Deaths at home from cancer and cardiovascular disease rise in pandemic

Deaths at home from diseases that are not classified as Covid have jumped during the pandemic. Cancer, cardiovascular diseases and ill-defined causes were the main pathologies that influenced the growth of absolute numbers.

In 2020, there were 319,319 deaths from all causes of household deaths, which represents an increase of 20.7% compared to 2019, with 264,628 deaths recorded.

In 2021, an increase of 18% was observed compared to 2019. Household deaths from Covid are not part of this number. The 2021 database was released in March and is yet to be revised, with the possibility of increasing the number.

The exclusive survey was carried out with data from the SIM (Mortality Information System) by Vital Strategies, a global organization composed of specialists and researchers working with governments, at the request of the Sheet.

Fátima Marinho, an epidemiologist and senior specialist at Vital Strategies, said that it is noteworthy that the spikes in household deaths happened shortly after the Covid-19 spikes.

“During these periods there was an overload of the health system and a decrease in the coverage of primary care. Many people tried to go to the hospital and were unable to receive care because of the overload, others did not even try”, he said.

The data point, for example, to an increase in cancer deaths in home environments and a reduction in hospital environments. There were 42,460 deaths at home in 2020 against 34,101 in 2019, a growth of 24.51%. In 2021, there were 39,843 deaths at home.

The states of Amazonas, Roraima, Piauí, Alagoas and Sergipe had higher proportions of increase in household deaths from diseases not classified as Covid.

Marinho said many procedures were canceled and postponed, which may have exacerbated the situation and led to patients dying at home. With the postponement of surgical procedures, some cancer tumors are no longer operable, for example, reducing the patient’s life expectancy.

The doctor assesses that, in more advanced cases of cancer, the patient happens to go home and have palliative treatments. During the pandemic, this type of procedure may have increased among cases that would normally be treated with hospital admission.

Retired Rosemari Vieira Rodrigues, 68, lost her daughter Jessica Hellen Rodrigues, 28, to liver cancer in September 2020. The young woman died at her home in Cascavel, Paraná, after fighting the disease for four and a half years. .

Rosemari says that her daughter’s treatment was difficult in the pandemic and was even postponed a few times due to the difficulty of the bus, overcrowding in the hospital, fear of going to the place and getting infected with coronavirus. In addition, there was financial difficulty that worsened with the lack of work.

The family sought care at home when the young woman began to feel unwell, but it took almost an hour to arrive – in that time, she died.

“It was a very difficult period, I didn’t have much resources. She could have gone to the hospital more times, but she had to take two people to get there, we were afraid of catching the disease [Covid] and the picture just got worse”, he said.

The Ministry of Health was contacted, but did not respond until the end of the text.

Diego Xavier, a researcher at the Institute of Communication and Scientific and Technological Information in Health at Fiocruz, says that the states with the highest number of household deaths are those that have collapsed in the health system.

“Many people during the pandemic resorted to the hospital, found the unit full and ended up going home without care and dying at home. From the moment the health system collapses, people, regardless of the disease, cannot be cared for properly and end up dying,” he said.

Marinho adds that overcrowded hospitals and emergency rooms also caused an increase in cardiac deaths at home.

In addition, part of these deaths at home may have been due to cases of Covid that were not identified, and that ended up being registered as having an ill-defined cause.

In 2020, at the beginning of the pandemic in Brazil, there were few diagnostic tests for Covid-19, which contributed to the increase in deaths from ill-defined causes at home and in hospitals, a growth that persisted in the following year.

The group of diseases involving mental and behavioral disorders, despite having a lower number of deaths than other groups, also showed a large increase in household deaths during the pandemic.

It is noteworthy that deaths at home were higher than in hospitals from April 2020 to July 2021. This group includes diseases such as depression, mental and behavioral disorders due to alcohol use.

Endocrine, nutritional and metabolic diseases, whose main cause is diabetes, had an increase in deaths in households from April 2020.

Patients with postponed appointments and canceled exams may have had their diabetes worsened by lack of timely intervention.

“It’s an avoidable death, I could have often been hospitalized if there was a vacancy. These people for some reason stopped doing tests, appointments were postponed”, said Marinho.

Xavier adds that deaths at home are likely to decrease with the control of the pandemic. However, a high number of deaths from cancer and other diseases are still expected to occur because the diagnosis of the disease has also been compromised by the pandemic.