Prevalence of adult smokers in Brazilian capitals according to socioeconomic deprivation.

OBJECTIVE: To estimate the prevalence of adult smokers in the 26 capitals and the Federal District according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP). METHODS: Dataset on smoking were obtained from the Surveillance of Risk and Protective Factors for Noncommunicable Diseases by Survey (Vigitel) system for the 26 capitals and the Federal District, in the period from 2010 to 2013. The IBP classifies the census sectors according to indicators such as: income less than ½ minimum wage, illiterate population and without sanitary sewage. In the North and Northeast regions, the census sectors were grouped into four categories (low, medium, high and very high deprivation) and in the South, Southeast and Midwest regions into three (low, medium and high deprivation). Prevalence estimates of adult smokers were obtained using the indirect estimation method in small areas. To calculate the prevalence ratios, Poisson models are used. RESULTS: The positive association between prevalence and deprivation of census sector categories was found in 16 (59.3%) of the 27 cities. In nine (33.3%) cities, the sectors with the greatest deprivation had a higher prevalence of smokers when compared to those with the least deprivation, and in two (7.4%) there were no differences. In Aracaju, Belém, Fortaleza, João Pessoa, Macapá and Salvador, the prevalence of adult smokers was three times higher in the group of sectors with greater deprivation compared to those with less deprivation. CONCLUSION: Sectors with greater social deprivation had a higher prevalence of smoking, compared with less deprivation, pointing to social inequalities.

Prevalence of adult smokers in Brazilian capitals according to socioeconomic deprivation / Prevalência de fumantes adultos nas capitais brasileiras, segundo privação socioeconômica

ABSTRACT Objective: To estimate the prevalence of adult smokers in the 26 capitals and the Federal District according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP). Methods: Dataset on smoking were obtained from the Surveillance of Risk and Protective Factors for Noncommunicable Diseases by Survey (Vigitel) system for the 26 capitals and the Federal District, in the period from 2010 to 2013. The IBP classifies the census sectors according to indicators such as: income less than ½ minimum wage, illiterate population and without sanitary sewage. In the North and Northeast regions, the census sectors were grouped into four categories (low, medium, high and very high deprivation) and in the South, Southeast and Midwest regions into three (low, medium and high deprivation). Prevalence estimates of adult smokers were obtained using the indirect estimation method in small areas. To calculate the prevalence ratios, Poisson models are used. Results: The positive association between prevalence and deprivation of census sector categories was found in 16 (59.3%) of the 27 cities. In nine (33.3%) cities, the sectors with the greatest deprivation had a higher prevalence of smokers when compared to those with the least deprivation, and in two (7.4%) there were no differences. In Aracaju, Belém, Fortaleza, João Pessoa, Macapá and Salvador, the prevalence of adult smokers was three times higher in the group of sectors with greater deprivation compared to those with less deprivation. Conclusion: Sectors with greater social deprivation had a higher prevalence of smoking, compared with less deprivation, pointing to social inequalities.

RESUMO Objetivo: Estimar as prevalências de adultos fumante nas 26 capitais e no Distrito Federal segundo o Índice Brasileiro de Privação. Métodos: Os dados sobre tabagismo foram obtidos junto ao sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito (Vigitel) para as 26 capitais e o Distrito Federal, no período de 2010 a 2013. O Índice Brasileiro de Privação classifica os setores censitários segundo indicadores como: renda menor que meio salário mínimo, população não alfabetizada e sem esgotamento sanitário. Nas regiões Norte e Nordeste, os setores censitários foram agrupados em quatro categorias (baixa, média, alta e muito alta privação) e, nas regiões Sul, Sudeste e Centro-Oeste, em três (baixa, média e alta privação). As estimativas de prevalências de adultos fumantes foram obtidas pelo método indireto de estimação em pequenas áreas. Para o cálculo das razões de prevalências, empregram-se modelos de Poisson. Resultados: A associação positiva entre a prevalência e a privação das categorias de setores censitários foi encontrada em 16 (59,3%) das 27 cidades. Em nove (33,3%) cidades, os setores de maior privação apresentaram maior prevalência de fumantes quando comparados aos de menor privação e, em duas (7,4%), não apresentaram diferenças. Em Aracaju, Belém, Fortaleza, João Pessoa, Macapá e Salvador, as prevalências de adultos fumantes foram três vezes maiores no grupo de setores com maior privação em relação aos de menor privação. Conclusão: Setores de maior privação social apresentaram maiores prevalências de tabagismo, comparados com menor privação, apontando desigualdades sociais.

