Fatal journeys: causes of death in international travellers in South America

Kasim Allel; Miguel M Cabada; Behzad Kiani; Beatris Mario Martin; Melinda Tanabe; Angela Cadavid Restrepo; Gabriela De Souza Dos Santos; Susana Lloveras; Wondimeneh Shiferaw; Benn Sartorius; Deborah J Mills; Colleen L Lau; Luis Furuya-Kanamori

doi:10.1093/jtm/taae119

Fatal journeys: causes of death in international travellers in South America

J Travel Med. 2024 Aug 29:taae119. doi: 10.1093/jtm/taae119. Online ahead of print.

Authors

Affiliations

¹ Nuffield Department of Population Health, University of Oxford, Oxfordshire, UK.
² Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica, Santiago, Chile.
³ Division of Infectious Diseases, University of Texas Medical Branch. Galveston, Texas, USA.
⁴ Cusco Branch - Alexander von Humboldt Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru.
⁵ UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia.
⁶ School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia.
⁷ State Health Department of Parana, Curitiba, Brazil.
⁸ Hospital de Enfermedades Infecciosas F. J. Muñiz, Buenos Aires, Argentina.
⁹ Dr Deb The Travel Doctor, Travel Medicine Alliance, Brisbane, Australia.

PMID: 39209328
DOI: 10.1093/jtm/taae119

Abstract

Background: Understanding mortality among travellers is essential for mitigating risks and enhancing travel safety. However, limited evidence exists on severe illnesses and injuries leading to death among travellers, particularly in low- and middle-income countries and remote regions.

Methods: We conducted a retrospective census study using country-level observational data from death certificates of travellers of seven South American countries (Argentina, Brazil, Chile, Colombia, Ecuador, Peru, and Uruguay) from 2017 to 2021. Causes of death were evaluated using ICD-10 codes, categorised into non-communicable diseases (NCDs), communicable diseases, and injuries. We quantified causes of death by demographic characteristics (e.g. age, sex), and geographical variables. Chi-square tests were used to assess differences between categories. We calculated crude mortality rates and incidence rate ratios (IRRs) per country's subregions.

Results: A total of 17 245 deaths were reported. NCDs (55%) were the most common cause of death, followed by communicable diseases (23.4%) and injuries (18.1%). NCD-associated deaths increased after age 55 years and were highest among ≥85 years. Communicable diseases were more common at younger age (<20 years). Injury-associated deaths were more common in men (79.9%) and 25-29-year-olds (17.1%). Most deaths (68.2%) could have been avoided by prevention or treatment. Mortality risk was higher among travellers in bordering regions between countries. In Roraima [Brazil] and Norte de Santander [Colombia], locations bordering Venezuela, the death incidence rate ratio was 863 and 60, respectively. These countries' reference mortality rates in those regions were much lower. More than 80% of the deaths in these border regions of Brazil and Colombia involved Venezuelan citizens. Conclusion: The study identified risk factors and high-risk locations for deaths among travellers in seven countries of South America. Our findings underscore the need for specific health interventions tailored to traveller demographics and destination to optimise prevention of avoidable deaths in South America.

Keywords: America; Communicable; Diseases; Injuries; Migrant; Mortality; Non-communicable; Prevention; Travel.