Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 2 - Apr/Jun - 2018

Original Article Imprimir 

Páginas 29 a 38


Lost lives: a descriptive analysis of the profile of adolescent´s mortality in Brazil

Vidas perdidas: análisis descriptivo del perfil de la mortalidad de los adolescentes en Brasil

Vidas perdidas: análise descritiva do perfil da mortalidade dos adolescentes no Brasil

Autores: Caroline da Rosa

Doctor Student in Epidemiology by the Rio Grande do Sul Federal University (UFRGS). Porto Alegre, RS, Brazil

Caroline da Rosa
Rua Professor Fitzgerald, 177, Petrópolis
Porto Alegre, RS, Brasil. CEP: 90470-160
(caroliner2007@gmail.com)

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Keywords: Adolescent, mortality, cause of death.
Palabra Clave: Adolescente, mortalidad, causas de muerte.
Descritores: Adolescente, mortalidade, causas de morte.

Abstract:
OBJECTIVE: Perform a descriptive analysis of the epidemiological profile of adolescent´s mortality in Brazil in the five-year period from 2008 to 2012.
METHODS: An observational, descriptive, retrospective epidemiological study based on secondary data obtained from the DATASUS - Mortality Information System. The socioeconomic variables studied were: gender, color / race, education level and marital status. The cause of death was analyzed according to the ICD-10 chapters. This study uses the descriptive statistics and the calculation of the age-specific mortality rate for data analysis.
RESULTS: In the analyzed time series were recorded, 126.031 adolescent deaths. The year 2012 presented the highest death register and increase of the age-specific mortality coefficient. The male adolescents corresponded to 75.26% of this population. Brown skin color were predominant (52.2%) in the analyzed adolescent, as well as having 4-7 years of scholarity (35.36%) and single marital status (92.02%). External causes of morbidity and mortality accounted for 66.25% of deaths in the period. It was identified that, among external causes, assault was the most frequent (51.62%) followed by transport accidents (25.62%). The male adolescents are more prone to death by external factors than females.
CONCLUSION: External causes were responsible for two thirds of the adolescents Brazilian deaths. In order for the adolescent to have his right to a guaranteed life, it is necessary an intersectoral action, where the Unified Health System has an important place of health promotion in its broadest concept.

Resumen:
OBJETIVO: Realizar un análisis descriptivo del perfil epidemiológico de la mortalidad de los adolescentes en Brasil en el quinquenio de 2008 a 2012.
MÉTODOS: Estudio epidemiológico observacional, descriptivo, retrospectivo, basado en datos secundarios obtenidos en el DATASUS - Sistema de Información sobre Mortalidad. Las variables socioeconómicas estudiadas fueron: sexo, color / raza, escolaridad y estado civil. Se analizó la causa de la muerte de acuerdo con los capítulos del CID-10. Este estudio se utiliza de la estadística descriptiva y del cálculo del coeficiente de mortalidad específico por edad para el análisis de los datos.
RESULTADOS: En la serie temporal analizada se registraron 126.031 muertes de adolescentes. El año 2012 presentó el mayor registro de muertes y el aumento del coeficiente de mortalidad específico por edad. Los adolescentes del sexo masculino correspondieron al 75,26% de esa población. En la mayoría de los casos, el color de piel parda (52,22%), la escolaridad de 4 a 7 años de estudio (35,63%) y el estado civil soltero (92,02%). Las causas externas de morbilidad y mortalidad representaron el 66,25% de las muertes en el período. Se identificó que, entre las causas externas, la agresión fue la más frecuente (51,62%) seguida de los accidentes de transporte (25,62%). El sexo masculino es acometido con una frecuencia mucho mayor que el sexo femenino en las muertes por causas externas en adolescentes.
CONCLUSIÓN: Las causas externas fueron responsables de dos tercios de las muertes de adolescentes en Brasil. Para que el adolescente pueda tener el derecho a la vida garantizado, es necesaria una articulación intersectorial, siendo el Sistema Único de Salud un importante lugar de promoción de salud en su concepto más amplio.

