The burden of Neglected Tropical Diseases in Brazil, 1990-2016: A subnational analysis from the Global Burden of Disease Study 2016

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Abstract

Background

Neglected Tropical Diseases (NTDs) are important causes of morbidity, disability, and mortality among poor and vulnerable populations in several countries worldwide, including Brazil. We present the burden of NTDs in Brazil from 1990 to 2016 based on findings from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016).

Methodology

We extracted data from GBD 2016 to assess years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for NTDs by sex, age group, causes, and Brazilian states, from 1990 to 2016. We included all NTDs that were part of the priority list of the World Health Organization (WHO) in 2016 and that are endemic/autochthonous in Brazil. YLDs were calculated by multiplying the prevalence of sequelae multiplied by its disability weight. YLLs were estimated by multiplying each death by the reference life expectancy at each age. DALYs were computed as the sum of YLDs and YLLs.

Principal findings

In 2016, there were 475,410 DALYs (95% uncertainty interval [UI]: 337,334–679,482; age-standardized rate of 232.0 DALYs/100,000 population) from the 12 selected NTDs, accounting for 0.8% of national all-cause DALYs. Chagas disease was the leading cause of DALYs among all NTDs, followed by schistosomiasis and dengue. The sex-age-specific NTD burden was higher among males and in the youngest and eldest (children <1 year and those aged ≥70 years). The highest age-standardized DALY rates due to all NTDs combined at the state level were observed in Goiás (614.4 DALYs/100,000), Minas Gerais (433.7 DALYs/100,000), and Distrito Federal (430.0 DALYs/100,000). Between 1990 and 2016, the national age-standardized DALY rates from all NTDs decreased by 45.7%, with different patterns among NTD causes and Brazilian states. Most NTDs decreased in the period, with more pronounced reduction in DALY rates for onchocerciasis, lymphatic filariasis, and rabies. By contrast, age-standardized DALY rates due to dengue, visceral leishmaniasis, and trichuriasis increased substantially. Age-standardized DALY rates decreased for most Brazilian states, increasing only in the states of Amapá, Ceará, Rio Grande do Norte, and Sergipe.

Conclusions/Significance

GBD 2016 findings show that, despite the reduction in disease burden, NTDs are still important and preventable causes of disability and premature death in Brazil. The data call for renewed and comprehensive efforts to control and prevent the NTD burden in Brazil through evidence-informed and efficient and affordable interventions. Multi-sectoral and integrated control and surveillance measures should be prioritized, considering the population groups and geographic areas with the greatest morbidity, disability, and most premature deaths due to NTDs in the country.

Author summary

Neglected Tropical Diseases (NTDs) are a public health problem in Brazil. We used findings from the Global Burden of Disease Study 2016 (GBD 2016) to explore the burden of NTDs in Brazil by sex, age group, specific causes, and Brazilian states from 1990 to 2016. In 2016, NTDs caused 475,410 disability-adjusted life-years (DALYs) (95% uncertainly interval [UI]: 337,334–679,482; equating to an age-standardized rate of 232.0 DALYs/100,000 population) in Brazil. Chagas disease was the main cause of DALYs among all NTDs. The disease burden was higher among males, in the youngest and eldest (children under 1 year and elderly aged 70 years and older), and in Brazilian states considered endemic for the major NTDs. There was a consistent reduction in overall age-standardized DALY rates for all NTDs combined (overall reduction of 45.7%) and most NTD causes between 1990 and 2016, but with a pronounced increase for dengue and visceral leishmaniasis. Despite of the remarkable progress in reducing the DALY rates, NTDs remain as important preventable and neglected causes of disability and premature death in Brazil. GBD 2016 results call for intensified and comprehensive efforts to prevent and reduce the burden of NTDs in Brazil, with special emphasis on less developed areas and vulnerable populations.

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Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

Yuan-Pang Wang, Maheswar Satpathy, Elisabete Weiderpass … (2017)

Summary Background Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. Methods We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15–60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. Findings Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5–24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates—a measure of relative inequality—increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7–87·2), and for men in Singapore, at 81·3 years (78·8–83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. Funding Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

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Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010.

Louisa Degenhardt, Harvey Whiteford, Alize J Ferrari … (2013)

