Título:	Estudo caso-coorte para identificação de fatores associados ao óbito por malária no Brasil (2010-2017) e revisão metodológica desse tipo de estudo
Autor(es):	Sousa, Artur Iuri Alves de
Orientador(es):	Duarte, Elisabeth Carmen
Assunto:	Epidemiologia - malária Morte - causas Malária - epidemiologia
Data de publicação:	10-Ago-2020
Data de defesa:	17-Mar-2020
Referência:	SOUSA, Artur Iuri Alves de. Estudo caso-coorte para identificação de fatores associados ao óbito por malária no Brasil (2010-2017) e revisão metodológica desse tipo de estudo. 2020. 121 f., il. Tese (Doutorado em Medicina Tropical)—Universidade de Brasília, Brasília, 2020.
Abstract:	Introduction: Death from malaria in Brazil is currently a rare event (<1% of cases), but relevant in epidemiological terms due to its avoidability and great social impact by frequently involves children and young adults. Considering the existence of a diagnosis with high accuracy, the low resistance of Plasmodium sp. antimalarial drugs and the free availability of diagnosis and treatment by the Health System of Brazil (SUS), it is necessary to understand in which situations malaria death still occurs today. The identification of factors associated with death can be done through different designs in analytical epidemiological case-control studies. Objective: Review methodological options related to case-control studies and analyze the prognostic factors associated with death from malaria (as a basic cause) in Brazil from 2010 to 2017. Methods: A narrative review of the literature was carried out on the methodological characteristics that differentiate the traditional case-control, nested case-control and case-cohort studies. An analysis of prognostic factors associated with death from malaria was also performed, using a case-cohort design. Malaria deaths (defined as cases in the design) and malaria cases (defined as controls in the design) were identified for the period from 2010 to 2017, originating from the Mortality Information System (SIM) or from the Epidemiological Surveillance Information Systems (Sivep) and Notifiable Diseases (Sinan), respectively. Lethality rates and associations between selected characteristics were estimated and the chance of death was estimated using odds ratio (OR) originated from adjusted logistic regression models. Results: In traditional case-control studies that are not population-based, the option of using a secondary basis for the choice of controls contributes to the potential for selection bias and limits the representativeness of the control group in relation to the population base of cases. The "nested case- control" and "case-cohort" studies partly overcome these limitations, as 17 they are based on a true cohort and often use incident cases. In the case- cohort study to identify factors associated with death from malaria, 390 deaths and 1,944,939 cases were included, which occurred in Brazil in the period 2010-2017. A higher chance of death from malaria was identified (p <0.05) in individuals aged <5 years (OR = 2.6) and aged between 50 and 69 years (OR = 4.9) and aged 70 and over (OR = 25.9), pregnant women in the 3rd trimester (OR = 4.8) and individuals residing or treated in Federated Units outside the Legal Amazon region (OR = 5.6). The chance of death from falciparum malaria was 4.8 times the chance of death from non-falciparum malaria. Conclusion: With regard to the different designs of case-control studies, the "case-cohort" studies emphasize the contrast between the chance of experience of exposure between the cases and the population base, providing additional benefits when there is temporal pairing between cases and population base (“Controls”). The debate on the methodological arsenal of “case-control” studies allows to critically assess the internal validity and efficiency of the different types of design of this nature and to make choices that are more appropriate to the objectives and resources of the study. With regard to the analysis of factors associated with death from malaria, the identified factors already known (age, pregnancy) and, in particular, the increased risk of death in regions with a tendency for the endemic to fall and among people treated in the extra-Amazon region points to failures in health care, indicating the need for a joint effort by the community and the health sector to prevent these preventable deaths.
Unidade Acadêmica:	Faculdade de Medicina (FM)
Informações adicionais:	Tese (doutorado)—Universidade de Brasília, Faculdade de Medicina, Programa de Pós-Graduação em Medicina Tropical, 2020.
Programa de pós-graduação:	Programa de Pós-Graduação em Medicina Tropical
Licença:	A concessão da licença deste item refere-se ao termo de autorização impresso assinado pelo autor com as seguintes condições: Na qualidade de titular dos direitos de autor da publicação, autorizo a Universidade de Brasília e o IBICT a disponibilizar por meio dos sites www.bce.unb.br, www.ibict.br, http://hercules.vtls.com/cgi-bin/ndltd/chameleon?lng=pt&skin=ndltd sem ressarcimento dos direitos autorais, de acordo com a Lei nº 9610/98, o texto integral da obra disponibilizada, conforme permissões assinaladas, para fins de leitura, impressão e/ou download, a título de divulgação da produção científica brasileira, a partir desta data.
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