Neglected Mycoses in Brazil: A Population-Based Study of Mortality and In-Hospital Mortality Over 25 Years.

Abstract

Objective: To describe the epidemiology, associated factors, spatial distribution, and temporal trends of mortality and in-hospital mortality related to systemic mycoses in Brazil, 2000-2024.

Methods: This is a nationwide ecological study combining temporal and spatial analyses using death certificates (DC; underlying and/or associated causes) and hospital admissions (HA; primary and/or secondary diagnoses) with in-hospital deaths. We estimated rate ratios (RR) with 95% confidence intervals (CI) interpreted as comparative mortality and in-hospital mortality rates between sociodemographic categories at the aggregate level, stratified by sex and age group; temporal trends were presented with the average annual percent change (AAPC) and 95% CIs; spatial heterogeneity was described across states. Outcomes were expressed as population-based rates (per 100,000 inhabitants).

Results: We identified 22,230 mycosis-related deaths among a total of 30,488,786 deaths (0.07%), corresponding to an overall mortality rate of 0.46 per 100,000 population. Mortality was higher in males (RR 2.91; 95% CI 2.51-3.38) and peaked at ages 60-69 years (RR 3.47; 95% CI 2.67-4.51). Nationwide mortality declined over time (AAPC -1.12; 95% CI -1.41 to -0.83). Deaths were geographically concentrated in the states of Rondônia, Mato Grosso, Goiás and Mato Grosso do Sul. We recorded a total of 4471 in-hospital deaths among 11,367,369 admissions (0.04%), yielding an in-hospital mortality rate of 0.09 per 100,000 population. In-hospital risk of death was higher in males (RR 2.12; 95% CI 1.55-2.89) and in those aged ≥ 70 years (RR 12.50; 95% CI 7.38-21.17). No significant nationwide trend was observed for in-hospital mortality (AAPC 0.64; 95% CI -1.20 to 2.59). Spatial distribution during the analysis period was heterogeneous, especially in the states of Rondônia, São Paulo, Rio de Janeiro, Paraíba and Paraná.

Conclusion: Our findings fill an important gap by jointly analysing long-term mortality and in-hospital mortality related to systemic mycoses at a nationwide scale, using two complementary information systems. Neglected mycoses remain an important cause of death in Brazil, including deaths during hospitalisation. Distinct individual-level and spatial patterns support the need for strengthened surveillance, prevention, control, and therapeutic strategies within the Brazilian Unified Health System.