Trends in mortality rates where alcohol was a necessary cause of death in Brazil, 2000-2013.

OBJECTIVE: To analyze trends in mortality due to diseases and conditions fully attributable to alcohol in Brazil. METHODS: This was an ecological time-series study. Proportional, specific, and age-standardized mortality rates between 2000 and 2013 that were due to underlying or contributing causes fully attributable to alcohol use were analyzed by sex, ethnicity/skin color, age group, and region of residence in the country. Data on deaths were obtained from the Brazilian Mortality Information System (SIM). Prais-Winsten regression was used to analyze trends. RESULTS: Deaths with underlying causes and/or conditions contributing to death fully attributable to alcohol accounted for 2.5% of total deaths in the period. There were more deaths among men (3.8%) than among women (0.7%). In both sexes, there was a higher proportion of deaths in those 40-49 years old (27.9%) and those of black or pardo (mixed race) skin color (48.8%). Between 2000 and 2013, there was an upward trend in specific mortality rates attributable to alcohol in the country as a whole (average annual growth rate (AAGR) = 5.59%; 95% confidence interval (CI) = 3.55%-7.68%), especially in people aged less than 20 years old, in pardos (AAGR = 13.42%; 95% CI = 9.70%-17.25%), and in residents of the North region (AAGR = 17.01%; 95% CI = 14.94%-19.13%), the Northeast region (AAGR = 15.49%; 95% CI = 10.61%-20.58%), and the Midwest region (AAGR = 8.40%; 95% CI = 5.57%-11.32%). CONCLUSION: Alcohol is an important and growing cause of premature death in Brazil, especially among men, black/pardo people, and the population living in the most disadvantaged regions. This overall increase in the harmful use of alcohol reflects ethnic and socioeconomic inequalities in Brazil, and it also points to the need for population-based policies to reduce the impact of morbidity and to prevent early mortality.

Leading Causes of Cancer Mortality - Caribbean Region, 2003-2013.

Cancer is one of the leading causes of deaths worldwide (1); in 2012, an estimated 65% of all cancer deaths occurred in the less developed regions of the world (2). In the Caribbean region, cancer is the second leading cause of mortality, with an estimated 87,430 cancer-related deaths reported in 2012 (3). The Pan American Health Organization defines the Caribbean region as a group of 27 countries that vary in size, geography, resources, and surveillance systems.* CDC calculated site- and sex-specific proportions of cancer deaths and age-standardized mortality rates (ASMR) for 21 English- and Dutch-speaking Caribbean countries, the United States, and two U.S. territories (Puerto Rico and the U.S. Virgin Islands [USVI]), using the most recent 5 years of mortality data available from each jurisdiction during 2003-2013. The selection of years varied by availability of the data from the countries and territories in 2015. ASMR for all cancers combined ranged from 46.1 to 139.3 per 100,000. Among males, prostate cancers were the leading cause of cancer deaths, followed by lung cancers; the percentage of cancer deaths attributable to prostate cancer ranged from 18.4% in Suriname to 47.4% in Dominica, and the percentage of cancer deaths attributable to lung cancer ranged from 5.6% in Barbados to 24.4% in Bermuda. Among females, breast cancer was the most common cause of cancer deaths, ranging from 14.0% of cancer deaths in Belize to 29.7% in the Cayman Islands, followed by cervical cancer. Several of the leading causes of cancer deaths in the Caribbean can be reduced through primary and secondary preventions, including prevention of exposure to risk factors, screening, early detection, and timely and effective treatment.

[Alcohol use as a necessary cause of death in Brazil, 2010-2012]. / Uso de álcool como causa necessária de morte no Brasil, 2010 a 2012.

OBJECTIVE: To describe mortality from diseases, conditions, and injuries for which alcohol consumption is a necessary cause during the 2010-2012 triennium in Brazil. METHODS: A descriptive study was conducted with data from the Brazilian Ministry of Health's Mortality Information System (SIM). The analysis included deaths whose primary cause was classified as any of the 78 codes of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) corresponding to the diseases, conditions, and injuries for which the use of alcohol is a necessary cause. RESULTS: Deaths with alcohol consumption as a necessary cause totaled 55 380 (88.5% in men). The crude mortality rate for the triennium was 9.6/100 000 people in the overall population, 17.35/100 000 men in males, and 2.15/100 000 women in females. Higher mortality rates were observed in the 50-59 year (28.45) and 60-69 year (27.23) age groups and among people with black or brown skin color (10.15). The Northeast (11.70) and Midwest (11.04) regions exhibited higher age-adjusted mortality rates. Liver diseases were the leading cause of death (55.3%). CONCLUSIONS: Mortality from causes related to alcohol consumption is high in Brazil, especially among men, people aged 50-69 years, and residents in the Northeast and Midwest regions.

Cervical and female breast cancers in the Americas: current situation and opportunities for action.

