# Neglected Mycoses in Brazil: A Population‐Based Study of Mortality and In‐Hospital Mortality Over 25 Years

## TL;DR

This study examines how fungal infections have caused deaths in Brazil over 25 years, showing higher risks for certain groups and regions.

## Contribution

The study is the first to jointly analyze long-term mortality and in-hospital mortality from systemic mycoses nationwide in Brazil.

## Key findings

- Mortality from mycoses was higher in males and those aged 60–69, with a nationwide decline in mortality over time.
- In-hospital deaths were concentrated in specific Brazilian states and showed higher risk for males and those aged ≥70.
- The study highlights the need for improved surveillance and treatment strategies for neglected mycoses in Brazil.

## Abstract

To describe the epidemiology, associated factors, spatial distribution, and temporal trends of mortality and in‐hospital mortality related to systemic mycoses in Brazil, 2000–2024.

This is a nationwide ecological study combining temporal and spatial analyses using death certificates (DC; underlying and/or associated causes) and hospital admissions (HA; primary and/or secondary diagnoses) with in‐hospital deaths. We estimated rate ratios (RR) with 95% confidence intervals (CI) interpreted as comparative mortality and in‐hospital mortality rates between sociodemographic categories at the aggregate level, stratified by sex and age group; temporal trends were presented with the average annual percent change (AAPC) and 95% CIs; spatial heterogeneity was described across states. Outcomes were expressed as population‐based rates (per 100,000 inhabitants).

We identified 22,230 mycosis‐related deaths among a total of 30,488,786 deaths (0.07%), corresponding to an overall mortality rate of 0.46 per 100,000 population. Mortality was higher in males (RR 2.91; 95% CI 2.51–3.38) and peaked at ages 60–69 years (RR 3.47; 95% CI 2.67–4.51). Nationwide mortality declined over time (AAPC −1.12; 95% CI −1.41 to −0.83). Deaths were geographically concentrated in the states of Rondônia, Mato Grosso, Goiás and Mato Grosso do Sul. We recorded a total of 4471 in‐hospital deaths among 11,367,369 admissions (0.04%), yielding an in‐hospital mortality rate of 0.09 per 100,000 population. In‐hospital risk of death was higher in males (RR 2.12; 95% CI 1.55–2.89) and in those aged ≥ 70 years (RR 12.50; 95% CI 7.38–21.17). No significant nationwide trend was observed for in‐hospital mortality (AAPC 0.64; 95% CI −1.20 to 2.59). Spatial distribution during the analysis period was heterogeneous, especially in the states of Rondônia, São Paulo, Rio de Janeiro, Paraíba and Paraná.

Our findings fill an important gap by jointly analysing long‐term mortality and in‐hospital mortality related to systemic mycoses at a nationwide scale, using two complementary information systems. Neglected mycoses remain an important cause of death in Brazil, including deaths during hospitalisation. Distinct individual‐level and spatial patterns support the need for strengthened surveillance, prevention, control, and therapeutic strategies within the Brazilian Unified Health System.