Premature mortality due to noncommunicable diseases in Brazilian capitals: redistribution of garbage causes and evolution by social deprivation strata / Mortalidade prematura por doenças crônicas não transmissíveis em capitais brasileiras: redistribuição de causas garbage e evolução por estratos de privação social

ABSTRACT Objective: To analyze premature mortality due to noncommunicable chronic diseases (NCDs) in Brazilian capitals and the Federal District (DF) after redistribution of garbage causes and the temporal evolution according to social deprivation strata in the 2010 to 2012 and 2017 to 2019 triennia. Methods: Corrections were applied to the Mortality Information System (Sistema de Informação sobre Mortalidade - SIM) data such as the redistribution of garbage codes (GC). Premature mortality rates due to NCDs were calculated and standardized by age. The differences among NCDs mortality rates were analyzed according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP) categories and between the three-year periods. Results: In the capitals as a whole, rates increased between 8 and 12% after GC redistribution and the greatest increases occurred in areas of high deprivation: 11.9 and 11.4%, triennia 1 and 2, respectively. There was variability between the capitals. There was a reduction in rates in all strata of deprivation between the three-year periods, with the greatest decrease in the stratum of low deprivation (-18.2%) and the lowest in the stratum of high deprivation (-7.5%). Conclusion: The redistribution of GC represented an increase in mortality rates, being higher in the strata of greater social deprivation. As a rule, a positive gradient of mortality was observed with increasing social deprivation. The analysis of the temporal evolution showed a decrease in mortality from NCDs between the triennia, especially in areas of lower social deprivation.

RESUMO Objetivo: Analisar a mortalidade prematura por doenças crônicas não transmissíveis (DCNT) nas capitais brasileiras e Distrito Federal (DF) após redistribuição das causas garbage, e a evolução temporal segundo estratos de privação social nos triênios 2010 a 2012 e 2017 a 2019. Métodos: Foram aplicadas correções ao Sistema de Informação sobre Mortalidade (SIM), sendo empregada metodologia para redistribuição das causas garbage (CG). As taxas de mortalidade prematura por DCNT padronizadas por idade foram estimadas. Foram analisadas as diferenças entre as taxas de mortalidade por DCNT segundo categorias do Índice Brasileiro de Privação (IBP) e entre os triênios. Resultados: No conjunto das capitais, as taxas aumentaram entre 8 e 12% após a redistribuição de CG, e os maiores acréscimos ocorreram em áreas de alta privação: 11,9 e 11,4%, triênios 1 e 2, respectivamente. Houve variabilidade entre as capitais. Observou-se redução das taxas em todos os estratos de privação entre os triênios, sendo maior decréscimo no estrato de baixa privação (-18,2%), e menor no estrato de alta privação (-7,5%). Conclusão: A redistribuição de CG representou aumento das taxas de mortalidade, sendo maior nos estratos de maior privação social. Via de regra, observou-se gradiente positivo de mortalidade com o aumento da privação social. A análise da evolução temporal evidenciou decréscimo da mortalidade por DCNT entre os triênios, sobretudo em áreas de menor privação social.

Effectiveness of Telemedicine in Reducing Hospitalizations in Patients Discharged from the Hospital Due to Heart Failure: A Randomized Clinical Trial Protocol

Abstract Fundament: Telemedicine for follow-up in heart failure (HF) patients is effective in reducing hospitalizations, total and cardiovascular mortality. However, few studies were conducted in low and middle income, where lower access to technology and illiteracy could impact the results. Objective: To assess the effectiveness of associating telemedicine strategies, when compared to usual care, in reducing hospitalizations related to HF in patients discharged from the hospital due to HF. Methods: Controlled, randomized, multicenter, parallel-arm clinical trial, with an allocation ratio of 1:1, blinded to outcome evaluation, in which 340 patients who were discharged from public hospitals in Belo Horizonte due to HF will be randomized. Patients will be followed for 6 months and the intervention group will receive, in addition to the usual care, Structured Telephone Support (STS) from a nurse, a doctor, and an educational program. Counseling will be according to a clinical decision tree. The level of significance in the statistical analysis will be 5%. Expected results: Reduction in the number of hospital readmissions and/or in hospitalization time, in addition to developing a software with a clinical decision tree for remote follow-up and patient education about HF adapted to local culture. Conclusions: The intention of this study is to develop a telemedicine strategy and assess whether or not, in addition to the usual care, it is effective in reducing hospitalizations and mortality from HF. If effective, the aforementioned strategy could reduce costs and hospital needs in the Unified Health System (SUS, in Portuguese) for patients with HF. These results will be even more relevant considering the pandemic of COVID-19.

