Racial inequality in health care of adults hospitalized with COVID-19. / Desigualdade racial na assistência à saúde do adulto internado por COVID-19.

The objective was to analyze the association of race/skin color in health care, in adults hospitalized with severe acute respiratory syndrome (SARS)/COVID-19, between March 2020 and September 2022, with Brazil as the unit of analysis. This is a cross-sectional study that used the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) database and had a population composed of adults (≥ 18 years) and the final classification was SARS by COVID-19 or unspecified SARS. The direct effect of skin color on in-hospital mortality was estimated through logistic regression adjusted for age, gender, schooling level, health care system and period, stratified by vaccination status. This same model was also used to assess the effect of skin color on the variables related to access to health care services: intensive care unit (ICU), tomography, chest X-ray and ventilatory support. The results show that black, brown and indigenous people died more, regardless the schooling level and number of comorbidities, with 23%, 32% and 80% higher chances of death, respectively, when submitted to ventilatory support. Racial differences were observed in the use of health care services and in outcomes of death from COVID-19 or unspecified SARS, in which ethnic minorities had higher in-hospital mortality and lower use of hospital resources. These results suggest that black and indigenous populations have severe disadvantages compared to the white population, facing barriers to access health care services in the context of the COVID-19 pandemic.

O objetivo deste artigo foi analisar a associação entre raça/cor e assistência à saúde, em adultos hospitalizados pela síndrome respiratória aguda grave (SRAG)/COVID-19 no Brasil, entre março de 2020 e setembro de 2022. Trata-se de estudo transversal, que utilizou o banco de dados do Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) e contou com uma população composta por adultos (≥ 18 anos). A classificação final foi SRAG por COVID-19 ou SRAG não especificada. O efeito direto do aspecto cor na mortalidade intra-hospitalar foi estimado por meio de regressão logística ajustada por idade, sexo, escolaridade, sistema de saúde e período, estratificado por situação vacinal. Esse mesmo modelo foi utilizado também para avaliar o efeito do quesito cor nas variáveis de acesso aos serviços de saúde: unidade de terapia intensiva (UTI), tomografia, radiografia de tórax e suporte ventilatório. Os resultados evidenciam que pretos, pardos e indígenas morreram mais, independentemente do grau de escolaridade e da quantidade de comorbidades, com maiores chances de óbito em 23%, 32% e 80%, respectivamente, ao serem submetidos ao suporte ventilatório. Foram observadas diferenças raciais no uso de serviços de saúde e nos desfechos de morte por COVID-19 ou SRAG não especificada, em que minorias étnicas tiveram maiores taxas de mortalidade intra-hospitalar e os recursos hospitalares foram utilizados com menos frequência. Tais resultados sugerem que as populações negra e indígena têm severas desvantagens em relação à branca, enfrentando barreiras de acesso aos serviços de saúde no contexto da pandemia de COVID-19.

Se pretende analizar la asociación entre raza/color en la atención de la salud de adultos hospitalizados por síndrome respiratorio agudo severo (SARS)/COVID-19 en el período entre marzo de 2020 y septiembre de 2022, tomando Brasil como unidad de análisis. Se trata de un estudio transversal, en que se utilizó la base de datos del Sistema de Información de Vigilancia Epidemiológica de la Gripe (SIVEP-Gripe) y tuvo una muestra compuesta por adultos (≥ 18 años) y la clasificación final fue SARS por COVID-19 o SARS no especificado. El efecto directo de la pregunta color sobre la mortalidad intrahospitalaria se estimó mediante la regresión logística ajustada según edad, sexo, nivel de estudios, sistema de salud y período, estratificada por estado de vacunación. Este modelo también se utilizó para evaluar el efecto de la pregunta color en las variables de acceso a los servicios de salud: unidades de cuidado intensivo (UCI), tomografía, radiografía de tórax y soporte ventilatorio. Los resultados muestran que negros, pardos e indígenas murieron más, independientemente del nivel de estudios y el número de comorbilidades, y cuando fueron sometidos a soporte ventilatorio, tuvieron mayores probabilidades de muerte con el 23%, 32% y 80%, respectivamente. Se observaron diferencias raciales en el uso de los servicios de salud y los resultados de muerte por COVID-19 o SARS no especificado, en los que las minorías étnicas tuvieron una mayor mortalidad intrahospitalaria y los recursos hospitalarios se utilizaron con menos frecuencia. Estos resultados evidencian que las poblaciones negra e indígena tienen graves desventajas en comparación con la población blanca, afrontando dificultades de acceso a los servicios de salud en el contexto de la pandemia del COVID-19.

