Age, period, and cohort effects on HIV/AIDS mortality in Brazil, 1980–2019
Acquired Immunodeficiency Syndrome; mortality; Observational study.
Introduction: HIV/AIDS mortality is a relevant indicator for monitoring the evolution
of the epidemic and the effectiveness of health responses over time, especially in
countries with substantial territorial heterogeneity such as Brazil. In this context, using
approaches capable of disentangling patterns associated with aging, historical changes,
and generational differences can enhance understanding of temporal and regional
variations in mortality. Objectives: The overall objective is to analyze age–period–cohort
effects on HIV/AIDS mortality in the country from 1980 to 2019. The specific objectives
are to describe mortality in absolute and relative terms, calculate mortality rates in Brazil
and in the regions, and estimate age–period–cohort effects over the study period.
Methods: This is an observational, ecological study with temporal trend analysis and
application of the age–period–cohort model. Mortality information will be obtained from
the DATASUS Mortality Information System, and population denominators will come
from the Brazilian Institute of Geography and Statistics, based on censuses and
intercensal estimates. The definition of HIV/AIDS deaths will use CID-9 and CID-10
codes (279.1 and B20–B24). Rates will be calculated per 100.000 inhabitants, stratified
by age groups, and time will be organized into five-year periods covering 1980–1984
through 2015–2019. For description and analysis, age-specific rates and crude and age-
standardized rates will be calculated using the direct method and the WHO world standard
population, with the construction of time series and graphs to depict temporal trends. For
the age–period–cohort component, ages will be grouped into five-year intervals from 15–
19 to 80 years or older, totaling 14 groups; periods comprise 8 five-year intervals; and
birth cohorts will be derived from this structure, totaling 21 five-year cohorts. Effects will
be estimated using regression models according to the APC model formulation, and
nested submodels will be compared using deviance, the likelihood ratio test, and AIC.
APC analyses are planned for the five Brazilian regions, extracting estimated rates and
relative risks by period and cohort, with pre-defined reference categories. Regarding
ethical aspects, the study uses secondary data without nominal identification, with an
indication of waiver of submission to the ethics committee. Expected results: The study
is expected to describe the profile of HIV/AIDS mortality in Brazil over four decades,
distinguishing components attributable to age, period, and cohort, with regional
interpretation. The approach will produce evidence useful for surveillance and planning
by identifying temporal and generational patterns that may guide prevention, diagnosis,
and care strategies, with attention to inequalities across regions.