OBJECTIVE: To understand better the current regional situation and public health response to cervical cancer and female breast cancer in the Americas. METHODS: Data on cervical cancer and female breast cancers in 33 countries, for the period from 2000 to the last year with available data, were extracted from the Pan American Health Organization (PAHO) Regional Mortality Database and analysed. Changes in mortality rates over the study period - in all countries except those with small populations and large fluctuations in time-series mortality data - were calculated using Poisson regression models. Information from the PAHO Country Capacity Survey on noncommunicable diseases was also analysed. FINDINGS: The Bahamas, Trinidad and Tobago and Uruguay showed relatively high rates of death from breast cancer, whereas the three highest rates of death from cervical cancer were observed in El Salvador, Nicaragua and Paraguay. Several countries - particularly Paraguay and Venezuela - have high rates of death from both types of cancer. Although mortality from cervical cancer has generally been decreasing in the Americas, decreases in mortality from breast cancer have only been observed in a few countries in the Region of the Americas. All but one of the 25 countries in the Americas included in the PAHO Country Capacity Survey reported having public health services for the screening and treatment of breast and cervical cancers. CONCLUSION: Most countries in the Americas have the public health capacity needed to screen for - and treat - breast and cervical cancers and, therefore, the potential to reduce the burden posed by these cancers.

Trends in mortality from respiratory disease in Latin America since 1998 and the impact of the 2009 influenza pandemic.

OBJECTIVE: To determine trends in mortality from respiratory disease in several areas of Latin America between 1998 and 2009. METHODS: The numbers of deaths attributed to respiratory disease between 1998 and 2009 were extracted from mortality data from Argentina, southern Brazil, Chile, Costa Rica, Ecuador, Mexico and Paraguay. Robust linear models were then fitted to the rates of mortality from respiratory disease recorded between 2003 and 2009. FINDINGS: Between 1998 and 2008, rates of mortality from respiratory disease gradually decreased in all age groups in most of the study areas. Among children younger than 5 years, for example, the annual rates of such mortality - across all seven study areas - fell from 56.9 deaths per 100,000 in 1998 to 26.6 deaths per 100,000 in 2008. Over this period, rates of mortality from respiratory disease were generally highest among adults older than 65 years and lowest among individuals aged 5 to 49 years. In 2009, mortality from respiratory disease was either similar to that recorded in 2008 or showed an increase - significant increases were seen among children younger than 5 years in Paraguay, among those aged 5 to 49 years in southern Brazil, Mexico and Paraguay and among adults aged 50 to 64 years in Mexico and Paraguay. CONCLUSION: In much of Latin America, mortality from respiratory disease gradually fell between 1998 and 2008. However, this downward trend came to a halt in 2009, probably as a result of the (H1N1) 2009 pandemic.

Mortality in the Americas from 2013 to 2015 resulting from diseases, conditions and injuries which are 100% alcohol-attributable.

AIMS: To describe mortality in the Americas from 2013 to 2015 inclusive resulting from diseases, conditions and injuries which are 100% attributable to alcohol consumption. DESIGN AND SETTING: Mortality registry, population-based study. The data come from 30 of the 35 countries of the Americas for the triennium of 2013 to 2015. PARTICIPANTS AND CASES: A total of 18 673 791 deaths coded by three-digit ICD-10 codes were analyzed. MEASUREMENTS: Cause (underlying), and age-specific and age-adjusted mortality rates were calculated by sex and country. FINDINGS: From 2013 to 2015 inclusive, among 30 of the 35 countries of the Americas, an average of 85 032 deaths per year were entirely attributable to alcohol. Men accounted for 83.1% of all 100% alcohol-attributable deaths, and death rates were higher for men than for women across all countries; however, the ratios of 100% alcohol-attributable deaths by sex varied by country. The majority of all 100% alcohol-attributable deaths occurred among those aged under 60 years (64.9%) and were due to liver disease (63.9%) followed by neuropsychiatric disorders (27.4%). Age-adjusted 100% alcohol-attributable mortality rates were highest in Nicaragua (23.2 per 100 000) and Guatemala (19.0 per 100 000), although the majority of all 100% alcohol-attributable deaths occurred in the United States 36.9%), Brazil (24.8%), and Mexico (18.4%). CONCLUSIONS: From 2013 to 2015, more than 85 000 deaths in the Americas were 100% attributable to alcohol. Most of those occurred in people under 60 years and the highest mortality rates occurred in the United States, Brazil and Mexico.

[The importance of falls on the same level among the elderly in São Paulo state]. / A importância das quedas no mesmo nível entre idosos no estado de São Paulo.

OBJECTIVE: To analyze characteristics of fall related injuries, with emphasis on falls on the same level, of those with 60 years or more of age,, resident in the state of Sao Paulo, based on three official information sources. METHODS: A total of 1,328 deaths registered in the Information Mortality System in 2007, 20,726 hospital admissions registered in the Hospitalization Information System in 2008 and 359 visits to 24 different emergency departments (ED) in 2007 were analyzed. A logistic regression model was used to test associations between some variables. RESULTS: B More fatal fall victims were male (51.2%), while females were predominant among hospital admissions (61.1 %) and ED visits (60.4 %). The mortality rate was 31.0/100,000, reaching 110.7/100,000 among those aged 80 years or more. Falls on the same level were responsible for the largest proportion of definite deaths (35.0 %), hospital admissions (47.5 %) and also ED visits (66.0 %), increasing with the age groups. Residences were the place of occurrence for 65.8 % of the cases in EDs. Head trauma was important among deaths; femur fractures were the most frequent injuries for hospital admissions and ED visits. Compared to men, women were 1.55 times significantly more likely to be attended for a fall than other external causes. Comparatively In comparison to people aged 60 to 69 years, those aged 70 to 79 years and 80 years old or more were 2.10 and 2.26 times, respectively more likely to be fall victims than victims of other external causes. There was no statistically significant difference among people who suffered falls on the same level and other types of falls, for gender and age groups when one compared individuals. CONCLUSION: It is urgent to implement fall prevention programs forto the elderly.

