Temporal and spatial trends in infectious disease mortality in Amazonas, Brazil, 2013-2024: implications for surveillance

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BACKGROUND: Infectious and parasitic diseases remain a significant cause of mortality in the state of Amazonas, and are shaped by structural, environmental, and social vulnerabilities. METHODS: This descriptive, population-based study examines the temporal evolution and spatial distribution of mortality caused by infectious disease in Amazonas between 2013 and 2024. We analyzed monthly mortality rates using data from the Mortality Information System (SIM), focusing on International Classification of Diseases, 10th Revision (ICD-10) Chapter I (A00-B99) and selected codes from Chapter X (J09-J18). RESULTS: Despite initial stability (2013-2018), mortality rates increased markedly from 2019 to 2021, associated with the direct and indirect impacts of the Coronavirus Disease (Covid-19) pandemic. After 2022, rates stabilized but remained elevated, indicating a shift toward a new endemic level. Spatial analysis revealed a persistent concentration of deaths in metropolitan areas and riverine municipalities, with recent expansion into medium-sized towns of the interior. Pneumonia, human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS), septicemia, and tuberculosis accounted for most deaths, with a predominance of older adults and people identified as mixed race or Indigenous. High proportions of ill-defined causes and non-specific diagnoses, particularly in pneumonia and sepsis, highlight diagnostic limitations and the urgent need to strengthen death investigation services and expand etiological investigation. CONCLUSIONS: Our findings highlight persistent inequalities in health access and call for integrated public health strategies, including improved surveillance systems, expanded diagnostic capacity, and intersectoral approaches adapted to the Amazonian context.

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