O Brasil é um dos países mais afetados pela pandemia de COVID-19 e o real número de mortes pela doença torna o cenário ainda mais desafiador. O objetivo deste estudo foi estimar o excesso de mortes e suas diferenças em adultos com 20 anos e mais em Manaus (Amazonas), Fortaleza (Ceará), Rio de Janeiro e São Paulo, de acordo com o local de ocorrência do óbito, características demográficas e trajetória ao longo do tempo. Os dados foram obtidos no Sistema de Informações sobre Mortalidade e na Central de Informações do Registro Civil Nacional. As estimativas de óbitos esperados foram obtidas por meio de modelos aditivos generalizados quasi-Poisson com ajuste de sobredispersão. Entre 23 de fevereiro e 13 de junho de 2020, foram registradas 74.410 mortes naturais nas quatro cidades, com excesso de mortes de 46% (IC95%: 44-47). O maior excesso de mortes ocorreu em Manaus, 112% (IC95%: 103-121), seguido por Fortaleza, 72% (IC95%: 67-78), Rio de Janeiro, 42% (IC95%: 40-45) e São Paulo, 34% (IC95%: 32-36). O excesso de mortes foi maior nos homens e não significativo nas Semanas Epidemiológicas (SE) 9-12, exceto em São Paulo, 10% (IC95%: 6-14). Em geral, o pico de mortes excedentes ocorreu nas SE 17-20. O excesso de mortes não explicado diretamente pela COVID-19 e de mortes em domicílios/via pública foi alto, especialmente em Manaus. A elevada porcentagem de mortes excedentes, de mortes não explicadas diretamente pela COVID-19 e de mortes fora do hospital sugerem alta subnotificação de mortes por COVID-19 e reforça a extensa dispersão do SARS-CoV-2, como também a necessidade da revisão de todas as causas de mortes associadas a sintomas respiratórios pelos serviços de vigilância epidemiológica.

In the Brazilian Amazon, where the majority of Yanomami villages are settled, mercury (Hg) exposure due to artisanal small-scale gold mining (ASGM) has been reported since the 1980s. This study assessed mercury exposure in the Yanomami reserve and whether the level of contamination was related to the ASGM geographical location. It was conducted using a cross-sectional study of 19 villages. Direct interviews were performed and hair samples were used as a bioindicator of Hg exposure. The Prevalence-Ratio (PR) was estimated as an indicator of association between ASGM geographical locations and human exposure to mercury. Mercury levels (239 hair samples) ranged between 0.4 and 22.1 μg·g⁻¹ and presented substantial differences amongst the villages. In the Waikas-Aracaça region, where current ASGM was reported, we observed the highest Hg concentrations (median = 15.5 μg·g⁻¹). Almost all participants presented with hair-Hg levels >6 μg·g⁻¹ (prevalence = 92.3%). In the Paapiu region, we observed the lowest concentrations (median = 3.2 μg·g⁻¹; prevalence = 6.7%). Our findings showed that the Waikas Ye’kuana and Waikas Aracaca villages presented with 4.4 (PR = 4.4; Confidence Interval (CI) 95% = 2.2–9.0) and 14.0 (PR = 14.0; CI 95% = 7.9–24.9) times higher prevalence of hair-Hg concentration, respectively, compared with Paapiu. Considering seasonal variation of Hg-exposure, the lowest concentrations were observed during the wet season (June–September) and the highest in the dry season (December–April). Our study suggests that there is an association between mercury exposure and ASGM geographical locations.