Resumo:
OBJETIVO: Realizar uma análise descritiva do perfil epidemiológico da mortalidade dos adolescentes no Brasil no quinquênio de 2008 a 2012.
MÉTODOS: Estudo epidemiológico observacional, descritivo, retrospectivo, baseado em dados secundários obtidos no DATASUS - Sistema de Informação sobre Mortalidade. As variáveis socioeconômicas estudadas foram: sexo, cor/raça, escolaridade e estado civil. Foi analisada a causa da morte de acordo com os capítulos do CID-10. Esse estudo utiliza-se da estatística descritiva e do cálculo do coeficiente de mortalidade específico por idade para a análise dos dados.
RESULTADOS: Na série temporal analisada foram registradas 126.031 mortes de adolescentes. O ano de 2012 apresentou o maior registro de mortes e aumento do coeficiente de mortalidade específico por idade. Os adolescentes do sexo masculino corresponderam a 75,26% dessa população. Foram predominantes a cor de pele parda (52,22%), escolaridade de 4 a 7 anos de estudo (35,63%) e o estado civil solteiro (92,02%). As causas externas de morbidade e mortalidade representaram 66,25% das mortes no período. Identificou-se que, entre as causas externas, a agressão foi a mais frequente (51,62%) seguido dos acidentes de transporte (25,62%). O sexo masculino é acometido com uma frequência muito maior que o sexo feminino nas mortes por causas externas em adolescentes.
CONCLUSÃO: As causas externas foram responsáveis por dois terços das mortes de adolescentes no Brasil. Para que o adolescente possa ter o direito a vida garantido, é necessária uma articulação intersetorial, sendo o Sistema Único de Saúde um importante local de promoção de saúde no seu conceito mais amplo.

INTRODUCTION

Adolescence is characterized by being one of the fastest phases of human development. In addition to the physical and biological transformations, adolescence is also characterized by a period of physical, psychological and social vulnerability with complex changes. However, it is necessary to consider an important fact: both biological and psychological and social development will depend on the socio-cultural context in which the adolescent's family is inserted, thus outlining its possibilities and limitations1.

The World Health Organization (WHO) defines the chronological limits of adolescence from 10 to 19 years of age, that is, the second decade of life2. This criterion is adopted in Brazil by the Ministry of Health and by the Brazilian Institute of Geography and Statistics (IBGE).

It is estimated that adolescents represent 18% of the world's population3. In Brazil, adolescents accounted for 17.91% of the Brazilian population in 2010, as it corroborates with the global estimate. Analyzing the demographic data it is observed that Brazil is experiencing a decline in the number of adolescents: in the 2000 census adolescents represented 20.78% of the Brazilian population, in the census in 1991 they represented 21.82% and in the 1980 census they represented 23, 38%4.

Several authors and official publications highlight the complexity of adolescence5-6-7-8, where adolescents go through a dynamic process of maturation. It is a phase of major bodily transformations concomitantly with the emergence of new cognitive abilities. His new role in society brings with it a constant questioning of values. All of these modifications result in a predisposition to new experiences by testing attitudes and situations that may threaten their present and future health, such as: accidents, unplanned pregnancy, sexually transmitted diseases, drug use, and eating disorders6.

According to the WHO, teenage mortality rates are low in comparison to other age groups, and have shown a slight decline in the last decade. Overall, the main causes of death among adolescents are traffic accidents, AIDS, suicide, lower respiratory infections and interpersonal violence2. A study conducted by the United Nations Children's Fund in 2011 also points out that risks to adolescent survival and health have a number of causes, including accidents, AIDS, early pregnancy, unsafe abortions, risk behaviors, mental health problems and violence3.

In Brazil, the causes of adolescent mortality are a concern that has plagued public health9-10-11. The vulnerability and risks to which this age group is exposed shows that a large number of adolescents have their lives interrupted, with morbidity and mortality being related to the central external causes of this fact12. This study aims to perform a descriptive analysis of the epidemiological profile of the mortality of adolescents in Brazil in the five-year period from 2008 to 2012. The proposed analysis aims to give visibility to the theme so that more effective actions can be directed to public policies aimed at guaranteeing the adolescent the right to life.


METHODS

This is an observational, descriptive, retrospective epidemiological study based on secondary data obtained from the DATASUS - Mortality Information System (SIM). This system is managed by the Department of Health Situation Analysis of the Health Surveillance Secretariat of the Ministry of Health, in conjunction with the State and Municipal Health Secretariats. The Health Secretaries collect the Death Certificates from the registry offices and enter the information contained in the SIM. One of the primordial information is the basic cause of death, which is coded from the one declared by the medical examiner, according to rules established by the WHO.