Impact of the COVID-19 pandemic on hospital admissions for cardiovascular diseases in a large Brazilian urban center

Abstract INTRODUCTION: The COVID-19 pandemic has had a great impact on the behavior of individuals and the organization of health systems. This study analyzed the COVID-19 pandemic's effect on public hospitalizations for cardiovascular diseases (CVD) in a large city in Brazil, Belo Horizonte, MG, with approximately 2.5 million inhabitants. METHODS: In a time-series analysis, this study used administrative data from the national "Hospital Information System" from 2010 to February 2020 to estimate the expected number of hospitalizations for CVD by month during the COVID-19 pandemic in Belo Horizonte in 2020 using the Auto-Regressive Integrated Moving Average model. For CVD, this study compared the expected number of hospital admissions, intensive care use, deaths during hospitalization, and mean length of stay with the observed number during the period. RESULTS: There were 6,517 hospitalizations for CVD from March to December 2020, a decrease of 16.3% (95% CI: 4.7-25.3) compared to the projected. The number of intensive care hospitalizations for CVD fell 24.1% (95% CI 13-32.7). The number of deaths also decreased (17.4% [80% CI: 0 - 0.30]), along with the reduction in hospitalizations, as did the length of stay for CVD hospitalizations. These reductions, however, were not significant. CONCLUSIONS: Hospitalizations for CVD were 16.3% lower than expected in a large Brazilian city, possibly due to the fear of getting infected or going to hospitals. Public campaigns informing how to proceed in case of CVD show that prompt urgent attention is essential to mitigate the indirect effects of the pandemic on CVD.

Excess Mortality due to natural causes among whites and blacks during the COVID-19 pandemic in Brazil

Abstract INTRODUCTION: Excess Mortality by all causes considers deaths directly related to COVID-19 and those attributed to conditions caused by the pandemic. When stratified by social dimensions, such as race/color, it allows for the evaluation of more vulnerable populations. The study estimated the excess mortality by natural causes, separating the white and black populations in 2020. METHODS Public civil registration data on deaths observed in 2020, corrected for under registration, were used. The expected number of deaths was estimated based on the mortality rates observed in 2019, applied to the estimated population in 2020. The difference between the values expected and observed and the proportion of excess was considered the excess mortality. RESULTS: The present study found an excess of 270,321 deaths (22.2% above the expected) in 2020. Every state of Brazil reported deaths above the corresponding expected figure. The excess was higher for men (25.2%) than for women (19.0%). Blacks showed an excess of 27.8%, as compared to whites at 17.6%. In both sexes and all age groups, excess was higher in the black population, especially in the South, Southeast, and Midwest regions. São Paulo, the largest in population number, had twice as much excess death in the black population (25.1%) than in the white population (11.5%). CONCLUSIONS: The present study showed racial disparities in excess mortality during the COVID-19 pandemic in Brazil. The higher excess found for the black suggests an intrinsic relationship with the socioeconomic situation, further exposing the Brazilian reality, in which social and structural inequality is evident.

Maternal Mortality in Brazil, 1990 to 2019: a systematic analysis of the Global Burden of Disease Study 2019

Abstract INTRODUCTION Maternal death continues to be one of the most challenging public health problems that needs to be addressed in low and middle-income countries. The objective of this study was to describe the problem of maternal death in Brazil, using estimates from the Global Burden of Disease Study (GBD). METHODS This study used data from the GBD 2019 to show the numbers of deaths and the Maternal Mortality Ratio (MMR) - number of deaths/100,000 live births - in Brazil and its 27 Federated Units (FU), for ages 10 to 54 years, from 1990 to 2019. The annual variation of the MMR was estimated in 1990, 2010, and 2019. The MMR were shown for specific causes as well as for five-year age groups. The estimates were presented with 95% uncertainty intervals (UI). RESULTS The number of maternal deaths, as well as the MMR showed a 49% reduction from 1990 to 2019. This reduction occurred heterogeneously throughout the country, and the profile of the MMR for specific causes changed between 1990 and 2019: from hypertensive gestation diseases, to indirect maternal deaths, followed by hypertensive gestation diseases. In the extreme age groups, the MMR is higher, with mortality increasing exponentially in direct proportion with age. CONCLUSIONS Maternal deaths in Brazil have decreased substantially since 1990; however, the numbers still fall short of what was established by the World Health Organization (WHO). Indirect causes are the greatest problem in more than 60% of the FU, especially for hypertensive pregnancy diseases.

