Mortalidade por Diabetes Mellitus durante as epidemias de Chikungunya ocorridas no Ceará em 2016 e 2017

Abstract

The term diabetes mellitus (DM) describes a metabolic disorder of multiple etiology, characterized by chronic hyperglycemia resulting from defects in the secretion and / or action of insulin. Elevated plasma concentrations of glucose have complications in multiple systems, mainly eyes, kidneys, heart, nerves and blood vessels. It is estimated that the world population with diabetes, currently, is 382 million people, 46% of them without previous diagnosis, and is expected to reach 471 million in 2035. There is evidence that diabetes increases the severity of some endemic infections, such as tuberculosis, melioidosis, dengue virus infection, among others. Chikungunya (CHIK) is an arbovirus that was recently isolated in the Americas and there is little evidence about its relationship in patients with DM. In Brazil, in 2017, 131,749 probable cases of Chikungunya were registered and an incidence rate of 63.9 cases / 100 thousand inhabitants, giving the disease a huge challenge for public health, especially in the northeast region of the country. The objective of this research was, initially, to identify the probable excess of deaths due to type 2 DM during the Chikungunya epidemic that occurred in Ceará in 2017. Subsequently, if there was an excess, to analyze the possible factors associated with this mortality among the patients who had Chikungunya. Methods: A descriptive study was conducted to identify the excess of deaths from type 2 DM. The monthly averages of deaths attributable to type 2 DM between 2001 and 2016 were determined and compared with data equivalent to the year 2017; along with the recent CHIKV outbreak in Ceará. For the analysis of the association between CHIK infection and death from DM, an ecological, cross-sectional study was carried out using secondary data of deaths from DM that occurred in the state of Ceará, between January 2016 and December 2017 and that had or not , recent Chikungunya infection. Data from the Brazilian Mortality Information System (SIM) and the Brazilian Notification Diseases Information System (SINAN) were used. Probabilistic linkage was used, using the Reclink software for matching information and identifying the same individual in different databases. Results: The CHKV outbreak peaked in April 2017, with 4,394.4 cases / 100,000 inhabitants, while deaths attributable to DM in the same period increased by 35.2%. 116,252 deaths from all causes were recorded, with 6,638 (5.7%) having DM as a basic or intermediate cause. In the same period, 109,783 cases of Chikungunya were confirmed. We identified 68 deaths (perfect pairs) with a basic or intermediate cause of death such as DM and who 11 had a recent infection with Chikungunya. As for risk factors, it was found that the median time between the onset of the symptoms of Chikungunya and the date of death from DM was 63 days. Exposure to Chikungunya infection increased by 4.4 times (CI = 3.8 - 5.8; p = 0.000) the chance of progressing to death among diabetic patients in 2017. Conclusions: During the Chikungunya epidemic in Ceará, there was an increase in deaths from diabetes mellitus, and this increase was related temporarily to the increase in the incidence of CHIK. The increase in mortality from DM was more significant in April 2017, following the CHIK incidence curve. Having had Chikungunya increased the chance of a diabetic patient evolving to death during the epidemics recorded in Ceará.