Profile of cases due to burn attended in emergency care units in Brazilian capitals in 2017. / Perfil dos casos de queimadura atendidos em serviços hospitalares de urgência e emergência nas capitais brasileiras em 2017.

OBJECTIVES: To describe the profile of burn victims attended in emergency services and to identify associations between the variables investigated. METHODS: Cross-sectional study based on data from the 2017 survey "Surveillance of violence and accidents in emergency units". We used descriptive analysis, according to demographic characteristics and aspects related to the burn injury, as well as the correspondence analysis technique, which allowed to verify possible associations between the variables investigated. RESULTS: Burns were more frequent: in adults aged between 20 and 39 years (40.7%); in men (57.0%); in the household (67.7%); due to hot substances (52.0%). Household accidents were more frequent in the age group 0-15 years (92.0%) and elderly (84.4%), and in women (81.6%). Accidents in commerce, services and industry affected individuals aged 16 to 59 years (73.6%). Referral to other hospitals was associated with cases in the elderly and hospitalization with the cases in individuals aged between 0 and 15 years old. Events in the working age population were associated with alcohol use and the workplace. Among women, it is suggested to associate burn accidents with household and hot substances. CONCLUSIONS: The results point to the need for oriented actions in the field of health education, as well as labor regulation and supervision.

[Treatment of injuries in emergency departments: characteristics of victims and place of injury, São Paulo State, Brazil, 2005]. / Atendimentos de emergência por lesões decorrentes de causas externas: características das vítimas e local de ocorrência, Estado de São Paulo, Brasil, 2005.

The objective of this study was to analyze the characteristics and place of occurrence of injuries treated in emergency departments. A total of 35,107 emergency department visits for injuries were analyzed, excluding traffic injuries, in São Paulo State, Brazil, 2005. The majority of victims were male (59.1%), and from 0 to 29 years of age (62.1%). Leading causes were falls (39.3%) and accidental blows (16.5%). Most injuries occurred in the home (64.7%), followed by public places (19.9%). Assaults were more frequent in public. Women were more likely to suffer injuries at home, as compared to men (OR = 0.51; 95% CI: 0.48-0.53). Men were 1.34 times more likely to be injured in public places, 3.22 times in bars, and 2.82 times in the workplace. A higher proportion of events among children aged 0 to 9 and individuals 60 years or older occurred at home. The results highlighted the home as an important place for the occurrence of injuries, which should be considered when planning injury prevention programs.

The burden of injury in Brazil, 2003.

CONTEXT AND OBJECTIVE: Since 1980, injuries have been the second biggest cause of death among the Brazilian population. This study aimed to analyze national data on fatal injuries and nonfatal injury hospitalization in Brazil, for 2003. DESIGN AND SETTING: This was a population-based descriptive study, Brazil, 2003. METHODS: Data from 126,520 fatal injuries and 733,712 nonfatal injuries seen at public hospitals were analyzed. The data were stratified by sex, age, intent and injury mechanism. Raw and age- and sex-specific rates were calculated per 100,000 individuals. RESULTS: The raw injury mortality rate was 71.5/100,000 (122.6/100,000 for male and 22.0/100,000 for female). For fatal injuries, the proportions of unintentional and intentional injuries were equal (44.3% and 46.9%, respectively). Homicides were the leading cause, 40.3% overall (28.8/100,000), followed by transport-related deaths, 26.2% overall (17.0/100,000). For nonfatal injuries, the rate was 414.8/100,000 and unintentional injuries were predominant (88.9%). Overall, the leading cause was unintentional falls, accounting for 42.6% of victims treated in public hospitals (176.8/100,000). Transport-related injuries were second: 15.0% overall; 62.0/100,000. Fractures comprised 46.7% of principal diagnoses at hospitals. The injury types in the fatal and nonfatal datasets varied according to sex and age. The highest rates were found among young males and elderly people. CONCLUSIONS: Injury prevention activities need to be developed. To prevent deaths, homicide has to be addressed. Among hospitalized cases, falls are the most important problem. Traffic-related injuries play an important role in morbidity and mortality.

[Social inequality and homicide rates in Sao Paulo City, Brazil]. / Homicídios e desigualdades sociais no Município de São Paulo.

