Uneven state distribution of homicides in Brazil and their effect on life expectancy, 2000-2015: a cross-sectional mortality study.
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.
['Aburto|José Manuel|JM|0000-0002-2926-6879', 'Calazans|Julia|J|', 'Lanza Queiroz|Bernardo|B|0000-0002-2890-1025', 'Luhar|Shammi|S|', 'Canudas-Romo|Vladimir|V|0000-0001-6532-0089']
D001938:Brazil D002423:Cause of Death D003430:Cross-Sectional Studies D006708:Homicide D006801:Humans D008017:Life Expectancy D008297:Male D009026:Mortality D012189:Retrospective Studies
public health demography health policy