Mortalidade de adolescentes e adultos jovens brasileiros entre 1990 e 2019: uma análise do estudo Carga Global de Doença / Mortality among Brazilian adolescents and young adults between 1990 to 2019: an analysis of the Global Burden of Disease study

Resumo Trata-se de análise de indicadores de mortalidade de brasileiros com idades entre 10 e 24 anos. Foram analisados os dados do Global Burden of Disease (GBD) 2019, utilizando números absolutos, proporção de óbitos e taxas de mortalidade específicas entre 1990 e 2019, segundo faixa etária (10 a 14, 15 a 19 e 20 a 24 anos), sexo e causas de morte para Brasil, regiões e estados brasileiros. Houve redução de 11,8% nas taxas de mortalidade de indivíduos com idades entre 10 e 24 anos no período investigado. Em 2019, ocorreram 13.459 mortes entre mulheres, correspondendo à redução de 30,8% no período. Entre homens ocorreram 39.362 óbitos, redução de apenas 6,2%. Houve aumento das taxas de mortalidade no Norte e Nordeste e redução em estados do Sudeste e Sul. Em 2019, entre mulheres a primeira causa de morte foram lesões por transporte, seguidas por violência interpessoal, mortes maternas e suicídio. Para os homens, a violência interpessoal foi a primeira causa de morte, em especial no Nordeste, seguida das lesões por transporte, do suicídio e dos afogamentos. Execuções policiais passaram do 77º para o 6º lugar. Este estudo revelou desigualdades na mortalidade de adolescentes e adultos jovens segundo sexo, causas de óbito, regiões e estados brasileiros.

Abstract Mortality indicators for Brazilians aged between 10 and 24 years old were analyzed. Data were obtained from the Global Burden of Disease (GBD) 2019 Study, and absolute numbers, proportion of deaths and specific mortality rates from 1990 to 2019 were analyzed, according to age group (10 to 14, 15 to 19 and 20 to 24 years), sex and causes of death for Brazil, regions and Brazilian states. There was a reduction of 11.8% in the mortality rates of individuals aged between 10 and 24 years in the investigated period. In 2019, there were 13,459 deaths among women, corresponding to a reduction of 30.8% in the period. Among men there were 39,362 deaths, a reduction of only 6.2%. There was an increase in mortality rates in the North and Northeast and a reduction in the Southeast and South states. In 2019, the leading cause of death among women was traffic injuries, followed by interpersonal violence, maternal deaths and suicide. For men, interpersonal violence was the leading cause of death, especially in the Northeast, followed by traffic injuries, suicide and drowning. Police executions moved from 77th to 6th place. This study revealed inequalities in the mortality of adolescents and young adults according to sex, causes of death, regions and Brazilian states.

Cardiovascular Risk Estimates in Ten Years in the Brazilian Population, a Population-Based Study. / Estimativas do Risco Cardiovascular em Dez Anos na População Brasileira: Um Estudo de Base Populacional.

BACKGROUND: Cardiovascular diseases are the leading cause of morbidity and mortality, resulting in high health costs and significant economic losses. The Framingham score has been widely used to stratify the cardiovascular risk of the individuals, identifying those at higher risk for the implementation of prevention measures directed to this group. OBJECTIVE: To estimate cardiovascular risk at 10 years in the adult Brazilian population. METHODS: Cross-sectional study using laboratory data from a subsample of the National Health Survey. To calculate cardiovascular risk, the Framingham score stratified by sex was used. RESULTS: Most women (58.4%) had low cardiovascular risk, 32.9% had medium risk and 8.7% had high risk. Among men, 36.5% had low cardiovascular risk, 41.9% had medium risk and 21.6% had high risk. The risk increased with age and was high in the low-educated population. The proportion of the components of the Framingham model, by risk and sex, shows that, among women at high risk, the indicators that mostly contributed to cardiovascular risk were: systolic blood pressure, total cholesterol, HDL, diabetes and tobacco. Among men, systolic blood pressure, total cholesterol, HDL, tobacco and diabetes. CONCLUSION: The study estimates, for the first time in Brazil, the risk of developing cardiovascular disease in ten years. The risk score is useful to support the prevention practices of these diseases, considering the clinical and epidemiological context.

