The burden of Neglected Tropical Diseases in Brazil, 1990-2016: A subnational analysis from the Global Burden of Disease Study 2016

PLoS Negl Trop Dis. 2018 Jun 4;12(6):e0006559. doi: 10.1371/journal.pntd.0006559. eCollection 2018 Jun.

Abstract

Background: Neglected Tropical Diseases (NTDs) are important causes of morbidity, disability, and mortality among poor and vulnerable populations in several countries worldwide, including Brazil. We present the burden of NTDs in Brazil from 1990 to 2016 based on findings from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016).

Methodology: We extracted data from GBD 2016 to assess years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for NTDs by sex, age group, causes, and Brazilian states, from 1990 to 2016. We included all NTDs that were part of the priority list of the World Health Organization (WHO) in 2016 and that are endemic/autochthonous in Brazil. YLDs were calculated by multiplying the prevalence of sequelae multiplied by its disability weight. YLLs were estimated by multiplying each death by the reference life expectancy at each age. DALYs were computed as the sum of YLDs and YLLs.

Principal findings: In 2016, there were 475,410 DALYs (95% uncertainty interval [UI]: 337,334-679,482; age-standardized rate of 232.0 DALYs/100,000 population) from the 12 selected NTDs, accounting for 0.8% of national all-cause DALYs. Chagas disease was the leading cause of DALYs among all NTDs, followed by schistosomiasis and dengue. The sex-age-specific NTD burden was higher among males and in the youngest and eldest (children <1 year and those aged ≥70 years). The highest age-standardized DALY rates due to all NTDs combined at the state level were observed in Goiás (614.4 DALYs/100,000), Minas Gerais (433.7 DALYs/100,000), and Distrito Federal (430.0 DALYs/100,000). Between 1990 and 2016, the national age-standardized DALY rates from all NTDs decreased by 45.7%, with different patterns among NTD causes and Brazilian states. Most NTDs decreased in the period, with more pronounced reduction in DALY rates for onchocerciasis, lymphatic filariasis, and rabies. By contrast, age-standardized DALY rates due to dengue, visceral leishmaniasis, and trichuriasis increased substantially. Age-standardized DALY rates decreased for most Brazilian states, increasing only in the states of Amapá, Ceará, Rio Grande do Norte, and Sergipe.

Conclusions/significance: GBD 2016 findings show that, despite the reduction in disease burden, NTDs are still important and preventable causes of disability and premature death in Brazil. The data call for renewed and comprehensive efforts to control and prevent the NTD burden in Brazil through evidence-informed and efficient and affordable interventions. Multi-sectoral and integrated control and surveillance measures should be prioritized, considering the population groups and geographic areas with the greatest morbidity, disability, and most premature deaths due to NTDs in the country.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brazil / epidemiology
  • Child
  • Child, Preschool
  • Cost of Illness*
  • Female
  • Global Burden of Disease*
  • Global Health*
  • Humans
  • Infant
  • Life Expectancy
  • Male
  • Middle Aged
  • Morbidity
  • Neglected Diseases / economics
  • Neglected Diseases / epidemiology*
  • Prevalence
  • Quality-Adjusted Life Years
  • Tropical Medicine
  • Young Adult

Grant support

Bill & Melinda Gates Foundation (GBD Global) and Brazilian Ministry of Health (GBD Brazil; Grant No. 25000.479735/2017-40). FRM was funded by a postdoctoral fellowship from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES/Brazil). GLW, MC, JH, and ALPR are research fellows (Bolsista de Produtividade em Pesquisa- PQ) from the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq/Brazil). GLW would like to thank the Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ/Brazil) for the grant of the Programa Cientistas do Nosso Estado (CNE-2015). ALPR also receives unrestricted grants from the Instituto de Avaliação de Tecnologia em Saúde (IATS/CNPq) and Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG). MC would like to thank to the FAPEMIG for the grant of the Programa Pesquisador Mineiro (PPM-2016). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.