No systematic attempts have been made to estimate the global and regional prevalence of amphetamine, cannabis, cocaine, and opioid dependence, and quantify their burden. We aimed to assess the prevalence and burden of drug dependence, as measured in years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs). We conducted systematic reviews of the epidemiology of drug dependence, and analysed results with Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) Bayesian meta-regression technique (DisMod-MR) to estimate population-level prevalence of dependence and use. GBD 2010 calculated new disability weights by use of representative community surveys and an internet-based survey. We combined estimates of dependence with disability weights to calculate prevalent YLDs, YLLs, and DALYs, and estimated YLDs, YLLs, and DALYs attributable to drug use as a risk factor for other health outcomes. Illicit drug dependence directly accounted for 20·0 million DALYs (95% UI 15·3-25·4 million) in 2010, accounting for 0·8% (0·6-1·0) of global all-cause DALYs. Worldwide, more people were dependent on opioids and amphetamines than other drugs. Opioid dependence was the largest contributor to the direct burden of DALYs (9·2 million, 95% UI 7·1-11·4). The proportion of all-cause DALYs attributed to drug dependence was 20 times higher in some regions than others, with an increased proportion of burden in countries with the highest incomes. Injecting drug use as a risk factor for HIV accounted for 2·1 million DALYs (95% UI 1·1-3·6 million) and as a risk factor for hepatitis C accounted for 502,000 DALYs (286,000-891,000). Suicide as a risk of amphetamine dependence accounted for 854,000 DALYs (291,000-1,791,000), as a risk of opioid dependence for 671,000 DALYs (329,000-1,730,000), and as a risk of cocaine dependence for 324,000 DALYs (109,000-682,000). Countries with the highest rate of burden (>650 DALYs per 100,000 population) included the USA, UK, Russia, and Australia. Illicit drug use is an important contributor to the global burden of disease. Efficient strategies to reduce disease burden of opioid dependence and injecting drug use, such as delivery of opioid substitution treatment and needle and syringe programmes, are needed to reduce this burden at a population scale. Australian National Health and Medical Research Council, Australian Government Department of Health and Ageing, Bill & Melinda Gates Foundation. Copyright © 2013 Elsevier Ltd. All rights reserved.

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Incorporating a Rapid-Impact Package for Neglected Tropical Diseases with Programs for HIV/AIDS, Tuberculosis, and Malaria

Peter Hotez, David H. Molyneux, Alan Fenwick … (2006)

Hotez et al. argue that achieving success in the global fight against HIV/AIDS, tuberculosis, and malaria may well require a concurrent attack on the neglected tropical diseases.

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Author and article information

Contributors

Francisco Rogerlândio Martins-Melo:

ORCID: http://orcid.org/0000-0003-3690-5023

Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Mariângela Carneiro: Role: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Alberto Novaes Ramos Jr.: Role: Writing – original draftRole: Writing – review & editing

Jorg Heukelbach: Role: Writing – original draftRole: Writing – review & editing

Antonio Luiz Pinho Ribeiro: Role: ValidationRole: Writing – original draftRole: Writing – review & editing

Guilherme Loureiro Werneck: Role: SupervisionRole: Writing – original draftRole: Writing – review & editing

Andrea Angheben: Role: Editor

Journal

Journal ID (nlm-ta): PLoS Negl Trop Dis

Journal ID (iso-abbrev): PLoS Negl Trop Dis

Journal ID (publisher-id): plos

Journal ID (pmc): plosntds

Title: PLoS Neglected Tropical Diseases

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Print): 1935-2727

ISSN (Electronic): 1935-2735

Publication date (Electronic): 4 June 2018

Publication date Collection: June 2018

Volume: 12

Issue: 6

Electronic Location Identifier: e0006559

Affiliations

[1 ] Federal Institute of Education, Science and Technology of Ceará, Caucaia, Ceará, Brazil

[2 ] Institute of Studies in Public Health, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

[3 ] Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais

[4 ] Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil

[5 ] Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

[6 ] Department of Epidemiology, Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

Sacro Cuore Hospital, ITALY

Author notes

The authors have declared that no competing interests exist.

* E-mail: rogerlandio@ 123456bol.com.br

Author information

Francisco Rogerlândio Martins-Melo http://orcid.org/0000-0003-3690-5023

Article

Publisher ID: PNTD-D-18-00188

DOI: 10.1371/journal.pntd.0006559

PMC ID: 6013251

PubMed ID: 29864133

SO-VID: 9ef1b576-eba9-459e-b7c6-e354487f1f4e

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 6 February 2018

Date accepted : 24 May 2018

Page count

Figures: 7, Tables: 2, Pages: 24

Funding

Bill & Melinda Gates Foundation (GBD Global) and Brazilian Ministry of Health (GBD Brazil; Grant No. 25000.479735/2017-40). FRM was funded by a postdoctoral fellowship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/Brazil). GLW, MC, JH, and ALPR are research fellows (Bolsista de Produtividade em Pesquisa- PQ) from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq/Brazil). GLW would like to thank the Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ/Brazil) for the grant of the Programa Cientistas do Nosso Estado (CNE-2015). ALPR also receives unrestricted grants from the Instituto de Avaliação de Tecnologia em Saúde (IATS/CNPq) and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG). MC would like to thank to the FAPEMIG for the grant of the Programa Pesquisador Mineiro (PPM-2016). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

PLOS Publication Stage vor-update-to-uncorrected-proof

Publication Update 2018-06-21

Data Availability All relevant data are within the paper and its Supporting Information files. GBD 2016 results by location and year are available through of online visualization tools: https://vizhub.healthdata.org/gbd-compare and http://ghdx.healthdata.org/gbd-results-tool.

The burden of Neglected Tropical Diseases in Brazil, 1990-2016: A subnational analysis from the Global Burden of Disease Study 2016

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Abstract

Background

Methodology

Principal findings

Conclusions/Significance

Author summary

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Point-Of-Care Testing for NTDs

Most cited references 54

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010.

Incorporating a Rapid-Impact Package for Neglected Tropical Diseases with Programs for HIV/AIDS, Tuberculosis, and Malaria

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