FUNDAMENTO: As doenças cardiovasculares são a principal causa de morbimortalidade, altos custos com saúde e perdas econômicas importantes. O escore de Framingham tem sido amplamente utilizado para estratificar o risco dos indivíduos avaliados, identificando aqueles com risco maior para que sejam implementadas medidas de prevenção direcionadas para esse grupo. OBJETIVOS: Estimar o risco cardiovascular em 10 anos da população brasileira adulta. MÉTODOS: Estudo transversal, utilizando dados laboratoriais de uma subamostra da Pesquisa Nacional de Saúde. Para calcular o risco cardiovascular, utilizou-se o escore de Framingham, estratificado por sexo. RESULTADOS: A maioria das mulheres (58,4%) apresentou baixo risco cardiovascular, 32,9%, risco médio e 8,7%, risco elevado. Entre homens, 36,5% apresentaram risco cardiovascular baixo, 41,9%, risco médio e 21,6%, risco elevado. O risco aumentou com a idade e foi elevado na população com baixa escolaridade. A proporção dos componentes do modelo de Framingham, por grupos de risco e sexo, mostra que, no risco elevado entre mulheres, os indicadores que mais contribuíram para o risco cardiovascular foram: a pressão arterial sistólica, colesterol total, HDL, diabetes e tabagismo. Entre homens, pressão arterial sistólica, colesterol total, HDL, tabagismo e diabetes. CONCLUSÕES: Trata-se do primeiro estudo nacional com dados laboratoriais a estimar o risco de doença cardiovascular em dez anos. Os escores de risco são úteis para subsidiar as práticas de prevenção dessas doenças, considerando o contexto clínico e epidemiológico.

Monitoring and projection of targets for risk and protection factors for coping with noncommunicable diseases in Brazilian capitals. / Monitoramento e projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras.

This study aimed to monitor the trends and projections of targets of risk and protection factors for coping with noncommunicable diseases in Brazilian capitals and verify whether the economic crisis and austerity policies have interfered with these targets' behavior. This is a time-series study with data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey. We analyzed the trends in the prevalence of tobacco use, obesity, physical activity, consumption of fruits and vegetables, and alcohol abuse, and their projections until 2025. The Prais-Winsten regression was employed. We adopted the Interrupted Time-Series, considering the 2006-2014 and 2015-2019 periods. A reduction in tobacco use, increase in obesity, consumption of fruits and vegetables, physical activity, and alcohol use was observed between 2006 and 2014. Most indicators have shown worse performance since 2015. Projections foresee that targets for curbing obesity and alcohol abuse will not be achieved. Some changes were identified in the indicators profiles, reinforcing the importance of the continuous monitoring and sustainability of actions, policies, and programs to promote health and control these diseases and their risk factors.

Monitorar as tendências e as projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras e verificar se a crise econômica e as políticas de austeridade interferiram no comportamento dessas metas. Estudo de série temporal com dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. Foram analisadas as tendências das prevalências de fumantes, obesidade, prática de atividade física, consumo de frutas e hortaliças e de bebidas alcoólicas, e suas projeções até 2025. Empregou-se a regressão de Prais-Winsten. Utilizou-se a Série Temporal Interrompida de 2006 a 2014 e 2015 a 2019. Entre 2006 e 2014, houve redução de fumantes e aumento da obesidade, do consumo de frutas e hortaliças, de atividade física e do uso de álcool. A maioria dos indicadores demonstrou pior desempenho a partir de 2015. Pelas projeções, as metas de deter a obesidade e reduzir o uso de álcool não seriam atingidas. Houve mudanças no comportamento dos indicadores, o que reforça a importância do monitoramento contínuo, e da sustentabilidade das ações, políticas e programas de promoção a saúde e de controle dessas doenças e seus fatores de risco.

Premature mortality due to non-communicable diseases in Brazilian municipalities estimated for the three-year periods of 2010 to 2012 and 2015 to 2017.

OBJECTIVE: To estimate premature mortality due to noncommunicable diseases (NCDs) in Brazilian municipalities. METHODS: This ecological study estimated premature mortality rates due to cardiovascular diseases, chronic respiratory diseases, cancer and diabetes in Brazilian municipalities, for the three-year periods of 2010 to 2012 and 2015 to 2017, and it analyzed the spatial and temporal distribution of these rates. Data treatment combined proportional redistribution of the missing data and ill-defined causes, and the application of coefficients for under-registration correction. The local empirical Bayesian estimator was used to calculate municipal mortality rates. RESULTS: Rates for the set of chronic diseases decreased in Brazil between the three-year periods. The mean rates for total NCDs declined in the South, Southeast and Central-West regions, remained stable in the North and increased in the Northeast. Mortality rates due to cardiovascular diseases were the highest in all regions but showed the greatest declines between the periods. Cancers were the second leading cause of death. The North and Northeast regions stood out as having increased mean rates of cancer between the periods analyzed and showing the highest mean premature mortality rates due to diabetes in the 2015 to 2017 period. CONCLUSION: Spatial and temporal distribution of premature mortality rates due to NCDs differed between Brazilian municipalities and regions in the three-year periods evaluated. The South and Southeast had decreased rates of deaths due to cardiovascular and chronic respiratory diseases, as well as diabetes. The North and Northeast had increased rates of deaths due to cancer. There was an increase in the rate of deaths due to diabetes in the Central-West.