Desigualdade racial na assistência à saúde do adulto internado por COVID-19 / Desigualdad racial en la atención a la salud de adultos hospitalizados por COVID-19 / Racial inequality in health care of adults hospitalized with COVID-19

Resumo: O objetivo deste artigo foi analisar a associação entre raça/cor e assistência à saúde, em adultos hospitalizados pela síndrome respiratória aguda grave (SRAG)/COVID-19 no Brasil, entre março de 2020 e setembro de 2022. Trata-se de estudo transversal, que utilizou o banco de dados do Sistema de Informação de Vigilância Epidemiológica da Gripe (SIVEP-Gripe) e contou com uma população composta por adultos (≥ 18 anos). A classificação final foi SRAG por COVID-19 ou SRAG não especificada. O efeito direto do aspecto cor na mortalidade intra-hospitalar foi estimado por meio de regressão logística ajustada por idade, sexo, escolaridade, sistema de saúde e período, estratificado por situação vacinal. Esse mesmo modelo foi utilizado também para avaliar o efeito do quesito cor nas variáveis de acesso aos serviços de saúde: unidade de terapia intensiva (UTI), tomografia, radiografia de tórax e suporte ventilatório. Os resultados evidenciam que pretos, pardos e indígenas morreram mais, independentemente do grau de escolaridade e da quantidade de comorbidades, com maiores chances de óbito em 23%, 32% e 80%, respectivamente, ao serem submetidos ao suporte ventilatório. Foram observadas diferenças raciais no uso de serviços de saúde e nos desfechos de morte por COVID-19 ou SRAG não especificada, em que minorias étnicas tiveram maiores taxas de mortalidade intra-hospitalar e os recursos hospitalares foram utilizados com menos frequência. Tais resultados sugerem que as populações negra e indígena têm severas desvantagens em relação à branca, enfrentando barreiras de acesso aos serviços de saúde no contexto da pandemia de COVID-19.

Resumen: Se pretende analizar la asociación entre raza/color en la atención de la salud de adultos hospitalizados por síndrome respiratorio agudo severo (SARS)/COVID-19 en el período entre marzo de 2020 y septiembre de 2022, tomando Brasil como unidad de análisis. Se trata de un estudio transversal, en que se utilizó la base de datos del Sistema de Información de Vigilancia Epidemiológica de la Gripe (SIVEP-Gripe) y tuvo una muestra compuesta por adultos (≥ 18 años) y la clasificación final fue SARS por COVID-19 o SARS no especificado. El efecto directo de la pregunta color sobre la mortalidad intrahospitalaria se estimó mediante la regresión logística ajustada según edad, sexo, nivel de estudios, sistema de salud y período, estratificada por estado de vacunación. Este modelo también se utilizó para evaluar el efecto de la pregunta color en las variables de acceso a los servicios de salud: unidades de cuidado intensivo (UCI), tomografía, radiografía de tórax y soporte ventilatorio. Los resultados muestran que negros, pardos e indígenas murieron más, independientemente del nivel de estudios y el número de comorbilidades, y cuando fueron sometidos a soporte ventilatorio, tuvieron mayores probabilidades de muerte con el 23%, 32% y 80%, respectivamente. Se observaron diferencias raciales en el uso de los servicios de salud y los resultados de muerte por COVID-19 o SARS no especificado, en los que las minorías étnicas tuvieron una mayor mortalidad intrahospitalaria y los recursos hospitalarios se utilizaron con menos frecuencia. Estos resultados evidencian que las poblaciones negra e indígena tienen graves desventajas en comparación con la población blanca, afrontando dificultades de acceso a los servicios de salud en el contexto de la pandemia del COVID-19.

