Análise de tendência temporal da mortalidade por agressões entre adolescentes em Fortaleza-CE, de 2009 a 2022

Abstract

This ecological study analyzed the impact of deaths from undetermined causes (codes Y08- Y09, Y24, and Y34 from the International Classification of Diseases and Related Health Problems - ICD-10) on the interpretation of mortality from assaults (codes X85-Y04 from ICD10) among adolescents in Fortaleza from 2009 to 2022. Data were used from the Mortality Information System (SIM) and supplementary data from DATASUS. The study employed methods of descriptive statistical analysis and time series of mortality rates, and segmented Poisson regression analyses were used through the Joinpoint Regression Program version 4.9.1.0. This study is exempt from registration with the Research Ethics Committee on Human Subjects - CEP due to the use of public and anonymized databases. Between 2009 and 2022, there were 5,214 violent deaths among adolescents, of which 96.3% were attributed to assaults and 3.7% to undetermined causes. The average rate of assaults over the period was 90.3 cases/year, while for unspecified events/undetermined intention it was 3.5/year. Deaths with undetermined causes showed an increase of 129.4% between 2013 and 2022. An unequal distribution of deaths by firearm assault was observed, predominantly in the Regional Secretariats SR5 (93.8%) and SR6 (95.5%). The time trend analysis of all deaths (assault and undetermined) for both sexes combined shows a decreasing trend from 2009 to 2022 (AAPC = -1.6, 95% CI = -9.1 to 6.6), with a significant increasing trend from 2009 to 2013 (APC = 27.9%, 95% CI: 0.3-63), followed by a significant decreasing trend (APC = -12.4%, 95% CI: - 19 to -5.4). There is a decreasing and non-significant trend (AAPC = -1.7%, 95% CI: -9.6 to 6.9) for assaults across the entire group. From 2009 to 2013, there is a significant and higher increasing trend for all violent deaths (APC = 29.7%, 95% CI: 0.4 to 67.5), followed by a significant decreasing trend for deaths (APC = -13.1%, 95% CI: -20 to -5.7). When analyzing only deaths from events of undetermined intention, a positive but non-significant AAPC (0.2%, 95% CI: -17.8 to 22.1) is observed, with a growing but non-significant trend from 2009 to 2020 (APC = 7.1%, 95% CI: -0.2 to 14.9), and a statistically non-significant decreasing trend in the last biennium, 2020-2022 (APC = -30.6%, 95% CI: -83.5 to 191.8). When analyzing the time trend over the entire period, separated by age group, it is observed that among younger individuals (10 to 14 years) there is a non-significant increasing trend in cases for both all deaths (assault and undetermined), and for assaults and undetermined causes alone (AAPC = 1%, 95% CI: -10.7 to 14.2 vs AAPC = 1%, 95% CI: -11.8 vs AAPC = 0.5%, 95% CI: -33.2 to 51). The results reinforce the urgency of improving the mechanisms for recording and analyzing data on 10 violent mortality among adolescents in Fortaleza. Additionally, the research underscores the importance of differentiated approaches that take into account gender and age peculiarities in formulating intervention strategies.