OBJECTIVE: The relation between income and mortality due to violence has been studied in recent years. The Synthesis of Social Indicators of 2002 [Sintese de Indicadores Sociais, 2002], published by The Brazilian Institute of Geography and Statistics (IBGE), states that one of the most outstanding characteristic of Brazilian society is inequality. The proposal of this ecological study was to test the association between homicide rates, and some health and socioeconomic indicators. METHODS: This is an ecological cross-sectional study. Data regarding Sao Paulo City, Brazil in the year 2000 was analyzed. The association between homicide coefficients and the following five indicators were tested: infant mortality rates, monthly average income of household heads, percentage of adolescents aged 15 to 17 years not attending school, proportion of pregnant adolescent women aged 14 to 17 years and demographic density. Pearson's correlation coefficient and a multiple linear regression model were utilized to test these associations. RESULTS: The municipal homicide rate was 57.3/100,000. The correlation between homicide rates and average monthly income was strong and negative (r=-0.65). Higher homicide rates were found in the districts whose inhabitants had lower incomes and lower rates were found in those districts whose inhabitants had higher incomes. The correlation between homicide rates and proportion of adolescents not attending school was positive and strong (r=0.68). The correlation between homicide rates and the proportion of pregnant adolescent women was positive and strong (r=0.67). The correlation between homicides and the rate of infant mortality was r=0.24 (for all: p<0.05). The correlation between demographic density and homicides was not significant. Although the univariate regression was positive for four indicators, the multivariate regression test was only significant for average monthly income (negative) and proportion of adolescents not attending school (positive) (for both indicators: p<0.01). CONCLUSIONS: The findings highlight the problem of homicides and socioeconomic disparities in S. Paulo City. Economic development and reducing socioeconomic inequality may have an impact on the rates of mortality due to violence.

[Linking of information from health and security databases on homicides]. / Informações sobre homicídios e sua integração com o setor saúde e segurança pública.

OBJECTIVE: Increased homicide rates in the city of Sao Paulo, Brazil, in the last two decades points out to the need for better understanding this subject. The purpose of the present study was to link information about homicide from different sources of data. METHODS: Homicide data from death certificates, medical examiners and police records of residents in the city of Sao Paulo was linked for the second semester of 2001. Variables about victims, risk factors and homicide circumstances were analyzed using absolute numbers, proportions and coefficients. Statistical differences were tested using Pearson's Chi-square test. RESULTS: Homicide crude rate was 57.2/100,000. Higher rates were observed among men aged 15 to 29 years (56.0% of all cases). The proportion of firearm-related homicides was 88.6%, higher among men than women. Most injuries were to the head (68.9%). Among the victims who underwent to drug screening, 42.5% had high blood alcohol concentrations (44.0% for men and 24.0% for women). Most events occurred at night during weekends and it was found a high correlation (74.6%) between the victim's place of residence and event location. CONCLUSIONS: The study findings highlight that linking information provides better quality of data and allows for better understanding of homicides.

Premature Mortality from Cardiovascular Disease in the Americas - Will the Goal of a Decline of "25% by 2025" be Met?

BACKGROUND: Cardiovascular diseases (CVD) are the underlying cause 1.6 million deaths per year in the Americas, accounting for 30% of total mortality and 38% of by non-communicable deaths diseases (NCDs). A 25% reduction in premature mortality due four main NCDs was targeted by the 2011 High-level Meeting of the General Assembly on the Prevention and Control of NCDs. While overall CVD mortality fell in the Americas during the past decade, trends in premature CVD mortality during the same period have not been described, particularly in the countries of Latin America and the Caribbean. METHODS: This is a population-based trend-series study based on a total of 6,133,666 deaths to describe the trends and characteristics of premature mortality due to CVD and to estimates of the average annual percentage of change during the period 2000-2010 in the Americas. FINDINGS: Premature mortality due to CVD in the Americas fell by 21% in the period 2000-2010 with a -2.5% average annual rate of change in the last 5 year-a statistically significant reduction of mortality-. Mortality from ischemic diseases, declined by 25% - 24% among men and 26% among women. Cerebrovascular diseases declined by 27% -26% among men and 28% among women. Guyana, Trinidad and Tobago, the Dominican Republic, Bahamas, and Brazil had CVD premature mortality rates over 200 per 100,000 population, while the average for the Region was 132.7. US and Canada will meet the 25% reduction target before 2025. Mexico, Costa Rica, Venezuela, Dominican Republic, Panama, Guyana, and El Salvador did not significantly reduce premature mortality among men and Guyana, the Dominican Republic, and Panama did not achieve the required annual reduction in women. CONCLUSIONS: Trends in premature mortality due to CVD observed in last decade in the Americas would indicate that if these trends continue, the Region as a whole and a majority of its countries will be able to reach the goal of a 25% relative reduction in premature mortality even before 2025.