Methodological proposal for the redistribution of deaths due to garbage codes in mortality estimates for Noncommunicable Chronic Diseases.

OBJECTIVE: To propose a method for improving mortality estimates from noncommunicable diseases (NCD), including the redistribution of garbage codes in Brazilian municipalities. METHODS: Brazilian Mortality Information System (MIS) was used as a data source to estimate age standardized mortality rates, before and after correction, for NCD (cardiovascular, chronic respiratory, diabetes, and neoplasms). The treatment for the correction of data addressed missing data, under-registration, and redistribution of garbage codes (GCs). Three-year periods 2010-2012 and 2015-2017, and the Bayesian method were used to estimate mortality rates, reducing the effect of fluctuation caused by small numbers at the municipal level. RESULTS: GCs redistribution step showed greater weight in corrections, about 40% in 2000 and roughly 20% as from 2007, with stabilization starting in this year. Throughout the historical series, the quality of information on causes of death has improved in Brazil, with heterogeneous results being observed among municipalities. CONCLUSION: Methodological studies that propose correction and improvement of the MIS are essential for monitoring mortality rates due to NCD at regional levels. The methodological proposal applied, for the first time in real data from Brazilian municipalities, is challenging and deserves further improvements. Improving the quality of the data is essential in order to build more accurate estimates based on the raw data from the SIM.

Monitoramento e projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras / Monitoring and projection of targets for risk and protection factors for coping with noncommunicable diseases in Brazilian capitals

Resumo Monitorar as tendências e as projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras e verificar se a crise econômica e as políticas de austeridade interferiram no comportamento dessas metas. Estudo de série temporal com dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico. Foram analisadas as tendências das prevalências de fumantes, obesidade, prática de atividade física, consumo de frutas e hortaliças e de bebidas alcoólicas, e suas projeções até 2025. Empregou-se a regressão de Prais-Winsten. Utilizou-se a Série Temporal Interrompida de 2006 a 2014 e 2015 a 2019. Entre 2006 e 2014, houve redução de fumantes e aumento da obesidade, do consumo de frutas e hortaliças, de atividade física e do uso de álcool. A maioria dos indicadores demonstrou pior desempenho a partir de 2015. Pelas projeções, as metas de deter a obesidade e reduzir o uso de álcool não seriam atingidas. Houve mudanças no comportamento dos indicadores, o que reforça a importância do monitoramento contínuo, e da sustentabilidade das ações, políticas e programas de promoção a saúde e de controle dessas doenças e seus fatores de risco.

Abstract This study aimed to monitor the trends and projections of targets of risk and protection factors for coping with noncommunicable diseases in Brazilian capitals and verify whether the economic crisis and austerity policies have interfered with these targets' behavior. This is a time-series study with data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey. We analyzed the trends in the prevalence of tobacco use, obesity, physical activity, consumption of fruits and vegetables, and alcohol abuse, and their projections until 2025. The Prais-Winsten regression was employed. We adopted the Interrupted Time-Series, considering the 2006-2014 and 2015-2019 periods. A reduction in tobacco use, increase in obesity, consumption of fruits and vegetables, physical activity, and alcohol use was observed between 2006 and 2014. Most indicators have shown worse performance since 2015. Projections foresee that targets for curbing obesity and alcohol abuse will not be achieved. Some changes were identified in the indicators profiles, reinforcing the importance of the continuous monitoring and sustainability of actions, policies, and programs to promote health and control these diseases and their risk factors.

