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

Area of Science:

• Epidemiology
• Public Health
• Mycology

Background:

• Systemic mycoses represent a significant, yet often overlooked, public health concern.
• Understanding their epidemiological patterns is crucial for effective intervention.

Purpose of the Study:

• To analyze the epidemiology, contributing factors, spatial distribution, and temporal trends of mortality and in-hospital mortality due to systemic mycoses in Brazil from 2000 to 2024.
• To provide a comprehensive overview of fungal disease burden using national data.

Main Methods:

• Nationwide ecological study utilizing death certificates and hospital admission data.
• Employed temporal and spatial analyses to assess mortality rates, trends (Average Annual Percent Change), and geographical disparities.
• Calculated rate ratios (RR) and 95% confidence intervals (CI) for sociodemographic factors.

Main Results:

• Systemic mycoses accounted for 0.07% of all deaths (22,230 cases), with an overall mortality rate of 0.46 per 100,000 population.
• Mortality was higher in males and individuals aged 60-69 years. Nationwide mortality showed a declining trend (AAPC -1.12%).
• In-hospital deaths (4,471 cases) were more common in males and those aged ≥70 years, with no significant nationwide trend observed. Significant spatial heterogeneity was noted across Brazilian states.

Conclusions:

• This study provides a unique nationwide analysis of both long-term and in-hospital mortality from systemic mycoses.
• Neglected fungal infections remain a critical cause of death in Brazil, necessitating enhanced surveillance and control measures.
• Distinct epidemiological patterns underscore the need for strengthened prevention, control, and therapeutic strategies within Brazil's healthcare system.