	< 0.001	Rising
Center	2.11	4.83	7.32 (3.74;10.78)	0.001	Rising
East	0.50	4.07	11.93 (9.12;14.84)	< 0.001	Rising
South	0.78	5.12	13.10 (9.66;17.82)	< 0.001	Rising

Variables	Mean	Minimum; maximum
Socioeconomic indicators
Gini Index	0.56	0.45;0.72
Human Development Index (HDI)	0.57	0.44;0.76
Per capita income (in BRL)	225.70	95.59;770.52
Proportion of families headed by women (%)	38.70	19.22;56.20
Life expectancy at birth (in years)	71.40	67.4;74.7
Unemployment rate (%)	7.40	1.28;22.44
Illiteracy rate (%)	26.39	4.61;38.6
Health indicators
Birth rate (live births/1,000 inhabitantes)	20.85	10.34;29.8
Cervical cancer mortality rate (per 100,000)	16.75	0;32.84
Breast cancer mortality rate (per 100,000)	15.88	0;35.77
Male mortality rate due to assault (per 100,000)	27.82	0.64;31.57
Male mortality rate due to ill-defined causes (%)	8.67	0.78;12.78
Female mortality rate due to ill-defined causes (%)	7.92	0.93;16.48

Variables	Correlation coefficient (r)	Correlation interpretation	p-value
Socioeconomic indicators
Gini Index	0.045	Very weak	0.624
Human Development Index (HDI)	0.532	Moderate	0.034
Per capita income (in BRL)	-0.658	Moderate	< 0.001
Proportion of families headed by women (%)	0.673	Moderate	< 0.001
Life expectancy at birth (in years)	-0.479	Moderate	0.341
Unemployment rate (%)	0.477	Moderate	0.001
Illiteracy rate (%)	0.307	Weak	0.065
Health indicators
Birth rate (live births/1,000 inhabitantes)	-0.253	Weak	0.221
Cervical cancer mortality rate (per 100,000)	0.451	Moderate	0.001
Breast cancer mortality rate (per 100,000)	0.562	Moderate	0.001
Male mortality rate due to assault (per 100,000)	0.634	Moderate	< 0.001
Male mortality rate due to ill-defined causes (%)	0.546	Moderate	< 0.001
Female mortality rate due to ill-defined causes (%)	0.361	Weak	0.356

Variables	β	95%CI^a	p-value
Initial model
Human Development Index (HDI)	0.598	0.438;0.635	0.032
Per capita income (in BRL)	-0.573	-0.378;-0.796	0.041
Proportion of families headed by women (%)	0.641	0.492;0.845	0.001
Unemployment rate (%)	0.480	-0.897;0.576	0.431
Cervical cancer mortality rate (per 100,000)	0.431	-0.761;0.653	0.538
Breast cancer mortality rate (per 100,000)	0.591	-0.909;0.754	0.281
Male mortality rate due to assault (per 100,000)	0.658	0.451;0.833	0.001
Male mortality rate due to ill-defined causes (%)	0.501	-0.758;0.745	0.221
Final model
Human Development Index	0.573	0.421;0.702	0.423
Renda per capita (in BRL)	-0.553	-0.329;-0.843	0.031
Proportion of families headed by women (%)	0.637	0.381;0745	0.001
Male mortality rate due to assault (per 100,000)	0.624	0.398;0.786	0.001

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[1] Correspondence
Alberto Madeiro madeiro@uol.com.br