Estimativas do Risco Cardiovascular em Dez Anos na População Brasileira: Um Estudo de Base Populacional / Cardiovascular Risk Estimates in Ten Years in the Brazilian Population, a Population-Based Study

Resumo Fundamento: As doenças cardiovasculares são a principal causa de morbimortalidade, altos custos com saúde e perdas econômicas importantes. O escore de Framingham tem sido amplamente utilizado para estratificar o risco dos indivíduos avaliados, identificando aqueles com risco maior para que sejam implementadas medidas de prevenção direcionadas para esse grupo. Objetivos: Estimar o risco cardiovascular em 10 anos da população brasileira adulta. Métodos: Estudo transversal, utilizando dados laboratoriais de uma subamostra da Pesquisa Nacional de Saúde. Para calcular o risco cardiovascular, utilizou-se o escore de Framingham, estratificado por sexo. Resultados: A maioria das mulheres (58,4%) apresentou baixo risco cardiovascular, 32,9%, risco médio e 8,7%, risco elevado. Entre homens, 36,5% apresentaram risco cardiovascular baixo, 41,9%, risco médio e 21,6%, risco elevado. O risco aumentou com a idade e foi elevado na população com baixa escolaridade. A proporção dos componentes do modelo de Framingham, por grupos de risco e sexo, mostra que, no risco elevado entre mulheres, os indicadores que mais contribuíram para o risco cardiovascular foram: a pressão arterial sistólica, colesterol total, HDL, diabetes e tabagismo. Entre homens, pressão arterial sistólica, colesterol total, HDL, tabagismo e diabetes. Conclusões: Trata-se do primeiro estudo nacional com dados laboratoriais a estimar o risco de doença cardiovascular em dez anos. Os escores de risco são úteis para subsidiar as práticas de prevenção dessas doenças, considerando o contexto clínico e epidemiológico.

Abstract Background: Cardiovascular diseases are the leading cause of morbidity and mortality, resulting in high health costs and significant economic losses. The Framingham score has been widely used to stratify the cardiovascular risk of the individuals, identifying those at higher risk for the implementation of prevention measures directed to this group. Objective: To estimate cardiovascular risk at 10 years in the adult Brazilian population. Methods: Cross-sectional study using laboratory data from a subsample of the National Health Survey. To calculate cardiovascular risk, the Framingham score stratified by sex was used. Results: Most women (58.4%) had low cardiovascular risk, 32.9% had medium risk and 8.7% had high risk. Among men, 36.5% had low cardiovascular risk, 41.9% had medium risk and 21.6% had high risk. The risk increased with age and was high in the low-educated population. The proportion of the components of the Framingham model, by risk and sex, shows that, among women at high risk, the indicators that mostly contributed to cardiovascular risk were: systolic blood pressure, total cholesterol, HDL, diabetes and tobacco. Among men, systolic blood pressure, total cholesterol, HDL, tobacco and diabetes. Conclusion: The study estimates, for the first time in Brazil, the risk of developing cardiovascular disease in ten years. The risk score is useful to support the prevention practices of these diseases, considering the clinical and epidemiological context.

Estimates of hypertension and diabetes mellitus prevalence according to Health Vulnerability Index in Belo Horizonte, MG, Brazil / Estimativas de prevalência de hipertensão e diabetes mellitus segundo índice de vulnerabilidade da saúde em Belo Horizonte, MG, Brasil

ABSTRACT: Objective: To estimate the prevalences of hypertension and diabetes for small areas in Belo Horizonte, according to the Health Vulnerability Index (HVI). Methods: Ecological study with data from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) conducted in Belo Horizonte, from 2006 to 2013. The self-reported diagnosis of diabetes and hypertension were evaluated. The estimates of prevalence and the 95% confidence interval (95%CI) were calculated using the direct and indirect method by HVI grouped into four categories: low, medium, high and very high health risk. Results: During the period evaluated, 26% (95%CI 25.2 - 26.8) and 6.1% (95%CI 6.7 - 6.5) of the adult population from Belo Horizonte reported being hypertensive and diabetic, respectively. According to the indirect method to obtain estimates of hypertension and diabetes prevalences per HVI, it was found that areas of very high risk had a higher prevalence of adults with hypertension (38.6%; 95%CI 34.8 - 42.4) and diabetes (16.2%; 95%CI 13.1 - 19.3) when compared to the low risk (28.2%; 95%CI 27.0 - 29.4 and 6%; 95%CI 5.4 - 6.7, respectively). Conclusion: The adult population living in areas at high risk for health had a higher prevalence of hypertension and diabetes compared to those with a lower risk.