Perfil dos casos de queimadura atendidos em serviços hospitalares de urgência e emergência nas capitais brasileiras em 2017 / Profile of cases due to burn attended in emergency care units in Brazilian capitals in 2017

RESUMO: Objetivos: Definir o perfil das vítimas de queimadura atendidas nos serviços de emergência e identificar possíveis associações entre as variáveis investigadas. Métodos: Estudo transversal com base nos dados do inquérito "Vigilância de Violências e Acidentes em Unidades Sentinelas de Urgência e Emergência", de 2017. Procedeu-se à análise descritiva segundo características demográficas e aspectos relativos ao acidente por queimadura, bem como à técnica de análise de correspondência, que permitiu verificar possíveis associações entre as variáveis investigadas. Resultados: Os casos de queimadura foram mais frequentes: em adultos com idade entre 20 e 39 anos (40,7%); em homens (57%); no domicílio (67,7%); em decorrência do manuseio de substâncias quentes (52%). Acidentes no domicílio foram mais frequentes nas faixas etárias de 0 a 15 anos (92%) e idosos (84,4%) e em mulheres (81,6%). Acidentes no comércio, serviços e indústria acometeram indivíduos com idades entre 16 e 59 anos (73,6%). O encaminhamento para outros hospitais esteve associado aos casos ocorridos em idosos e a internação aos eventos que acometeram indivíduos na faixa de 0 a 15 anos de idade. Eventos na população em idade produtiva apresentaram associação com o uso de álcool e o local de trabalho. Entre as mulheres, sugere-se associação dos acidentes com o domicílio e substâncias quentes. Conclusão: Os resultados apontam para a necessidade de ações orientadas no campo da educação em saúde, bem como da regulamentação e da fiscalização trabalhistas.

ABSTRACT: Objectives: To describe the profile of burn victims attended in emergency services and to identify associations between the variables investigated. Methods: Cross-sectional study based on data from the 2017 survey "Surveillance of violence and accidents in emergency units". We used descriptive analysis, according to demographic characteristics and aspects related to the burn injury, as well as the correspondence analysis technique, which allowed to verify possible associations between the variables investigated. Results: Burns were more frequent: in adults aged between 20 and 39 years (40.7%); in men (57.0%); in the household (67.7%); due to hot substances (52.0%). Household accidents were more frequent in the age group 0-15 years (92.0%) and elderly (84.4%), and in women (81.6%). Accidents in commerce, services and industry affected individuals aged 16 to 59 years (73.6%). Referral to other hospitals was associated with cases in the elderly and hospitalization with the cases in individuals aged between 0 and 15 years old. Events in the working age population were associated with alcohol use and the workplace. Among women, it is suggested to associate burn accidents with household and hot substances. Conclusions: The results point to the need for oriented actions in the field of health education, as well as labor regulation and supervision.

[Morbidity and mortality from external causes in Brazil, 2000]. / As causas externas no Brasil no ano 2000: comparando a mortalidade e a morbidade.

Since the early 1980s, external causes have been the second greatest cause of death in Brazil. They also place a growing demand on health care services. The current study analyzes morbidity and mortality from external causes in Brazil. The study material consists of 118,367 deaths and 652,249 hospitalizations due to external causes during the year 2000. The data are from the National Mortality Information System and Hospital Information System. The mortality coefficient from external causes was 69.7/ 100 thousand (119.0/100 thousand for males and 21.8/100 thousand for women). Homicides were the leading cause of death (38.3% of the total), with a high coefficient of 26.7/100 thousand, while falls were the leading cause of hospitalizations (42.8% of the total). Motor vehicle accidents were a major cause of both morbidity and mortality. Fractures, mostly occurring in the upper and lower limbs, accounted for 42.6% of hospitalizations. Based on the findings, preventive programs should aim to decrease both mortality and morbidity, with special emphasis on homicides, traffic accidents, and falls.

[Injury among the elderly: the challenge to integrate preventive activities in public and individual levels]. / Mortes e internações por causas externas entre os idosos no Brasil: o desafio de integrar a saúde coletiva e atenção individual.

BACKGROUND: In Brazil and all over the world the elderly are increasing as a result of the raise in life expectancy. This group still faces a significant risk for some diseases as well as injuries. The proposal of this study was to describe fatal and nonfatal injuries among people aged 60 years and older in Brazil. SETTING: Brazil, the last year available was 2000. METHODS: The data from 13,383 injury deaths and 87,177 outcomes among people aged 60 years and older were analyzed. The data sets were obtained from Federal Health Department of Brazil from Mortality System Information (from death certificates) and Hospitalization Information System (from discharges registered in public hospitals). RESULTS: The mortality rate is 92.1/100,000 (135.3/100,000 for male and 56.8/100,000 for female) that are higher than overall population rates, especially for women. The lead cause is transport accidents (27.5% of total injury deaths) which mortality rate is 25.3/100,000 and 48.2% are pedestrian. Homicides rate is 9.5/100,000, it is almost three times lower than for total population in Brazil. Falls rate is 14.0/100,000, it is the third place in injury deaths for men and women and suicide rate is 6.9/100,000, lower than developed countries. Opposite to mortality, falls are the major cause of nonfatal injuries hospitalization for both men and women, accounting for 48,940 discharges (56.1%). Fractures are 52.8% of all injuries, especially in falls and transport accidents. CONCLUSIONS: It is crucial to develop injury preventive activities in both public and individual level. Falls should receive emphasis in injury prevention efforts.

Mortality from diseases, conditions and injuries where alcohol is a necessary cause in the Americas, 2007-09.