Abstract: The objective was to analyze the association of race/skin color in health care, in adults hospitalized with severe acute respiratory syndrome (SARS)/COVID-19, between March 2020 and September 2022, with Brazil as the unit of analysis. This is a cross-sectional study that used the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe) database and had a population composed of adults (≥ 18 years) and the final classification was SARS by COVID-19 or unspecified SARS. The direct effect of skin color on in-hospital mortality was estimated through logistic regression adjusted for age, gender, schooling level, health care system and period, stratified by vaccination status. This same model was also used to assess the effect of skin color on the variables related to access to health care services: intensive care unit (ICU), tomography, chest X-ray and ventilatory support. The results show that black, brown and indigenous people died more, regardless the schooling level and number of comorbidities, with 23%, 32% and 80% higher chances of death, respectively, when submitted to ventilatory support. Racial differences were observed in the use of health care services and in outcomes of death from COVID-19 or unspecified SARS, in which ethnic minorities had higher in-hospital mortality and lower use of hospital resources. These results suggest that black and indigenous populations have severe disadvantages compared to the white population, facing barriers to access health care services in the context of the COVID-19 pandemic.

Association between obesity and COVID-19 mortality and length of stay in intensive care unit patients in Brazil: a retrospective cohort study.

The present study aimed to evaluate the association between obesity and COVID-19 mortality and length of stay in ICU patients, and how these associations were modified by age groups. We performed a retrospective multicenter cohort study with data obtained from a hospital-based registry. The sample consisted of 8183 ICU hospitalized patients who tested positive for SARS-CoV-2. Cox proportional models were used to evaluate the association between BMI categories and COVID-19 mortality and generalized linear models for the length of stay in the ICU. After adjusting for confounders, those in the younger group with severe obesity had an increased risk of COVID-19 mortality compared to those with normal/overweight (HR 1.27; 95% CI 1.01-1.61). An increased risk of death was also observed for patients with underweight (HR 3.74; 95% CI 1.39-10.07). For patients aged ≥ 60 year, mild/moderate obesity was associated with reduced mortality risk (HR 0.87; 95% CI 0.78-0.97). For the age group < 60 year, the length of stay in ICU for those patients with severe obesity was 35% higher compared to the normal/overweight category (eß 1.35; 95% CI 1.21-1.51). Conversely, for the survivors in the underweight category, the length of stay in ICU was 51% lower compared to the normal/overweight group (eß 0.49; 95% CI 0.31-0.78). In the age group ≥ 60 year, mild/moderate obesity was associated with an increased length of stay in the ICU (eß 1.10; 95% CI 1.01-1.21), adjusting for confounders. These findings could be helpful for health professionals to identify subgroups at higher risk for worse outcomes.

Obesidade e COVID-19: estudo de base populacional da mortalidade por SRAG no Brasil / Obesity and COVID-19: a population-based study of SARS mortality in Brazil