RESUMO: Objetivo: Estimar as prevalências de hipertensão e diabetes para pequenas áreas em Belo Horizonte, MG, segundo o índice de vulnerabilidade da saúde (IVS). Métodos: Estudo ecológico com dados do sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico realizado em Belo Horizonte, nos anos de 2006 a 2013. Foi avaliado o diagnóstico autorreferido de diabetes e de hipertensão. As estimativas de prevalência e o intervalo de 95% de confiança (IC95%) foram calculados, segundo IVS, usando os métodos de estimação direto e indireto para pequenas áreas. Resultados: Durante o período avaliado, 26 (IC95% 25,2 - 26,8) e 6,1% (IC95% 6,7 - 6,5) da população adulta de Belo Horizonte reportaram ser hipertensos e diabéticos, respectivamente. Segundo o método indireto para obtenção das estimativas de hipertensão e diabetes por IVS, verificou-se que as áreas de risco muito elevado apresentaram maior prevalência de adultos com hipertensão (38,6%; IC95% 34,8 - 42,4) e diabetes (16,2%; IC95% 13,1 - 19,3) quando comparadas com as de baixo risco (28,2%; IC95% 27,0 - 29,4) e (6%; IC95% 5,4 - 6,7), respectivamente. Conclusão: A população de adultos residentes em áreas com risco elevado à saúde apresentou maiores prevalências de hipertensão e diabetes em comparação àquelas com menor risco.

Relationship between GDP per capita and traffic accidents in Brazilian municipalities in 2005, 2010 and 2015 / A relação entre PIB per capita e os acidentes de transporte nos municípios brasileiros, em 2005, 2010 e 2015

ABSTRACT: Objective: The main objective of this paper was to analyze the relation between GDP and three variables linked to traffic accidents in Brazilian municipalities: traffic accident mortality, deaths per vehicle; and vehicles per inhabitant. Methods: 2005, 2010 and 2015 traffic accident (TA) mortality rates were estimated using a three-year moving average and were standardized; then, we applied the empirical Bayes estimator (EBE). Fatality rates (deaths per vehicle) were also based on EBE. The variable vehicles per inhabitant considered the ratio between the fleet and the population at municipal level. For every studied year, we estimated linear regression models between GDP and the interest variables. Results: The variables distribution indicates that, between 2005 and 2015, GDP and vehicles per inhabitant kept the same rising relationship. Fatality rates show a decreasing association with GDP. The distribution of mortality by TA had an inverted U-shaped pattern. The model coefficients practically did not change for the vehicle per inhabitant. Estimated association between deaths per vehicle and GDP kept the same sign, but diminished between 2005 and 2015. Model coefficient sign changed in 2015 for TA mortality. Conclusion: Similar to what was observed in developed countries, the relation between mortality by traffic accidents and GDP changed in the analyzed period.

RESUMO: Objetivo: O artigo pretende analisar a relação entre o produto interno bruto (PIB) per capita e três variáveis relacionadas aos acidentes de transporte (AT) nos municípios brasileiros: a mortalidade por AT, as mortes por veículo e o número de veículos por pessoa. Métodos: As taxas de mortalidade por AT foram estimadas (2005, 2010 e 2015) por meio do estimador bayesiano empírico (EBE). A taxa de mortalidade por veículo foi também estimada pelo EBE. O número de veículos por pessoa foi baseado na razão entre a frota de automóveis e a população residente. Para os três anos em análise, estimamos um modelo de regressão linear entre o PIB per capita municipal e as três variáveis de interesse. Resultados: A distribuição das variáveis mostra que a relação entre o PIB e o número de veículos por pessoa se manteve crescente ao longo dos anos e foi sempre negativa, considerando-se as mortes por veículo. A taxa de mortalidade por AT apresentou distribuição próxima a um U invertido. Os coeficientes do modelo de regressão praticamente não variaram para a relação entre PIB e os veículos por habitante. O sinal para o modelo com a taxa de mortalidade por veículo manteve-se o mesmo (negativo), mas apresentou diminuição. A taxa mortalidade por AT, por sua vez, apresentou inversão do sinal em 2015. Conclusão: De modo similar ao observado nos países desenvolvidos, parece ter havido inversão na relação entre mortalidade por AT e PIB nos municípios brasileiros entre 2005 e 2015.

Reduction in Hospital Admissions Associated with Coronary Events during the COVID-19 Pandemic in the Brazilian Private Health System: Data from the UNIMED-BH System

Abstract INTRODUCTION: We aimed to evaluate the impact of the new coronavirus disease 2019 on coronary hospitalizations in the Brazilian private health system. METHODS: Data on coronary admissions in 2020 and a 2-year historical series were collected from the UNIMED-BH insurance system. RESULTS: Admission rates in 2020 reduced by 26% (95%CI, 22-30) in comparison with 2018/2019, markedly from March to May (37%) compared to the peak of the pandemic (June-September, 19%). Mortality was higher in 2020 (5.4%, 95%CI 4.5-6.4) than in 2018/2019 (3.6%, 95%CI 3.2-4.1). CONCLUSIONS: There was a significant decrease in coronary admissions, with higher mortality during the COVID-19 pandemic.