A mortalidade por causas externas na região metropolitana de Curitiba: uma relação com os fatores socioeconômicos nos anos de 2000, 2010 e 2022

Abstract

Mortality from external causes is an important indicator of economic, social, and territorial inequalities, directly affecting population dynamics and regional development. In the Curitiba Metropolitan Region (CMR), these deaths predominantly affect individuals of working age, especially young and adult men, producing impacts on life expectancy, population age structure, and the labor market. In this context, this study aimed to analyze the relationship between mortality from external causes and the main socioeconomic factors in the CMR in 2000, 2010, and 2022. Specifically, the study sought to characterize the region's sociodemographic profile; analyze the structure of overall mortality and mortality from external causes; estimate gains in life expectancy resulting from a 15% reduction in male deaths and a 5% reduction in female deaths from external causes; identify spatial patterns of mortality; and examine the association between socioeconomic factors and mortality from external causes. Secondary data were obtained from the Brazilian Institute of Geography and Statistics (IBGE/SIDRA), the Mortality Information System (SIM/DATASUS), and the National Registry of Health Establishments (CNES/DATASUS). Demographic and statistical techniques were applied, including Crude Mortality Rates, Age-Specific Mortality Rates, Life Tables, Multiple-Decrement Life Tables, Cause-Deleted Life Tables, spatial autocorrelation analysis using the Global and Local Moran's Index (LISA), and quasi-Poisson regression models due to overdispersion in the count data. The analyses considered demographic, socioeconomic, and health service variables. The results showed that the CMR has undergone demographic and epidemiological transition, characterized by declining fertility, population aging, and increasing life expectancy. However, external causes remain a major component of premature mortality, with pronounced excess male mortality concentrated among men aged 15 to 59 years, mainly due to assaults and transport accidents, whereas among women deaths were concentrated at older ages and were primarily associated with falls and other accidental injuries. Spatial analysis identified significant positive spatial autocorrelation only in 2010, revealing significant territorial clusters of mortality from external causes, predominantly associated with the male population. Quasi-Poisson regression models demonstrated significant associations between mortality from external causes and male sex, individuals aged 20 to 59 years, and municipal socioeconomic indicators, while higher income, gross domestic product per capita, and hospital bed availability were associated with lower mortality. Simulations of partial reductions in deaths from external causes indicated substantial gains in life expectancy, particularly among men. It is concluded that mortality from external causes in the CMR does not occur randomly but reflects structural, social, economic, and territorial inequalities, highlighting the need for intersectoral public policies aimed at preventing violence, accidents, and social vulnerabilities. This thesis contributes by integrating demographic, statistical, spatial, and econometric methods to better understand the determinants of mortality from external causes and their impacts on life expectancy and regional development.