Tendência temporal de morbimortalidade associadas às síndromes hemorrágicas maternas no Brasil e Ceará de 1990 a 2019: estimativas do estudo “Global Burden of Disease 2019"

Abstract

Maternal bleeding syndromes have a high impact on public health due to their repercussions on mortality and the quality of life of women. The objective was to evaluate the morbidity and mortality trends associated with maternal hemorrhagic syndromes in Brazil and Ceará; to analyze the temporal trend of maternal mortality and disability-adjusted years of life lost (DALY), years lived with disability (YLD) and years of life lost (YLL) due to hemorrhages in Brazil and Ceará. Ecological time series study based on secondary data from the Global Burden of Disease Study provided by the Institute for Health Metrics and Evaluation. Data consultation and protection took place in two periods, initially in the months of May-July and later in AugustSeptember 2022. The cause filters were used (maternal disorders/maternal hemorrhage); location (Brazil-Ceará); period 1990-2019; population (women of childbearing age - 10 to 49 years). For the calculation of the rate of years of life lost due to disability (DALY), 100,000 live births were considered, and for YLD and YLL, 100,000 inhabitants were used. Data were exported via csv download to Excel® for Windows 2016. To analyze temporal and annual trends, segmented linear regression was performed using the Joinpoint Regression Program software, version 4.9.1.0®. There was a significant reduction in the YLD rate both in Brazil (- 3.8%) and Ceará (-5.1%). For the YLL the trends were different, Brazil presented a significant reduction until 1997, followed by a continuous fall and Ceará presented a significant reduction of -8.8% until 1996, followed by an important increase of 25.1%, from 1999 returned to present a continuous and more intense decline than in Brazil. As for the DALY in Brazil, there was a decrease in maternal mortality due to hemorrhage from 1990 to 2019. In Ceará, from 1990- 1996 mortality showed a sharp decline, from 1996-1999 a significant increase and from 1999- 2019 a reduction, and the DALY had a sharp drop, a significant increase and a continuous decline, respectively. A change of +0.6% was observed in Brazil since 2005, leading to a projection of 58.5 by 2030 in the estimates of maternal mortality ratio. It was concluded that in Brazil there has been a significant reduction in maternal indicators since 1990, however Ceará has not followed this trend, with greater variation being observed at the extremes of age. There are relevant advances in the reduction of indicators, but still insufficient to achieve the Sustainable Development Goals recommended by the World Health Organization for the year 2030. The importance of efforts aimed at reducing morbidity and mortality due to maternal hemorrhages is reinforced and the need for greater investments in the care of women in the puerperal pregnancy period.