Analysis of trends in sepsis mortality in Brazil and by regions from 2010 to 2019

Almeida, Nyara Rodrigues Conde de; Pontes, Giovana Fonseca; Jacob, Felipe Lima; Deprá, João Victor Salvador; Porto, João Pedro Pires; Lima, Fernanda Rocha de; Albuquerque, Mário Roberto Tavares Cardoso de

doi:10.11606/s1518-8787.2022056003789

Brasil

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Original Article • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056003789 linkcopy

Analysis of trends in sepsis mortality in Brazil and by regions from 2010 to 2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE To characterize the profile of inpatients and trend of sepsis mortality in the Brazilian Unified Health System (SUS), throughout Brazil, and in its regions separately, from 2010 to 2019.

METHODS Observational, analytical and retrospective study of secondary data obtained through consultation to the Sistema de Informação Hospitalar (Hospital Information System). All incoming septicemia notifications from January 1, 2010 to December 31, 2019 were included. The following sociodemographic variables were used: sex, age, race, region and federative unit of residence. For data analysis, we used mortality and hospitalization coefficient, relative risk and Joinpoint regression.

RESULTS There were a total of 1,044,227 cases of sepsis in Brazil, yielding a mean prevalence coefficient of 51.3/100 thousand inhabitants. There were 463,000 deaths from sepsis recorded, with a mean prevalence coefficient of 22.8 deaths/100,000 inhabitants. The highest rates occurred among the elderly, of brown race, and there was no significant difference between genders. The Southeast region accounted for the highest rates of hospitalization and deaths. A general trend toward increased mortality was observed in the period studied.

CONCLUSION The heterogeneity of Brazil should be considered regarding socioeconomic and demographic characteristics, and differences in health investment and underreporting between regions, in order to understand the disease’s epidemiological course. Finally, these findings should be correlated with other studies, in an effort to understand the behavior of the disease, and provide inputs for public and private policies in order to reduce the expressiveness of cases and deaths from sepsis in Brazil.

Sepsis, epidemiology; Hospital Mortality, trends; Risk Factors; Socioeconomic Factors; Unified Health System

Variable	Deaths		Mortality coeff.^a		Relative Risk (RR)

	n	%	Coeff.	95%CI	RR	95%CI
Total deaths	462,971	100	22.8	22.6–23.0	-	-
Sex
Male	237,891	51.4	24.1	23.8–24.4	Ref.	-
Female	225,080	48.6	21.5	21.2–21.7	1.04	1.04–1.05
Age range (years)
≤ 4	17,291	3.7	13.0	12.4–13.7	1.06	1.01–1.11
5 to 9	1,724	0.4	1.2	1.0–1.4	Ref.	-
10 to 19	5,113	1.1	1.5	1.4–1.7	1.57	1.49–1.65
20 to 29	9,272	2.0	2.9	2.7–3.1	2.24	2.13–2.35
30 to 39	16,047	3.5	5.0	4.8–5.3	3.01	2.88–3.16
40 to 49	30,006	6.5	10.8	10.5–11.2	3.76	3.59–3.94
50 to 59	55,628	12.0	24.0	23.4–24.6	4.35	4.15–4.55
≥ 60	327,890	70.8	114.1	112.9–115.4	5.65	5.40–5.91
Race^b
White	176,097	54.6	19.3	19.0–19.6	1.09	1.09–1.10
Black	18,804	5.8	10.7	10.2–11.2	1.17	1.15–1.18
Brown	127,450	39.5	13.7	13.4–13.9	Ref.	-
Great Region
North	20,962	4.5	12.1	11.6–12.6	Ref.	-
Northeast	84,701	18.3	15.1	14.8–15.4	1.10	1.09–1.11
Southeast	262,337	56.7	30.6	30.3–31.0	1.30	1.29–1.31
South	75,262	16.3	25.8	25.3–26.4	1.02	1.01–1.03
Midwest	19,709	4.3	12.8	12.2–13.4	1.14	1.13–1.16

