North-South asymmetry of Parkinson's disease mortality in Brazil between 2009 and 2023: a spatial analysis

This study investigated potential regional disparities in the mortality of individuals with Parkinson’s disease (PD) in Brazil. A nationwide ecological study was conducted investigating the spatial distribution of sex- and age-adjusted mortality rates of individuals with PD, whose deaths were caused or associated with the disease, in the Brazilian intermediate regions between 2009 and 2023. Global and local spatial analyses were conducted using the global and local Moran’s indices at a 95% confidence level to assess the presence of spatial dependence in mortality rates and identify spatial clusters in the country. The findings demonstrated that the PD mortality adjusted rates are uneven across the Brazilian territory, with higher rates in the south and lower in the north. It is hypothesized that the well-established gradient between the north and south can be caused by various factors, including population ageing, longer survival among people with PD, as well as environmental factors but can also be influenced by socio-economic vulnerabilities and disparities in access to specialized health services. In Brazil, PD has become a serious public health problem with marked regional differences over the years. It is therefore essential to develop public policies in Brazil that protect the health of residents with PD, mitigate risk factors, and ensure better living conditions throughout the disease’s progression.