Mortalidade prematura por hipertensão arterial sistêmica e diabetes mellitus no Maranhão: análise de tendência (2015-2024) e projeções para 2030

Abstract

Introduction: Non-Communicable Diseases (NCDs), particularly Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM), constitute major causes of premature mortality (ages 30 to 69), posing a significant challenge to Primary Health Care (PHC). In regional contexts such as the state of Maranhão, this scenario is heightened, impacting the organization of care within the territory. Searches in scientific databases reveal that research on premature mortality trends for SAH and DM remains incipient, especially in Maranhão, with no identified studies specifically addressing this issue in the local context. Objective: To analyze the temporal trend of premature mortality from SAH and DM in Maranhão from 2015 to 2024, with projections for the epidemiological scenario through 2030. Methodology: An ecological time-series study was conducted using secondary data from the Mortality Information System (SIM) and population estimates from the Brazilian Institute of Geography and Statistics (IBGE) for the 2015–2024 period, with projections for 2025–2030. Underlying causes of death were classified according to ICD-10, considering codes I10 to I15 (SAH) and E10 to E14 (DM). The premature mortality rate for SAH and DM was calculated as the ratio between the number of deaths in the 30–69 age group and the corresponding resident population, multiplied by 100,000 inhabitants. Statistical analysis employed stochastic modeling using the M6 Model, adjusted via Bayesian inference in R software, with validation performed through cross-validation techniques. Results: A total of 3,624 deaths were recorded during the analyzed period. The premature mortality rate for SAH and DM remained stable among younger age groups and showed a progressive increase starting at age 50, reaching peak values between 65 and 69 years. An overall declining trend was observed throughout the period, interrupted by an increase in 2020, followed by a resumption of the downward trend. Estimates of the kt2 parameter from the M6 model indicated an upward trajectory, suggesting an increase in the mortality slope over time. Projections for the 2025–2030 period indicated rising mortality rates, particularly in the 60–69 age group, while younger groups showed little variation. Conclusions: Premature mortality from SAH and DM in Maranhão exhibits a pattern associated with population aging and intensified risk after age 50, with a projected growth trend through 2030. These findings indicate a risk of failing to meet Target 3.4 of the Sustainable Development Goals and reinforce the need to strengthen Primary Health Care, utilizing epidemiological tools to improve the planning and organization of health actions within the territory.