Variable	Deaths		Mortality coeff.^a		Relative Risk (RR)

	n	%	Coeff.	95%CI	n	%
Total deaths	462,971	100	22.8	22.6–23.0	-	-
North Region
Rondônia	2,397	0.5	13.9	12.2–15.7	1.07	1.02–1.12
Acre	400	0.1	5.0	3.6–6.9	1.30	1.20–1.42
Amazonas	6,265	1.4	16.2	15.0–17.5	1.77	1.71–1.83
Roraima	298	0.1	5.8	3.9–8.3	1.36	1.24–1.50
Pará	9,703	2.1	11.9	11.1–12.7	1.25	1.21–1.29
Amapá	295	0.1	3.8	2.6–5.5	1.43	1.30–1.57
Tocantins	1,604	0.3	10.6	9.0–12.4	1.70	1.62–1.78
Northeast Region
Maranhão	6,025	1.3	8.7	8.1–9.5	1.52	1.47–1.57
Piauí	2,275	0.5	7.1	6.2–8.1	1.61	1.55–1.68
Ceará	17,483	3.8	19.6	18.7–20.5	1.91	1.85–1.97
Rio Grande do Norte	5,423	1.2	15.9	14.6–17.3	1.25	1.20–1.29
Paraíba	6,002	1.3	15.3	14.1–16.5	1.00	0.97–1.04
Pernambuco	25,956	5.6	27.8	26.7–28.9	1.70	1.65–1.75
Alagoas	3,638	0.8	11.0	9.9–12.2	Ref.	-
Sergipe	2,460	0.5	11.0	9.6–12.4	1.95	1.88–2.03
Bahia	15,439	3.3	10.4	9.9–10.9	1.40	1.36–1.44
Southeast Region
Minas Gerais	58,459	12.6	28.2	27.5–28.9	1.27	1.24–1.31
Espírito Santo	5,342	1.2	13.8	12.6–15.0	1.09	1.06–1.13
Rio de Janeiro	47,165	10.2	28.2	27.4–29.0	2.04	1.98–2.10
São Paulo	151,371	32.7	34.2	33.6–34.7	2.08	2.02–2.14
South Region
Paraná	27,516	5.9	24.8	23.8–25.7	1.47	1.42–1.51
Santa Catarina	13,221	2.9	19.4	18.4–20.5	1.31	1.27–1.35
Rio Grande do Sul	34,525	7.5	30.8	29.8–31.9	1.39	1.35–1.43
Midwest Region
Mato Grosso do Sul	2,393	0.5	9.1	8.0–10.4	1.63	1.57–1.70
Mato Grosso	7,425	1.6	22.6	21.0–24.3	1.65	1.60–1.71
Goiás	5,067	1.1	7.6	7.0–8.3	1.36	1.32–1.41
Distrito Federal	4,824	1.0	16.9	15.4–18.4	1.69	1.64–1.75

Variable	Hospitalizations		Hospitalization coeff.^a

	n	%	Coeff.	95%CI
Total hospitalizations	1,044,227	100	51.3	51.0–51.6
Sex
Male	547,269	52.4	55.5	55.0–56.0
Female	496,958	47.6	47.4	47.0–47.8
Age range (years)
≤ 4	155,541	14.9	117.4	115.6–119.3
5 to 9	16,422	1.6	11.4	10.8–11.9
10 to 19	31,094	3	9.4	9.1–9.8
20 to 29	39,464	3.8	12.5	12.1–12.9
30 to 39	50,744	4.9	15.9	15.5–16.3
40 to 49	75,970	7.3	27.4	26.8–28.1
50 to 59	121,939	11.7	52.5	51.5–53.4
≥ 60	553,053	53	192.1	190.5–193.7
Race^b
White	388,330	52.9	42.5	42.1–42.9
Black	38,764	5.3	22.2	21.5–22.9
Brown	306,687	41.8	32.9	32.6–33.3
Greats Region
North	56,001	5.4	32.4	31.5–33.2
Northeast	205,837	19.7	36.8	36.3–37.3
Southeast	539,158	51.6	62.9	62.4–63.5
South	197,240	18.9	67.8	66.8–68.7
Midwest	45,991	4.4	29.9	29.0–30.8