AIMS: To describe mortality from diseases, conditions and injuries where alcohol was a necessary cause in selected countries in the Americas. DESIGN: A descriptive, population-based study. SETTING: The data come from 16 countries in North, Central and South America for the triennium 2007-09 (latest available data). PARTICIPANTS/CASES: A total of 238 367 deaths were analyzed. MEASUREMENTS: We calculated age-adjusted and age-specific mortality rates by sex and country using the Pan American Health Organization (PAHO) mortality database. FINDINGS: The annual average of deaths where alcohol was a necessary cause in the 16 countries was 79, 456 (men comprised 86% and women 14%). People aged 40-59 years represented 55% overall. Most deaths were due to liver diseases (63% overall) and neuropsychiatric disorders (32% overall). Overall age-adjusted rates/100,000 were higher in El Salvador (27.4), Guatemala (22.3), Nicaragua (21.3) and Mexico (17.8) and lower in Colombia (1.8), Argentina (4.0) and Canada (5.7). The age groups at the highest risk were 54-59 to 64-69 years in most countries. In Guatemala, El Salvador and Nicaragua the rates increased earlier, among those aged 30-49 years. Male rates were higher than female rates in all countries, but the male : female ratio varied widely. CONCLUSIONS: Diseases, conditions or injuries where alcohol is a necessary cause are an important cause of premature mortality in the Americas, especially among men. Some countries show high risk of dying from this group of causes.

Mortality due to cardiovascular diseases in the Americas by region, 2000-2009.

CONTEXT AND OBJECTIVE: Cardiovascular diseases are the leading cause of death worldwide. The aim here was to evaluate trends in mortality due to cardiovascular diseases in three different regions of the Americas. DESIGN AND SETTING: This was a time series study in which mortality data from three different regions in the Americas from 2000 to the latest year available were analyzed. METHODS: The source of data was the Mortality Information System of the Pan-American Health Organization (PAHO). Data from 27 countries were included. Joinpoint regression analysis was used to analyze trends. RESULTS: During the study period, the age-adjusted mortality rates for men were higher than those of females in all regions. North America (NA) showed lower rates than Latin America countries (LAC) and the Non-Latin Caribbean (NLC). Premature deaths (30-69 years old) accounted for 22.8% of all deaths in NA, 38.0% in LAC and 41.8% in NLC. The trend analysis also showed a significant decline in the three regions. NA accumulated the largest decline. The average annual percentage change (AAPC) and 95% confidence interval was -3.9% [-4.2; -3.7] in NA; -1.8% [-2.2; -1.5] in LAC; and -1.8% [-2.7; -0.9] in NLC. CONCLUSION: Different mortality rates and reductions were observed among the three regions.

Trends in mortality rates where alcohol was a necessary cause of death in Brazil, 2000–2013

[ABSTRACT]. Objective. To analyze trends in mortality due to diseases and conditions fully attributable to alcohol in Brazil. Methods. This was an ecological time-series study. Proportional, specific, and age-standardized mortality rates between 2000 and 2013 that were due to underlying or contributing causes fully attributable to alcohol use were analyzed by sex, ethnicity/skin color, age group, and region of residence in the country. Data on deaths were obtained from the Brazilian Mortality Information System (SIM). Prais-Winsten regression was used to analyze trends. Results. Deaths with underlying causes and/or conditions contributing to death fully attributable to alcohol accounted for 2.5% of total deaths in the period. There were more deaths among men (3.8%) than among women (0.7%). In both sexes, there was a higher proportion of deaths in those 40–49 years old (27.9%) and those of black or pardo (mixed race) skin color (48.8%). Between 2000 and 2013, there was an upward trend in specific mortality rates attributable to alcohol in the country as a whole (average annual growth rate (AAGR) = 5.59%; 95% confidence interval (CI) = 3.55%-7.68%), especially in people aged less than 20 years old, in pardos (AAGR = 13.42%; 95% CI = 9.70%-17.25%), and in residents of the North region (AAGR = 17.01%; 95% CI = 14.94%-19.13%), the Northeast region (AAGR = 15.49%; 95% CI = 10.61%-20.58%), and the Midwest region (AAGR = 8.40%; 95% CI = 5.57%-11.32%). Conclusion. Alcohol is an important and growing cause of premature death in Brazil, especially among men, black/pardo people, and the population living in the most disadvantaged regions. This overall increase in the harmful use of alcohol reflects ethnic and socioeconomic inequalities in Brazil, and it also points to the need for population-based policies to reduce the impact of morbidity and to prevent early mortality.