A obesidade em pacientes com COVID-19 tem sido associada a um maior risco de desfechos como admissão em unidade de terapia intensiva (UTI), necessidade de ventilação mecânica (VM) e morte hospitalar. Entretanto, algumas lacunas ainda precisam ser preenchidas, como: a relação entre idade e obesidade na morte por COVID-19 e a magnitude de proteção conferida pela vacina nos obesos. Dessa forma, os objetivos deste estudo foram: i) avaliar o efeito da obesidade no risco de morte e se há modificação de efeito com a idade; ii) avaliar o efeito do número de doses (uma, duas ou três) da vacina contra SARS-CoV-2 nos desfechos morte hospitalar, admissão em UTI, necessidade de VM e tempo de internação em pacientes obesos e não obeso hospitalizado por COVID-19. A população de estudo foi composta de 2.429.183 adultos (≥18 anos), hospitalizados por SRAG entre março de 2020 e setembro de 2022 oriundos do banco de acesso público (SIVEP-Gripe). Para investigar o risco de admissão em UTI, necessidade de VM e morte, utilizou-se modelo de regressão logística e quando o desfecho foi tempo de internação (dias) optou-se por um modelo linear generalizado com distribuição gama e função de ligação log. A média de idade foi 60 anos, 56,4% homens, 19,8% obesos, a mortalidade hospitalar foi de 30,7% e 51,2% receberam ao menos uma dose da vacina contra SARS-CoV-2. No modelo logístico ajustado, o risco de morte no obeso vacinado com pelo menos uma dose foi 37% maior que o não obeso, ao passo que os obesos não vacinados apresentaram risco de morte 67% maior quando comparado aos não obesos não vacinados. Tanto nos vacinados quanto nos não vacinados o termo de interação entre as variáveis​ obesidade e idade (categórica) foi significativo (p<0,05) apenas para indivíduos obesos como idade maior que 90 anos, sendo grupo de comparação os não obesos de 18 a 40 anos. Duas e três doses da vacina reduziram o risco de morte e necessidade de VM nos obesos e não obesos em todas as faixas de idade, estando os com idade menor ou igual a 60 anos mais protegidos. Entre os indivíduos com idade até 60 anos que tomaram duas doses, os obesos foram mais protegidos quando comparados com os não obesos (nos grupos de idade 18-40 anos, 41-50 anos e 51-60 anos, os Odds Ratio (OR) para os obesos foram, respectivamente: OR = 0,32(IC 95%:0,23-0,43), OR = 0,29 (0,22-0,38) e OR = 0,30(0,24-0,38); enquanto para os não obesos foram, respectivamente: OR = 0,53(0,45-0,64), OR= 0,48(0,41-0,56) e OR= 0,49(0,44-0,55). O tempo de internação nos obesos foi 12% maior quando comparado com os não obesos (p<0,001). Não foi observada diferença no tempo de internação segundo status vacinal. Esses achados podem contribuir para uma campanha vacinal ainda mais assertiva.

Obesity in patients with COVID-19 has been associated with a higher risk of outcomes such as intensive care unit (ICU) admission, need for mechanical ventilation (MV), and in-hospital death. However, some gaps remain, such as the relationship between age and obesity in COVID-19 deaths and the magnitude of protection conferred by the vaccine on obese people. The study's objectives were thus as follows: i) to assess the effect of obesity on the risk of death and whether this effect changes with age; and ii) to assess the effect of the number of doses (one, two, or three) of the SARS-CoV-2 vaccine on the outcomes hospital death, ICU admission, need for MV, and length of stay in obese and non-obese patients hospitalized for COVID-19. The study population consisted of 2,429,183 adults (≥18 years old), hospitalized for SARI between March 2020 and September 2022, from the public access database (SIVEP-Gripe). To investigate the risk of admission to the ICU, the need for MV, and death, a logistic regression model was used, and when the outcome was length of stay (days), a generalized linear model with a gamma distribution and log link function was chosen. The mean age was 60 years, 56.4% men, 19.8% were obese, hospital mortality was 30.7%, and 51.2% received at least one dose of the vaccine against SARS-CoV-2. In the adjusted logistic model, the risk of death in the obese vaccinated with at least one dose was 37% higher than in the non-obese, whereas the unvaccinated obese had a 67% higher risk of death when compared to the non-vaccinated non-obese. Both in vaccinated and unvaccinated individuals, the interaction term between obesity and age (categorical) variables was significant (p<0.05) only for obese individuals aged over 90 years, with the comparison group being non-obese individuals aged 18 to 40 years. Two and three doses of the vaccine reduced the risk of death and need for MV in obese and non-obese individuals in all age groups, with those aged less than or equal to 60 years being more protected. Among individuals aged up to 60 years who took two doses, the obese were more protected when compared to the non-obese (in the age groups 18-40 years, 41-50 years, and 51-60 years, the Odds Ratio (OR) for the obese were, respectively: OR = 0.32 (CI 95%: 0.23-0.43), OR = 0.29 (0.22-0.38) and OR = 0.30 (0.24 -0.38); while for the non-obese, they were, respectively: OR = 0.53 (0.45-0.64), OR= 0.48 (0.41-0.56) and OR= 0.49 (0.44-0.55). Obese patients had a 12% longer length of stay than non-obese patients (p<0.001). No difference was observed in the length of stay according to vaccination status. These findings may contribute to an even more assertive vaccination campaign.

