Analysis of mortality from diarrheic diseases in under-five children in Brazilian cities with more than 150,000 inhabitants.

This study analyzes mortality from infectious diarrheic diseases in children under 5 years of age in Brazilian municipalities with more than 150,000 inhabitants, excluding State capitals. The annual mortality rates by municipality from 1990 to 2000 were analyzed using a multilevel model, with years as first level units nested in municipalities as second level units. The dependent variable was the yearly mortality rate by municipality, on the log scale. Polynomial time trends and indicator variables to account for differences in geographic regions were used in the modeling. Time trends were centered on 1995, so they could be modeled differently before and after 1995. From 1990 to 1995 there was a sharp decrease in mortality rates by diarrheic diseases in most Brazilian municipalities, while from 1995 to 2000 the decrease was more heterogeneous. In 1995 the North and Northeast of Brazil had higher mortality rates than the Southeast, and the differences were statistically significant. Most importantly, the study concludes that there was an important difference in the pattern of mortality rate decreases over time, comparing the country's five geographic regions.