[RESUMEN]. Objetivo. Analizar las tendencias en la mortalidad debido a enfermedades y condiciones totalmente atribuibles al alcohol en Brasil. Métodos. Se realizó un estudio ecológico de series temporales. Las tasas de mortalidad proporcionales, específicas y estandarizadas por edad entre 2000 y 2013 que se debieron a causas subyacentes o contribuyentes totalmente atribuibles al consumo de alcohol se analizaron por sexo, raza/ color de piel, grupo de edad y región de residencia en el país. Los datos sobre muertes se obtuvieron del Sistema Brasileño de Información de Mortalidad (SIM). Se utilizó la regresión de Prais-Winsten para analizar las tendencias. Resultados. Las muertes por causas subyacentes y / o condiciones que contribuyeron a causar la muerte totalmente atribuibles al alcohol representaron el 2,5% del total de muertes en el período en estudio. Hubo más muertes entre los hombres (3.8%) que entre las mujeres (0.7%). En ambos sexos hubo una mayor proporción de muertes entre los 40–49 años (27.9%) y en las personas de piel negra o parda (mestizos) (48.8%). Entre 2000 y 2013, hubo una tendencia ascendente en las tasas de mortalidad específicas atribuibles al alcohol en el país en general (Tasa de Crecimiento Anual Promedio (TCAP) = 5,59%, Intervalo de Confianza(IC) 95% = 3,55% -7,68%), especialmente en personas menores de 20 años, de tez pardos (TCAP = 13.42%, IC 95% = 9.70% -17.25%), y en residentes de la región Norte (TCAP= 17.01%, IC 95% = 14.94% -19.13%), Región Nordeste (AAGR = 15.49%, IC 95% = 10.61% -20.58%) y la región Medio Oeste (AAGR = 8.40%, IC 95% = 5.57% -11.32%). Conclusión. El alcohol es una causa importante y creciente de muerte prematura en Brasil, especialmente entre hombres, personas de raza negra y parda y la población que viven en las regiones más desfavorecidas. Este aumento general en el uso nocivo de alcohol refleja las desigualdades étnicas y socioeconómicas en Brasil, y también señala la necesidad de políticas basadas en la población para reducir el impacto de la morbilidad y prevenir la mortalidad temprana.

[RESUMO]. Objetivo. Analisar tendências de mortalidade por doenças e condições totalmente atribuíveis ao álcool no Brasil. Métodos. Este foi um estudo ecológico de séries temporais. As taxas de mortalidade proporcionais, específicas e padronizadas por idade entre 2000 e 2013, decorrentes de causas subjacentes ou contribuintes, totalmente atribuíveis ao consumo de álcool foram analisadas por sexo, etnia / cor da pele, faixa etária e região de residência no país. Os dados sobre óbitos foram obtidos do Sistema Brasileiro de Informações sobre Mortalidade (SIM). A regressão Prais-Winsten foi usada para analisar as tendências. Resultados. Mortes com causas subjacentes e / ou condições que contribuíram para a morte, totalmente atribuíveis ao álcool, representaram 2,5% do total de mortes no período. Houve mais mortes entre homens (3,8%) do que entre mulheres (0,7%). Em ambos os sexos houve uma maior proporção de óbitos entre 40–49 anos (27,9%) e na cor da pele negra ou pardo (mestiço) (48,8%). Entre 2000 e 2013, houve uma tendência ascendente nas taxas de mortalidade específicas atribuíveis ao álcool no país como um todo (Taxa de Crescimento Anual Média (TCAM) = 5,59%; Intervalo de Confiança (IC) 95% = 3,55% -7,68%), especialmente em pessoas com idade com menos de 20 anos, em pardos (TCAM = 13,42%; IC 95% = 9,70% -17,25%) e em residentes da região Norte (TCAM = 17,01%; IC 95% = 14,94% -19,13%), Região Nordeste (TCAM= 15,49%; IC 95% = 10,61% -20,58%) e região Centro-Oeste (TCAM= 8,40%; IC 95% = 5,57% -11,32%). Conclusão. O álcool é uma causa importante e crescente de morte prematura no Brasil, especialmente entre homens, negros / pardos e a população que vive nas regiões mais desfavorecidas. Esse aumento geral do uso prejudicial do álcool reflete desigualdades étnicas e socioeconômicas no Brasil e também aponta a necessidade de políticas baseadas na população para reduzir o impacto da morbidade e prevenir a mortalidade precoce.

Trends in mortality rates where alcohol was a necessary cause of death in Brazil, 2000-2013 / Tendencias en las tasas de mortalidad donde el alcohol fue una causa necesaria de muerte en Brasil, 2000-2013 / Tendências nas taxas de mortalidade onde o álcool foi uma causa necessária de morte no Brasil, 2000-2013

ABSTRACT Objective To analyze trends in mortality due to diseases and conditions fully attributable to alcohol in Brazil. Methods This was an ecological time-series study. Proportional, specific, and age-standardized mortality rates between 2000 and 2013 that were due to underlying or contributing causes fully attributable to alcohol use were analyzed by sex, ethnicity/skin color, age group, and region of residence in the country. Data on deaths were obtained from the Brazilian Mortality Information System (SIM). Prais-Winsten regression was used to analyze trends. Results Deaths with underlying causes and/or conditions contributing to death fully attributable to alcohol accounted for 2.5% of total deaths in the period. There were more deaths among men (3.8%) than among women (0.7%). In both sexes, there was a higher proportion of deaths in those 40-49 years old (27.9%) and those of black or pardo (mixed race) skin color (48.8%). Between 2000 and 2013, there was an upward trend in specific mortality rates attributable to alcohol in the country as a whole (average annual growth rate (AAGR) = 5.59%; 95% confidence interval (CI) = 3.55%-7.68%), especially in people aged less than 20 years old, in pardos (AAGR = 13.42%; 95% CI = 9.70%-17.25%), and in residents of the North region (AAGR = 17.01%; 95% CI = 14.94%-19.13%), the Northeast region (AAGR = 15.49%; 95% CI = 10.61%-20.58%), and the Midwest region (AAGR = 8.40%; 95% CI = 5.57%-11.32%). Conclusion Alcohol is an important and growing cause of premature death in Brazil, especially among men, black/pardo people, and the population living in the most disadvantaged regions. This overall increase in the harmful use of alcohol reflects ethnic and socioeconomic inequalities in Brazil, and it also points to the need for population-based policies to reduce the impact of morbidity and to prevent early mortality.