High discrepancies in the mortality of hospitalized patients with COVID-19 in the two most economically important states in Brazil.

OBJECTIVE: The aim of this study was to compare the proportion of deaths among hospitalized cases of COVID-19 in São Paulo and Rio de Janeiro, stratified by private and public services. METHODS: Hospitalization data for severe acute respiratory syndrome (SARS) were obtained using the SIVEP-Gripe Database. All hospitalized adults who were diagnosed as COVID-19 or unspecified SARS, between January and December 2020, were included in the analysis. Logistic regression models were fitted to evaluate the risk of death between Rio de Janeiro and São Paulo, adjusted for age, sex, and comorbidities. RESULTS: A total of 388,657 hospital registers for Rio de Janeiro and São Paulo (91,532 and 297,125, respectively) were analyzed. Missing data are frequent in the database and it was greater in Rio de Janeiro, at the state and capital levels. Adjusting for confounders, the odds ratio of dying by COVID-19, comparing the state of Rio de Janeiro with São Paulo, was 2.51 in the private hospitals and 2.29 in the public ones. For the capitals, the scenario is worse. The lethality among hospitalized patients with COVID-19 is at least twice in Rio de Janeiro than São Paulo, both at the states and capitals. The public or private services showed important differences, with odds ratios of 2.74 and 3.46, respectively. CONCLUSION: It appears that the worst governance in the health sector in Rio de Janeiro, more than lack of resources, explains the excess mortality of hospitalized COVID-19 patients in Rio de Janeiro.

Metabolic Evaluation in Patients With Hepatitis C Treated With Direct Antiviral Agents.

Epidemiological data clearly indicate a link between hepatitis C virus (HCV) and altered glucose homeostasis. Objective: To evaluate the response of treatment with direct antiviral agents (DAAs) on metabolic variables of patients with hepatitis C. Methods: Observational, cross-sectional study in a sample of patients with hepatitis C starting therapy with DAAs followed on the hepatology division of Federal University of Rio de Janeiro State. Data were collected in two stages: before the start of therapy and between 12 and 52 weeks after obtaining the sustained virological response. Results: In the baseline assessment of the 97 patients selected, 19.3% were obese, 38.6% were overweight, 50% were hypertensive, 43.8% were pre-diabetic, 12.5% were diabetic, 31.2% were dyslipidemic, and 21.8% had metabolic syndrome. There was an increase in total cholesterol and LDL levels (p < 0.001), and a non-significant reduction in blood glucose, glycated hemoglobin, insulin, and HOMA-IR levels after treatment. In the post-treatment, there was a reduction in fibrosis (p = 0.016), with a reduction in the levels of GGT, AST, and ALT (all with p < 0.001), as well as in the FIB4 and APRI scores (both with p < 0.001) and in the degree of fibrosis evaluated by elastography represented in kPa (p = 0.006). The blood glucose level was higher in patients with steatosis (p = 0.039) after treatment. There was a positive pre-treatment correlation between the degree of fibrosis (kPa) and FIB4 (r = 0.319, p = 0.004), APRI (r = 0.287, p = 0.010), and the NAFLD score (r = 0.275, p = 0.016). Conclusion: Patients with hepatitis C had a high prevalence of metabolic disturbance in the pre-treatment phase, but the therapy did not show beneficial effects, especially on glucose metabolism.