Data were collected regarding the mortality of adolescents in Brazil. As WHO states that adolescents are in the 10-19 age group, two age groups were selected in DATASUS: one from 10 to 14 years old, and another from 15 to 19 years old. The path followed in the database was DATASUS - Health Information (TabNet) - Vital Statistics - Mortality4. In SIM, death certificates are coded using the 10th Revision of the International Classification of Diseases - ICD-10. For this analysis was considered death by residence, that is, number of deaths occurred counted according to the place of residence of the deceased.

The time series analyzed was from year 2008 to 2012 as the years in which the demographic and socioeconomic data of the resident population were published in full in the DATASUS portal, thus allowing the calculation of the specific mortality coefficient by age group in the national territory and in each federative unit. For comparison purposes, demographic data of the resident population of other years were used. All data from this study were extracted from the DATASUS4 portal.

The socioeconomic variables studied were: gender, color / race, schooling and marital status. The cause of death was analyzed according to the chapters of ICD-10. Chapter XX of the ICD-10, which addresses the external causes of morbidity and mortality, was detailed using the ICD-BR-10 list of elements.

The data collected were tabulated through a spreadsheet (Excel® software version 2010). This study uses the descriptive statistics and the calculation of the age-specific mortality coefficient for data analysis.

The present research uses only secondary data from the public domain database. For this reason, it is exempted from the need for approval by the Research Ethics Committee, as recommended by Resolution of the National Health Council (CNS) No. 466/12.


RESULTS

In the analyzed time series, 126,031 adolescent deaths were recorded in Brazil. The year 2012 was the year with the highest number of deaths in this population, accounting for 26,979 deaths. Based on the data analyzed, it was recorded that the deaths of adolescents represented on average 2.22% of the total deaths of the Brazilian population. In previous quinquennial, in the years 2001 to 2005, adolescent deaths accounted for 2.56% of total deaths in Brazil and in the five-year period from 1996 to 2000, these represented 2.78%.

Table 1 shows the socioeconomic characteristics of adolescents who died in Brazil during the study period. It is observed that the male adolescents correspond to 75.26% of this population, and the brown color was predominant in 52,22% of the cases. The highest school attendance of the population was 4 to 7 years of schooling, which represented 35.63%, and the second highest frequency was recorded for the ignored item (25.89%). The adolescents who died during the period were predominantly single marital status (92.02%).




The specific mortality rate by age group, calculated per 100,000 inhabitants aged 10 to 19 years, was higher in 2012 than in the other years of the series, and showed a considerable increase from 2011 to 2012, when this coefficient increased from 73.36 to 77.65. When the age-specific mortality coefficient is analyzed by federative units, it was identified that the State of Paraná in the south, Rio de Janeiro and Espírito Santo in the southeast region, Bahia, Alagoas and Pernambuco in the northeast and the State of Pará in the north presented in all the analyzed years their coefficient above the national coefficient. The State of São Paulo presented the lowest coefficient in all the analyzed years. In 2008 and 2009, the highest coefficient was recorded in the state of Espírito Santo, in 2010, 2011 and 2012, the state of Alagoas recorded the highest number of adolescent deaths in relation to the population in this age group (Table 2).




Deaths from external causes of morbidity and mortality, included in chapter XX of the ICD-10, are identified as the main cause of death of adolescents in Brazil. External causes represented 66.25% of the deaths of the population aged 10 to 19 years in the time series analyzed. The second most common cause of death among adolescents was neoplasms, chapter II of ICD-10, with 6.56%. These data are shown in Table 3.




External causes were analyzed in detail using the ICD-BR-10 list of elements. It was identified that the aggression represented 51.62% of deaths due to external causes in the period analyzed, followed by transportation accidents (25.62%) (Table 4). The year 2012 was the year of the time series in which the highest frequency of aggression deaths occurred in the period, accounting for 36.45% of the total teenage deaths in the year.




Table 4 also shows the frequency of external causes, detailed by the list of elements of ICD-BR-10, separated by the feminine and masculine genres. It is observed that the male sex is affected much more frequently than the female sex in the deaths due to external causes. The male involvement in deaths from external causes was 85.24% while the female sex was 14.76%.


DISCUSSION

In this study the alarming data were found that 66.25% of the deaths of adolescents are caused by external causes, chapter XX of the ICD-10. External causes are injuries, injuries or any other health effects - intentional or otherwise - of sudden onset and as an immediate consequence of violence or other exogenous cause13. Aggressions are included in this chapter, and are the leading cause of death among external causes of morbidity and mortality. In 2012, 36.45% of adolescents who died in the 10 to 19 age group lost their lives as a result of aggression. When comparing this percentage with the relative to the total population (4.8%) we found a stereotypical difference12.

