Neurocysticercosis-related mortality in Brazil, 2000–2011: epidemiology of a neglected neurologic cause of death

Abstract

Neurocysticercosis (NCC) is an important cause of severe neurological disease mainly in low- and middle-income countries, but data on NCC mortality from endemic areas are scarce. Here we analysed theepidemiological patterns of NCC-related mortality in Brazil. We included all deaths recorded in Brazilbetween 2000 and 2011, in which NCC was mentioned on death certificates, either as underlying oras associated cause of death. NCC was identified in 1829/12,491,280 deaths (0.015%), 1130 (61.8%) asunderlying cause, and 699 (38.2%) as associated cause. Overall age-adjusted mortality rate for the periodwas 0.97 deaths/1,000,000 inhabitants (95% confidence interval [CI]: 0.83–1.12). The highest NCC-relatedmortality rates were found in males, elderly, white race/colour and residents in endemic states/regions.Age-adjusted mortality rates at national level decreased significantly over time (annual percent change[APC]: −4.7; 95% CI: −6.0 to −3.3), with a decrease in the Southeast, South and Central-West regions,and a non-significant increasing trend in the North and Northeast regions. We identified spatial andspatiotemporal high-risk mortality clusters located mainly in NCC-endemic areas. Conditions related tothe nervous system were the most commonly associated causes of death when NCC was mentioned asan underlying cause, and HIV/AIDS was the main underlying cause when NCC was an associated cause.NCC is a neglected and preventable cause of severe neurologic disease and death with high public healthimpact in Brazil. There is a clear need to strengthen nationwide epidemiological surveillance and controlfor the taeniasis/cysticercosis complex.