High discrepancies in the mortality of hospitalized patients with COVID-19 in the two most economically important states in Brazil / Alta discrepância na mortalidade de pacientes hospitalizados por COVID-19 nos dois estados economicamente mais importantes do Brasil

ABSTRACT: Objective: The aim of this study was to compare the proportion of deaths among hospitalized cases of COVID-19 in São Paulo and Rio de Janeiro, stratified by private and public services. Methods: Hospitalization data for severe acute respiratory syndrome (SARS) were obtained using the SIVEP-Gripe Database. All hospitalized adults who were diagnosed as COVID-19 or unspecified SARS, between January and December 2020, were included in the analysis. Logistic regression models were fitted to evaluate the risk of death between Rio de Janeiro and São Paulo, adjusted for age, sex, and comorbidities. Results: A total of 388,657 hospital registers for Rio de Janeiro and São Paulo (91,532 and 297,125, respectively) were analyzed. Missing data are frequent in the database and it was greater in Rio de Janeiro, at the state and capital levels. Adjusting for confounders, the odds ratio of dying by COVID-19, comparing the state of Rio de Janeiro with São Paulo, was 2.51 in the private hospitals and 2.29 in the public ones. For the capitals, the scenario is worse. The lethality among hospitalized patients with COVID-19 is at least twice in Rio de Janeiro than São Paulo, both at the states and capitals. The public or private services showed important differences, with odds ratios of 2.74 and 3.46, respectively. Conclusion: It appears that the worst governance in the health sector in Rio de Janeiro, more than lack of resources, explains the excess mortality of hospitalized COVID-19 patients in Rio de Janeiro.

RESUMO: Objetivo: Comparar a proporção de óbitos entre os casos de COVID-19 hospitalizados em São Paulo e Rio de Janeiro, estratificados por serviços públicos e privados. Métodos: Os dados de hospitalização por Síndrome Respiratória Aguda Grave (SRAG) foram obtidos do banco de dados SIVEP-Gripe. Todos os adultos hospitalizados com diagnóstico de COVID-19 ou SRAG não especificado, entre janeiro e dezembro de 2020, foram incluídos na análise. Modelos de regressão logística foram usados para avaliar o risco de morte entre Rio de Janeiro e São Paulo, ajustados para idade, sexo e comorbidades. Resultados: Foram analisados 388.657 registros hospitalares do Rio de Janeiro e de São Paulo (91.532 e 297.125, respectivamente). Os dados faltantes no banco são frequentes e maiores no Rio de Janeiro (estado e capital). Ajustando para fatores de confusão, a razão de chance de morrer por COVID-19, comparando o estado do Rio de Janeiro com o de São Paulo, foi de 2,51 nos hospitais privados e de 2,29 nos públicos. Para as capitais, o cenário é pior. A letalidade entre pacientes internados com COVID-19 no Rio de Janeiro é pelo menos o dobro da de São Paulo, tanto para os estados quanto para as capitais. Os serviços públicos ou privados apresentaram diferenças importantes, com razão de chance de 2,74 e 3,46, respetivamente. Conclusão: Parece que a pior governança do setor da saúde no Rio de Janeiro, mais do que a falta de recursos, explica o excesso de mortalidade de pacientes internados com COVID-19 no Rio de Janeiro.

Trends in obesity prevalence among Brazilian adults from 2002 to 2013 by educational level.

BACKGROUND: Obesity ranks as a major public health problem in many countries in the world. The obesity-socioeconomic status relationship is not well established in middle-income countries. METHODS: The aim of this study was to estimate the obesity and overweight trends from 2002 to 2013 by sex, age, and educational levels among Brazilian adults. The panel prevalence trend study was conducted, considering the sample weights and study design. Three nationwide surveys were analyzed: the Household Budget Survey 2002/2003 and 2008/2009, and the National Health Survey 2013. The total sample was 234,791 adults aged 20-59 years. RESULTS: The prevalence of obesity increased from 7.5 to 17.0% from 2002 to 2013 among adults aged 20-39 years and from 14.7 to 25.7% among those aged 40-59 years, slightly higher among young women. In each survey, education was positively associated with the prevalence of obesity among men, whereas this association was negative among women. The greatest increase in the prevalence of obesity was 90% (11.9 to 22.5%) and occurred from 2008 to 2013 among women with secondary educational level, whereas at the pre-primary level there was a 42% (20.4 to 29.0%) increase. CONCLUSIONS: Obesity prevalence in Brazil continued to increase, mostly among women with secondary education. Policies aimed at reducing the prevalence of obesity should consider sociodemographic characteristics in the population.

