Dinâmica espacial e temporal da mortalidade infantil por cardiopatias congênitas no Brasil

Abstract

Introduction: Congenital Heart Defects (CHD) is a structural anomaly of the heart present at birth and is one of the main causes of infant mortality. Early detection is essential for the survival of newborns. In Brazil, CHD is among the most prevalent congenital anomalies, and its distribution may be associated with socioeconomic and geographic factors. Objective: To analyze the spatial and temporal distribution of infant mortality due to congenital heart disease in Brazil from 2012 to 2022. Methods: This is an ecological study that used secondary data from the Mortality Information System (SIM) and the Live Birth Information System (SINASC). Univariate statistics were applied for the descriptive analysis of the epidemiological profile. Spatial analysis was performed using the Global Moran Index, the Getis-Ord Gi* technique to identify hotspots and coldspots, and the Scan scanning method. Temporal evolution was assessed using Joinpoint regression, considering p<0.05. Results: A total of 34,242 infant deaths due to CHD were recorded in Brazil between 2012 and 2022. The average mortality rate was 11.28 deaths per 10,000 live births (LB). The highest number of cases occurred in male newborns (53.9%), white newborns (53.4%) and newborns up to 27 days of age (52.8%). Most deaths occurred in hospital settings (96.8%). The most prevalent ICD-10 category was "Other congenital malformations of the heart" (Q24), representing 52.4% of cases. Regarding the reporting region, the Southeast recorded the highest proportion of deaths (37.7%), while the Central-West had the lowest percentage (9.6%). The year 2019 had the highest mortality peak, with 11.59 deaths per 10,000 LB, while 2020 recorded the lowest value, with 10.10 deaths per 10,000 LB. The highest mortality rate was recorded in the Central-West (12.67 deaths/10,000 LB). The temporal trend remained stationary in the country, but there was a significant growth of 1.44% (95% CI: 0.01-2.91; p=0.049) in the North region. The spatial analysis revealed a higher concentration of significant clusters in the states of Roraima, Rondônia, and Mato Grosso. In addition, the municipalities of Eugênio de Castro (RS), Ponte Preta (RS), Jacuizinho (RS), and Antônio Prado de Minas (MG) presented a risk for CC of 3.00 to 8.99 times greater than that observed in the entire Brazilian region. Conclusion Infant mortality due to CHD showed a steady trend throughout Brazil, except in the North region, and a heterogeneous distribution of cases across the country, with a higher concentration of deaths in certain areas. The results highlight the need to improve neonatal screening, early diagnosis and specialized care for CHD, especially in the most vulnerable regions. These findings support the formulation of public policies that expand screening coverage, decentralize health services and qualify professionals, ensuring better prognosis and reduced morbidity and mortality.