Background: The COVID-19 pandemic has exceeded 6 million known disease-related deaths and there is evidence of an increase in maternal deaths, especially in low- and middle-income countries. We aimed to estimate excess maternal deaths in Brazil and its macroregions as well as their trajectories in the first 15 months of the COVID-19 epidemic. Methods: This study evaluated maternal deaths from the Mortality Information System of the Ministry of Health, with excess deaths being assessed between March 2020 and May 2021 by quasi-Poisson generalized additive models adjusted for overdispersion. Observed deaths were compared to deaths expected without the pandemic, accompanied by 95% confidence intervals according to region, age group, and trimester of occurrence. Analyses were conducted in R version 3.6.1 and RStudio version 1.2.1335. Results: There were 3,291 notified maternal deaths during the study period, resulting in a 70% excess of deaths regardless of region, while in the North, Northeast, South and Southeast regions, excess deaths occurred regardless of age group. Excess deaths occurred in the March-May 2021 trimester regardless of region and age group. Excess deaths were observed in the Southeast region for the 25-36-year-old age group regardless of the trimester assessed, and in the North, Central-West and South regions, the only period in which excess deaths were not observed was September-November 2020. Excess deaths regardless of trimester were observed in the 37-49-year-old age group in the North region, and the South region displayed explosive behavior from March-May 2021, with a 375% excess of deaths. Conclusions: Excess maternal deaths, with geographically heterogenous trajectories and consistently high patterns at the time of the epidemic’s greatest impact, reflect not only the previous effect of socioeconomic inequalities and of limited access to maternal health services, but most of all the precarious management of Brazil’s health crisis.

Manaus, capital do estado brasileiro do Amazonas, é o atual epicentro da epidemia na Amazônia com um aumento repentino de mortes que preocupa gestores e sociedade. O objetivo do estudo foi analisar o excesso na mortalidade geral, segundo Semanas Epidemiológicas (SE), visando a identificar mudanças potencialmente associadas à epidemia em Manaus. Dados de mortalidade geral e grupos de causas foram obtidos na Central de Informações do Registro Civil Nacional e no Sistema de Informações sobre Mortalidade, para 2018, 2019 e 2020. Analisou-se faixa etária, sexo, local de ocorrência do óbito, SE, ano-calendário e causas de morte. Calcularam-se razões entre as mortes ocorridas em 2019/2018 e 2020/2019 para avaliar o excesso de mortes, com intervalos de confiança no nível de 5%. Não observou-se excesso de mortalidade geral significativo nas razões 2019/2018, independentemente da SE. Já as razões de 2020/2019 passaram de 1,0 (IC95%: 0,9-1,3) na SE 12 para 4,6 (IC95%: 3,9-5,3) na SE 17. Observou-se excesso de mortalidade geral com a progressão da idade, especialmente em indivíduos com 60 anos e mais, os quais concentraram 69,1% (IC95%: 66,8-71,4) das mortes. A razão 2020/2019 para óbitos em domicílio/via pública foi de 1,1 (IC95%: 0,7-1,8) na SE 12 e de 7,8 (IC95%: 5,4-11,2) na SE 17. A explosão da mortalidade geral em Manaus e a elevada proporção de óbitos em domicílio/via pública expõe a gravidade da epidemia em contextos de grande desigualdade social e fraca efetividade de ações governamentais, em especial aquelas voltadas ao enfrentamento das desigualdades sociais e para a garantia e fortalecimento do Sistema Único de Saúde.

Background: The COVID-19 pandemic has already claimed more than six million direct deaths. Low-and middle-income countries, such Brazil, were severely hit, not only due to direct effects on mortality, but also for its indirect effects on other causes of deaths. Aims: The objective of this study was to estimate the excess suicides in Brazil and evaluate patterns within and between its regions during the COVID-19 pandemic in 2020. Method: The observed suicides are gathered from the mortality information system of the Brazilian Ministry of Health. The estimates of expected suicides, according to sex, age group, bimonthly period and region, were reached through quasi-Poisson generalized additive models, with adjustment for overdispersion. The analyses were performed in R software, version 3.6.1 and RStudio, version 1.2.1335. Results: From March 2020 to December 2020, 10,409 suicides were observed in Brazil, resulting in an overall decrease of 13%, in comparison to the expected rate for the period. There were excess suicides of 26% in men from the Northern region in the 60 years and more age group, as well as in women from the Northern region in the 30 to 59 years age group in two consecutive bimonthly periods. Excess suicides of 40% was also observed in women in the 60 years and more age group from the Northeastern region. Conclusions: Despite the overall decrease in suicides in Brazil over the period assessed, substantial excess suicides were observed in different age groups and sexes from the Northern and Northeastern regions of the country, which are regions that are historically more prone to health and socioeconomic inequalities.