MORTALIDADE PELA COVID-19 NO MARANHÃO E EXCESSO DE ÓBITOS NO BRASIL

Abstract

Introduction: Introduction: The number of cases of contamination by the new coronavirus has triggered a threat to millions of lives around the world, and the COVID-19 pandemic has become the most rapidly spreading, widespread and challenging Public Health Emergency of International Importance since The Second World War. Objective: To analyze deaths due to COVID-19 in Maranhão in the years 2020 - 2022 and the excess deaths in Brazil, in the years 2021-2022. Objective: To analyze deaths due to COVID-19 in Maranhão in the years 2020 - 2022 and the excess deaths in Brazil, in the years 2021-2022. Method: Ecological study of the total number of deaths and mortality due to Severe Acute Respiratory Syndrome (SARS) due to COVID-19, from March 2020 to December 2022, based on records from the Influenza Epidemiological Surveillance Information System (SIVEP- Influenza) and the Mortality Information System (SIM). And the excess deaths from COVID-19, in Brazil, in the period 2021 and 2022, based on SIM records, based on place of residence from 2015 to 2022 available on SIM, accessed on September 14, 2023. Results: In Maranhão, there were 11,034 death records from 2020 to 2022. Of these, 8,742 were reported in SIM and 9,493 in SIVEP- Gripe. In SIM, São Luís (n = 1,442), Imperatriz (n = 838) and Caxias (n = 281) were the municipalities with the highest number of deaths and in 6 municipalities there were no notifications. In SIVEP-Gripe, the municipalities with the highest number of deaths were São Luis (n = 3,727), Imperatriz (1,902) and Santa Inês (n = 427), however, 119 municipalities did not declare deaths. According to SIM, the municipalities with the highest mortality rate due to COVID-19 were Imperatriz (n = 323), Campestre do Maranhão (n = 256) and Trizidela do Vale (n = 248). Analyzing data from SIVEP-Gripe, the municipalities with the highest mortality rates were Imperatriz, Santa Inês and Lago da Pedra. In Brazil in 2021, 1,828,070 deaths were registered on the SIM, 32.2% more than expected. Among these deaths, the total number of excess deaths (445,032) was greater than deaths from COVID-19 (422,654), resulting in a ratio of excess deaths to deaths from COVID-19 of 1.05. The Brazilian states that exhibited the highest percentages of excess deaths were RO (66.1%), AM (52.1%), MT (49.4%), PR (48.1%) and DF (46. 3%). On the other hand, the states with the lowest percentage of excess deaths were RN (19.4%), BA (20.6%), PA (21.3%), AC (22.4%) and AP and PI, both with ( 22.6%). The states with the highest ratio of excess deaths/deaths due to COVID-19 were Pernambuco and Paraíba. In 2022, 1,537,025 deaths were registered in SIM, 9.5% more than expected. The total excess deaths (133,283) were 2.04 times the total deaths from COVID-19 (65,278). Greater proportional excesses of deaths were observed in RO (19.9%), PB (17.1%), PR (16.7%) and MS (14.9%). The study showed, in the form of waves, that there was a significant excess of deaths during the period studied throughout the national territory. Conclusion: Throughout this thesis, we evaluated the records of deaths carried out in the SIM and SIVEP-Gripe database, identifying different values of notifications by municipality, which leads to unreliability of the information. Unavailability, divergence and delays in data cannot be allowed, much less in a time of public health emergency. Excess mortality is an extremely important indicator for monitoring and setting priorities by decision makers, especially in developing countries, where the difficulties in adequate diagnosis and coping with the disease are well known. Some temporal distribution patterns of excess deaths common among Brazilian states were detected. However, most states showed divergent standards. This study is extremely important due to the exclusivity of the results, as they have not yet been discussed in other studies published on the subject. Our study has a limitation that deserves to be highlighted: death registration coverage in Brazil reaches percentages below 100% in some locations, especially in less developed regions, which may have biased our estimates of excess mortality.