Variable	Hospitalizations		Hospitalization coeff.^a

	n	%	Coeff.	IC95%
Total hospitalizations	1,044,227	100	51.3	51.0–51.6
North Region
Rondônia	8,229	0.8	47.5	44.3–50.9
Acre	1,128	0.1	14.1	11.6–17.0
Amazonas	13,011	1.2	33.8	32.0–35.7
Roraima	804	0.1	16	12.7–19.9
Pará	28,602	2.7	35.1	33.8–36.4
Amapá	759	0.1	10.1	7.9–12.6
Tocantins	3,468	0.3	23.1	20.7–25.6
Northeast Region
Maranhão	14,572	1.4	21.2	20.1–22.3
Piauí	5,185	0.5	16.1	14.7–17.6
Ceará	33,625	3.2	37.7	36.5–39.0
Rio Grande do Norte	15,973	1.5	46.9	44.7–49.3
Paraíba	21,962	2.1	56.2	53.8–58.5
Pernambuco	56,022	5.4	60.1	58.5–61.7
Alagoas	13,359	1.3	40.5	38.4–42.7
Sergipe	4,633	0.4	20.6	18.8–22.6
Bahia	40,506	3.9	27.3	26.5–28.1
Southeast Region
Minas Gerais	168,546	16.1	81.3	80.0–82.5
Espírito Santo	17,937	1.7	46.3	44.2–48.5
Rio de Janeiro	84,965	8.1	50.9	49.8–52.0
São Paulo	267,710	25.6	60.4	59.7–61.1
South Region
Paraná	68,893	6.6	62	60.5–63.5
Santa Catarina	37,116	3.6	54.6	52.8–56.4
Rio Grande do Sul	91,231	8.7	81.5	79.8–83.2
Midwest Region
Mato Grosso do Sul	5,377	0.5	20.5	18.9–22.4
Mato Grosso	16,506	1.6	50.5	48.1–53.0
Goiás	13,647	1.3	20.5	19.4–21.7
Distrito Federal	10,461	1	36.6	34.4–38.9

Variable	Trend 1			Trend 2			Total period

	Period	APC	95%CI	Period	APC	95%CI	AAPC	95%CI
Brazil – Total	2010–2016	9.1^a	7.5 to 10.8	2016–2019	4.0^a	0.2 to 8.0	7.4^a	6.1 to 8.7
Sex
Female	2010–2016	9.2^a	7.3 to 11.2	2016–2019	4.0	-0.7 to 8.8	7.4^a	5.9 to 9.0
Male	2010–2016	9.1^a	7.8 to 10.4	2016–2019	4.0^a	0.8 to 7.2	7.3^a	6.3 to 8.4
Age range (years)
≤ 4	2010–2015	-2.6^a	-4.3 to -0.8	2015–2019	-0.1	-2.9 to 2.8	-1.5^a	-2.7 to -0.3
5 to 9	2010–2014	-6.8^a	-9.4 to -4.2	2014–2019	3.1^a	1.1 to 5.2	-1.4^a	-2.7 to -0.2
10 to 19	2010–2016	3.0^a	2.2 to 3.7	2016–2019	-2.3	-5.1 to 0.6	1.2^a	0.4 to 2.0
20 to 29	2010–2015	7.2^a	4.1 to 10.4	2015–2019	-0.3	-4.1 to 3.7	3.8^a	2.0 to 5.7
30 to 39	2010–2015	5.8^a	2.7 to 9.0	2015–2019	-0.8	-4.5 to 3.2	2.8^a	1.0 to 4.7
40 to 49	2010–2016	4.8^a	4.1 to 5.4	2016–2019	0.3	-1.6 to 2.2	3.3^a	2.7 to 3.8
50 to 59	2010–2016	5.0^a	3.6 to 6.4	2016–2019	0.4	-3.7 to 4.7	3.4^a	2.2 to 4.7
≥ 60	2010–2016	8.4^a	7.2 to 9.6	2016–2019	1.9	-1.4 to 5.2	6.2^a	5.1 to 7.2
Race
White	2010–2019	7.9^a	7.1 to 8.8				7.9^a	7.1 to 8.8
Brown	2010–2019	12.0^a	10.1 to 14.0				12.0^a	10.1 to 14.0
Black	2010–2013	2.4	-16.9 to 26.3	2013–2019	12.8^a	8.2 to 17.6	9.2^a	3.1 to 15.7
Great Region
North	2010–2019	7.7^a	5.8 to 9.7				7.7^a	5.8 to 9.7
Northeast	2010–2016	17.8^a	14.5 to 21.2	2016–2019	1.1	-6.0 to 8.6	11.9^a	9.4 to 14.6
Southeast	2010–2015	8.1^a	5.8 to 10.4	2015–2019	4.6^a	2.0 to 7.3	6.5^a	5.2 to 7.9
South	2010–2019	6.3^a	5.8 to 6.9				6.3^a	5.8 to 6.9
Midwest	2010–2016	8.2^a	6.1 to 10.3	2016–2019	4.2	-1.2 to 9.9	6.9^a	5.1 to 8.7

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[TFN1] Coeff.: coefficient; 95%CI: confidence interval of 95%.

[TFN2] ^a Mean annual coefficient obtained by the direct standardization method, where numerator was the mean number (mean from 2010 to 2019) of deaths applied to the reference population (2014), and the denominator was the population of the respective stratum in this reference year.

[TFN3] ^b Information not available for all races. Population information for sex, age group, race/color, and Great Region were obtained from the IBGE 2010 Demographic Census or from estimates from the PNAD for intercensal years.