Tendência de sobrepeso e obesidade em adultos segundo nível de escolaridade: Brasil, 2002 a 2013 / Trends in obesity prevalence among Brazilian adults according to educational level, 2002­2013

A presente dissertação aborda a tendência do sobrepeso e obesidade no Brasil e sua relação com a escolaridade entre os anos de 2002 e 2013. Para tal, foram utilizadas três bases de dados oriundas de inquéritos nacionais: Pesquisas de Orçamento Familiar 2002/2003 e 2008/2009 e Pesquisa Nacional de Saúde 2013, totalizando 240.051 adultos de 20-59 anos, após exclusão das gestantes. Esta dissertação foi estruturada em cinco seções: Revisão da literatura, material e métodos, justificativa, objetivos e resultados preliminares, no qual é apresentado, como proposta de produto final, o manuscrito: Trends in obesity prevalence among Brazilian adults according to educational level, 2002­2013. As prevalências de sobrepeso e obesidade foram estimadas por sexo, idade e escolaridade. A idade foi categorizada em dois grupos (20 a 39 anos e 40 a 59 anos) e a escolaridade em quatro: pré-primário, primário, secundário e terciário, seguindo a International Standard Classification of Education. Modelos de regressão logística foram desenvolvidos para avaliar a tendência da prevalência de obesidade e sobrepeso de acordo com o nível de escolaridade, ajustados por sexo e idade. Nas análises, foram levados em conta os pesos amostrais e o desenho de estudo. A prevalência de obesidade passou de 7,5% para 17,0% no período de 2002 a 2013 nos adultos com 20-39 anos e de 14,7% para 25,7% nos de 40-59 anos. Em todos os inquéritos a escolaridade associou-se positivamente com a prevalência de obesidade nos homens, entretanto a associação foi negativa nas mulheres. A maior prevalência de obesidade foi de 35,3% nas mulheres de nível secundário (ensino médio completo ou superior incompleto) e elas foram as que apresentaram o maior incremento na prevalência de obesidade no período de 2008 a 2013 (24,4% para 35,3%). Para ambos os sexos, a chance de se tornar obeso dobrou de 2002 para 2013, para mulheres de 20-39 anos a chance foi de duas vezes e meia. Dessa forma, observou-se que diferenças quanto ao nível de escolaridade e o sexo impactam na prevalência de obesidade no Brasil. Dessa forma, políticas públicas de enfrentamento da obesidade devem levar em conta características sociodemográficas da população

The present dissertation addresses the trend of overweight and obesity in Brazil and its relationship with educational level between 2002 and 2013. Three national databases were used: Household Budget Surveys (Pesquisas de Orçamento Familiar) 2002/2003, 2008/2009 and National Health Survey (Pesquisa Nacional de Saúde) 2013, with a total of 240,051 adults aged 20-59 years, excluding pregnant women. This dissertation was structured in five sections: Review of the literature, material and methods, justification, objectives and results, that is presented as a manuscript: Trends in obesity prevalence among Brazilian adults according to educational level, 2002- 2013. The prevalence of overweight and obesity was estimated by sex, age and educational level. Age was categorized into two groups (20 to 39 years and 40 to 59 years) and education in four: pre-primary, primary, secondary and tertiary, following the International Standard Classification of Education. Logistic regression models were developed to evaluate the prevalence trend of obesity and overweight according to educational level, adjusted for sex and age. Sample weights and study design were taken into account. The prevalence of obesity increased from 7.5% to 17.0% between 2002 and 2013 in adults aged 20-39 years and from 14.7% to 25.7% in those aged 40-59 years. In all surveys, education was positively associated with the prevalence of obesity in men, although this association was negative in women. The highest prevalence of obesity was 35.3% in women at secondary level (complete secondary school and incomplete tertiary school) they presented the greatest increase in the prevalence of obesity between 2008 and 2013 (24.4% for 35,3%). For both sexes, the chance of becoming obese has doubled from 2002 to 2013, and for the women aged 20-39 the chance was two and a half times. Thus, it was observed that differences in educational level and sex impact on the prevalence of obesity in Brazil. Thus, public policies for fighting with obesity should take into account the sociodemographic characteristics of the population