RESUMEN Objetivo Analizar las tendencias en la mortalidad debido a enfermedades y condiciones totalmente atribuibles al alcohol en Brasil. Métodos Se realizó un estudio ecológico de series temporales. Las tasas de mortalidad proporcionales, específicas y estandarizadas por edad entre 2000 y 2013 que se debieron a causas subyacentes o contribuyentes totalmente atribuibles al consumo de alcohol se analizaron por sexo, raza/ color de piel, grupo de edad y región de residencia en el país. Los datos sobre muertes se obtuvieron del Sistema Brasileño de Información de Mortalidad (SIM). Se utilizó la regresión de Prais-Winsten para analizar las tendencias. Resultados Las muertes por causas subyacentes y / o condiciones que contribuyeron a causar la muerte totalmente atribuibles al alcohol representaron el 2,5% del total de muertes en el período en estudio. Hubo más muertes entre los hombres (3.8%) que entre las mujeres (0.7%). En ambos sexos hubo una mayor proporción de muertes entre los 40-49 años (27.9%) y en las personas de piel negra o parda (mestizos) (48.8%). Entre 2000 y 2013, hubo una tendencia ascendente en las tasas de mortalidad específicas atribuibles al alcohol en el país en general (Tasa de Crecimiento Anual Promedio (TCAP) = 5,59%, Intervalo de Confianza(IC) 95% = 3,55% −7,68%), especialmente en personas menores de 20 años, de tez pardos (TCAP = 13.42%, IC 95% = 9.70% −17.25%), y en residentes de la región Norte (TCAP= 17.01%, IC 95% = 14.94% −19.13%), Región Nordeste (AAGR = 15.49%, IC 95% = 10.61% −20.58%) y la región Medio Oeste (AAGR = 8.40%, IC 95% = 5.57% −11.32%). Conclusión El alcohol es una causa importante y creciente de muerte prematura en Brasil, especialmente entre hombres, personas de raza negra y parda y la población que viven en las regiones más desfavorecidas. Este aumento general en el uso nocivo de alcohol refleja las desigualdades étnicas y socioeconómicas en Brasil, y también señala la necesidad de políticas basadas en la población para reducir el impacto de la morbilidad y prevenir la mortalidad temprana.

RESUMO Objetivo Analisar tendências de mortalidade por doenças e condições totalmente atribuíveis ao álcool no Brasil. Métodos Este foi um estudo ecológico de séries temporais. As taxas de mortalidade proporcionais, específicas e padronizadas por idade entre 2000 e 2013, decorrentes de causas subjacentes ou contribuintes, totalmente atribuíveis ao consumo de álcool foram analisadas por sexo, etnia / cor da pele, faixa etária e região de residência no país. Os dados sobre óbitos foram obtidos do Sistema Brasileiro de Informações sobre Mortalidade (SIM). A regressão Prais-Winsten foi usada para analisar as tendências. Resultados Mortes com causas subjacentes e / ou condições que contribuíram para a morte, totalmente atribuíveis ao álcool, representaram 2,5% do total de mortes no período. Houve mais mortes entre homens (3,8%) do que entre mulheres (0,7%). Em ambos os sexos houve uma maior proporção de óbitos entre 40-49 anos (27,9%) e na cor da pele negra ou pardo (mestiço) (48,8%). Entre 2000 e 2013, houve uma tendência ascendente nas taxas de mortalidade específicas atribuíveis ao álcool no país como um todo (Taxa de Crescimento Anual Média (TCAM) = 5,59%; Intervalo de Confiança (IC) 95% = 3,55% −7,68%), especialmente em pessoas com idade com menos de 20 anos, em pardos (TCAM = 13,42%; IC 95% = 9,70% −17,25%) e em residentes da região Norte (TCAM = 17,01%; IC 95% = 14,94% −19,13%), Região Nordeste (TCAM= 15,49%; IC 95% = 10,61% −20,58%) e região Centro-Oeste (TCAM= 8,40%; IC 95% = 5,57% −11,32%). Conclusão O álcool é uma causa importante e crescente de morte prematura no Brasil, especialmente entre homens, negros / pardos e a população que vive nas regiões mais desfavorecidas. Esse aumento geral do uso prejudicial do álcool reflete desigualdades étnicas e socioeconômicas no Brasil e também aponta a necessidade de políticas baseadas na população para reduzir o impacto da morbidade e prevenir a mortalidade precoce.