Uneven state distribution of homicides in Brazil and their effect on life expectancy, 2000-2015: a cross-sectional mortality study

José Manuel Aburto; Julia Calazans; Bernardo Lanza Queiroz; Shammi Luhar; Vladimir Canudas-Romo

doi:10.1136/bmjopen-2020-044706

Uneven state distribution of homicides in Brazil and their effect on life expectancy, 2000-2015: a cross-sectional mortality study

BMJ Open. 2021 Feb 15;11(2):e044706. doi: 10.1136/bmjopen-2020-044706.

Authors

José Manuel Aburto^{1

2}, Julia Calazans³, Bernardo Lanza Queiroz³, Shammi Luhar⁴, Vladimir Canudas-Romo⁵

Affiliations

¹ Leverhulme Centre for Demographic Science, Department of Sociology and Nuffield College, University of Oxford, Oxford, UK jose-manuel.aburto@sociology.ox.ac.uk.
² Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, Denmark.
³ CEDEPLAR, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
⁴ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
⁵ School of Demography, Australian National University, Canberra, Australian Capital Territory, Australia.

Abstract

Objective: To determine cause-specific and age-specific contributions to life expectancy changes between 2000 and 2015, separately by state and sex in Brazil, with a focus on homicides.

Design: Retrospective cross-sectional demographic analysis of mortality.

Setting and population: Brazilian population by age, sex and state from 2000 to 2015.

Main outcome measure: Using mortality data from the Brazilian Mortality Information System and population estimates from the National Statistics Office, we used death distribution methods and the linear integral decomposition model to estimate levels and changes in life expectancy. We also examine how multiple causes of death, including those attributable to homicides and amenable/avoidable mortality, contributed to these changes from 2000 to 2015.

Results: Between 2000 and 2015, life expectancy in Brazil increased from 71.5 to 75.1 years. Despite state-level variation in gains, life expectancy increased in almost all states over this period. However across Brazil, homicide mortality contributed, to varying degrees, to either attenuated or decreased male life expectancy gains. In Alagoas in 2000-2007 and Sergipe in 2007-2015, homicides contributed to a reduction in life expectancy of 1.5 years, offsetting gains achieved through improvements due to medically amenable causes. In the period 2007-2015, male life expectancy could have been improved by more than half a year in 12 of Brazil's states if homicide mortality had remained at the levels of 2007.

Conclusions: Homicide mortality appears to offset life expectancy gains made through recent improvements to mortality amenable to medical services and public health interventions, with considerable subnational heterogeneity in the extent of this phenomenon. Efforts combating the causes of homicides can increase life expectancy beyond what has been achieved in recent decades.

Keywords: demography; health policy; public health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brazil / epidemiology
Cause of Death
Cross-Sectional Studies
Homicide*
Humans
Life Expectancy*
Male
Mortality
Retrospective Studies