Mortality trends among Indigenous women of reproductive age in Brazil: a time series analysis.

Background: Reports on Brazilian Indigenous peoples highlight mortality disparities, yet little is known about death aetiology-particularly among women of reproductive age-or how structural discrimination based on race/skin colour influences mortality rates in this group. This study aimed to assess and compare cause-specific mortality rates between Indigenous and White Brazilian women of reproductive age, identifying health disparities to inform targeted public health interventions. Methods: This ecological study used mortality data from Brazil's Mortality Information System (SIM). Population estimates were based on census projections. We calculated annual age-standardized mortality rates (ASMR) for women of reproductive age (10-49 years) from Indigenous and White groups who died between 2010 and 2019 all over the country. Causes of death were classified by ICD-10. Trends were estimated using Prais-Winsten regression, expressed as annual percentage change. Findings: We analysed 3185 deaths among Indigenous women and 274,393 among White women. ASMR among Indigenous women did not decline for any ICD-10 cause. Unlike White women, Indigenous women exhibited rising ASMR for digestive (+12·36%), circulatory (+8·88%), and respiratory (+4·56%) causes. Both groups experienced rising ASMR due to neoplasms and endocrine, metabolic, and nutritional diseases, with higher increases among Indigenous women. Maternal deaths remained stable in both groups but at different magnitudes. ASMR from external and infectious/parasitic causes remained stable among Indigenous women but declined among White women. Interpretation: Mortality from predominantly chronic circulatory, digestive and respiratory diseases is increasing without a decline in infectious/parasitic, maternal, or external causes. Further investigation into rising chronic disease deaths could reveal inequities driving early mortality. Identifying gaps in Indigenous health policies may guide more effective interventions tailored to Indigenous people needs. Funding: This study was funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Ministério da Educação, and Pró-Reitoria de Pesquisa, Universidade Federal de Minas Gerais.