Minayo14 in his study on teenage violence states that the preferred victim of homicides is the poor, non-white, male youth, with a mean age between 15 and 18 years old, living in urban peripheries or slums, often murdered by a gun projectile and called marginal in police records. In the present analysis we can see the predominant involvement of the male sex in the external causes, especially in the aggressions, which encompass homicides. The other socioeconomic variables listed by Minayo were not specifically analyzed for external causes in this study.

Judging from the data found in this analysis, we can describe the profile of adolescents who die in Brazil: it is predominantly male, brown, with 4 to 7 years of formal education, single and a victim of external causes of morbidity and mortality. The finding that the main determinants that kill our adolescents are outside the strictly medical procedures14, give the impression that this scenario can be modified. However, this phenomenon isn´t unique to Brazilian society. The great vulnerability of the adolescent to death from external causes, especially the male adolescents, has been described in several other studies with data from the reality of Brazil and the world9-15-16-17-18.

The age-specific mortality coefficient was calculated for the national territory and in each federative unit, allowing a general and fragmented view of the Brazilian scenario, respectively. In this way it is possible to verify the places where adolescents are most vulnerable. Identifying this reality is fundamental for management decision making. It can be seen that São Paulo presented the lowest age-specific mortality coefficient in all years of the time series. In analyzing the lethal violence to which adolescents are exposed through the Adolescence Homicide Index of 2012, it was noted that São Paulo, the most populous state in the country and with a large number of large municipalities, had the largest fall of this in recent years. This phenomenon was not restricted only to the capital, but expanded to a set of municipalities of the State12.

The single health system (SUS) has been in adolescent health care programs for decades. The essence of SUS is the practices of disease prevention and health promotion. However, in the age group between 10 and 19 years there is an increase of problems that could be avoided by these measures. Given this scenario, the viable and coherent alternative is the modification of the emphasis of the health services directed to the adolescent. Health professionals should include preventive measures as a key component of their care practice, rather than strictly biological and curative care. The activity of health promotion directed to the young population is more effective when developed from a collective health perspective, considering the individual within its context. This approach makes it easier to approach the problems of this public, such as early sexual activity, group pressure, drug use, accident prevention and urban violence. Internationally, it is called health promotion to the interventions that allow the adolescent to acquire competence and security in the self-management of his life6.

Data from this analysis are secondary data obtained through the SIM, which was created in 1975 with the main purpose of providing subsidies to draw the country's mortality profile, and has a national coverage since 1979.16 Data from mortality statistics are affected by several sources of error, but within an epidemiological perspective, provide valuable data on the health status of populations. The use of data depends, among other reasons, on the adequate completion of records and on the accuracy of determining the underlying cause of death19. Deaths from the SIM and the quality of the death certificate have improved significantly throughout the country. Deaths from external causes in particular have mandatory referrals to legal medical institutes where death certificates tend to be better fulfilled20. The improvement in the quality of vital statistics allows the information and their analysis to provide positive changes in the living conditions of the population, since they have the opportunity to provide subsidies to managers in the processes of planning actions and decision making.

However, even though it is possible to celebrate better performances in vital statistics in Brazil, the present analysis showed that there are aspects of the records that need to be improved, as in the case of the educational variable. This item was ignored in 25.89% of the time series analyzed. The incomplete completion of the variable schooling in the vital records was also verified by Soares Filho et al.20, who point out that this variable offers more reliable and less fluctuating information than the average monthly income to define the socioeconomic level of the population. Absent information about schooling or any other variable that one may wish to consider may lead to erroneous conclusions impairing the monitoring of events in the population.


CONCLUSION

The present descriptive analysis of the mortality profile of adolescents in Brazil shows that the majority of Brazilian adolescents have their lives interrupted by external causes of morbidity and mortality. For the Brazilian teenager to have his right to a guaranteed life, it is necessary to prioritize this theme in public agendas. Alertness to the public and public managers is essential so that the dimensions of the problem of lethal violence against adolescents can be modified.

The greatest success in reducing the mortality of adolescent victims of external causes is a matter of intersectoral articulation. From this perspective, the SUS is an important area of disease prevention and health promotion in its broadest concept.


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