Fatal journeys: causes of death in international travellers in South America
Allel K., Cabada MM., Kiani B., Martin BM., Tanabe M., Restrepo AC., De Souza Dos Santos G., Lloveras S., Shiferaw W., Sartorius B., Mills DJ., Lau CL., Furuya-Kanamori L.
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, categorized 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 IRR 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 optimize prevention of avoidable deaths in South America.