4141 Distribution of Asthma Mortality in Various Districts of Salvador, Brazil

Wednesday, 7 December 2011
Poster Hall (Cancún Center)

Carolina Souza-Machado, Msc, RN , School of Nursing, FEDERAL UNIVERSITY OF BAHIA, Salvador, Brazil

Adelmir Souza-Machado, MD, PhD , Institute of Science Biomorphology Health Department , FEDERAL UNIVERSITY OF BAHIA, Salvador, Brazil

Márcio S. da Natividade, BSc , Institute of Public Health, FEDERAL UNIVERSITY OF BAHIA, Salvador, Brazil

Ana Carla Carvalho Coelho, Msc, RN , School of Nursing, FEDERAL UNIVERSITY OF BAHIA, Salvador, Brazil

Magali Teresópolis Reis Amaral, Msc , State University of Feira de Santana, Salvador, Brazil

Alvaro Cruz, MD , Medicine, ProAR - Núcleo de Excelência em Asma da UFBA, Salvador, Brazil

Background:  Brazil still does not have a national program to combat asthma. Isolated initiatives have been developed in a non-standardized fashion. The Program for Control of Asthma in Bahia (ProAR) was established in Salvador - Bahia, in 2003, aiming for the control of the most severe cases. 

Objective: To analyze time trends in mortality from asthma and its distribution in the districts of Salvador (2000-2009) and to correlate mortality rates with social indicators. 

Methods:  observational study of deaths from asthma registered by the National Database of Mortality according to ICD-10. Mortality rates were calculated per 100,000 inhabitants and analyzed by simple linear regression. The distribution of mortality for asthma in the period was mapped into the 12 health districts of Salvador. The correlation of the number of deaths in Salvador with GDP per capita, HDI and Index Gini was evaluated.

Results:  The average asthma mortality in Salvador between 2000 and 2009 was 1.542/100.000 inhabitants, with a declining trend (R²=0.539, b =-11.1, p=0.016). Deaths occurred more frequently in women than men (66% vs. 34%). Asthma mortality rates were higher in subjects > 35 years. There was a  reduction at ages younger than 1 year, 5 to 14 years, 25-34 years, and 45-54 years with a sharp decline between 55 and 64 (-8.14/100,000).The mortality rate (19.68/100,000 inhabitants in 2009) was higher for individuals > 75 years. The highest mortality rates were noted in more populated and poorer areas with less infrastructure and access to health services. It was observed that 78% of the deaths occurred in hospitals or health facilities. Deaths rates for asthma correlated directly with the district Gini index (rho = 0.400, p = .505) and inversely with HDI (rho = -0.300, p = .624), though not statistically significant. 

Conclusions: asthma mortality in Salvador is concentrated in the poorest areas with less infrastructure and access to health services, most commonly affecting women and the elderly. There was a reduction in mortality during the study period, possibly related to interventions for asthma control in the municipality. Mortality from asthma behaves differently in each district of the city.