Mortalidade por doenças crônicas não transmissíveis no Maranhão: análise temporal e alinhamento com a agenda 2030

Abstract

Introduction: Brazil's Northeast region, particularly the state of Maranhão, exhibits high rates of premature mortality from non-communicable chronic diseases (NCDs), a situation exacerbated by persistent socioeconomic inequalities and structural challenges within the health system. Analysis of the historical evolution of these mortality rates is essential to inform public policies capable of accelerating the reduction of preventable deaths and contributing to the achievement of Sustainable Development Goal 3 (Good Health and Well-being) of the 2030 Agenda. Objective: To analyze the temporal evolution of premature mortality rates (ages 30-69 years) attributed to cardiovascular diseases, cancer, diabetes mellitus, and chronic respiratory diseases in the state of Maranhão, as well as health expenditures, during the period 2015-2023. Methods: An ecological, exploratory study with an analytical approach, based on secondary data from the Brazilian Indicators for Sustainable Development Goals (ODS Brasil/IBGE), specifically indicator 3.4.1. Time series of premature mortality rates due to NCDs in Maranhão between 2015 and 2023 were analyzed, stratified by sex and age groups. Temporal trends were estimated using Prais-Winsten regression, with calculation of the annual percentage change (APC) and respective 95% confidence intervals. Results: Premature NCD mortality in Maranhão declined from 14.59 to 13.26 deaths per 100,000 between 2015 and 2023 (APC ≈ 1.03%/year). Among men, mortality decreased from 16.02 to 15.35 (not statistically significant), whereas among women there was a significant decline from 13.23 to 11.34 deaths per 100,000 (APC = –1.47%, p < 0.05). By age group, mortality rates in 2023 were 2.29 (ages 55–59 years), 3.59 (ages 60–64), and 5.66 per 100,000 (ages 65 69), with the largest declines (APC ≈ –1.20% to –1.45%); the 40–44 age group remained stable (0.53–0.61 per 100,000). Regarding financing, state per capita health expenditure increased from R$ 1,597.19 (2015) to R$ 2,603.19 (2023), with a mean of R$ 2,038.97 over the period. Correlation between mortality and per capita expenditure was strong and negative (r = –0.884), and negative for overall revenue (r = –0.8165), whereas federal transfers showed weaker correlation (r = –0.4122). In log-log models, per capita expenditure demonstrated a significant inverse association with mortality (β ≈ –0.17, p < 0.05), indicating negative elasticity; analysis with a 1-year lag confirmed a similar effect (β ≈ –0.15, p < 0.05). Stratified analyses revealed significant effects among women (β ≈ –0.14 to –0.18, p < 0.05) and absence of significance among men (β ≈ –0.08 to –0.10, p > 0.05). Federal transfers showed no statistically relevant association in most models. Conclusion: There was a moderate decline in NCD mortality in Maranhão and an inverse association with health financing; however, progress remains insufficient to meet the SDG 3.4 target. More effective actions are necessary to accelerate the reduction of preventable deaths from NCDs in the state.