Mortalidade por Diabetes Mellitus em crianças e adolescentes no Brasil: estudo ecológico dos fatores associados (2009 – 2023)

Abstract

Introduction: Diabetes Mellitus (DM) is a major public health issue, with type 1 (DM1) being the most prevalent form among children and adolescents. Despite the expected low lethality in this age group, deaths still occur and may reflect inequalities in access to diagnosis, treatment, and clinical follow-up. Objective: This study aimed to describe rate and trend of DM-related mortality in children and adolescents in Brazil and its regions from 2009 to 2023, correlating it with estimated population coverage by the Family Health Strategy (FHS) and socioeconomic data from the Mortality Information System. Mortality trends were analyzed using Prais Winsten regression, and associations were assessed using Spearman's correlation. Results: A total of 2,319 deaths were recorded during the study period, with the highest average mortality rates observed in the Northeast and Central-West regions. Mortality showed an increasing trend in Brazil, driven by the South, Southeast, and Northeast regions. The increase was significant among males and in the 15–19-year age group, particularly in the North. No significant correlations were found between mortality rates and FHS coverage or the Human Development Index at the regional level. However, a paradoxically strong and positive correlation was observed between FHS coverage and mortality at the national level (ρ = 0.900; p = 0.002). Conclusion: In conclusion, DM-related mortality in children and adolescents in Brazil showed an upward trend and regional heterogeneity, with greater vulnerability among male adolescents. The lack of correlation with structural indicators suggests that factors such as quality of care, treatment adherence, and health system organization may be more decisive than mere service expansion.