Exposure to and Burden of Major Non-Communicable Disease Risk Factors in Brazil and its States, 1990-2019: The Global Burden of Disease Study.

INTRODUCTION: Non-Communicable Diseases (NCDs) have become the main cause of disease burden in Brazil. Our objective was to describe trends (1990 to 2019) in prevalence and attributable burden of five modifiable risk factors and related metabolic risk factors in Brazil and its states. METHODS: In Global Burden of Disease 2019 analyses, we described trends in prevalence of modifiable risk factors and their metabolic mediators as percentage change in Summary Exposure Value (SEV). We estimated deaths and disability-adjusted life years (DALYs) attributable to the risk factors. RESULTS: Age-adjusted exposures to alcohol [41.0%, Uncertainty Interval (UI): 24.2 - 63.4], red meat (61.2%, UI: 42.4-92.3), low physical activity (3.9%, UI: -5-17.5) and ambient particulate matter pollution (3.3%, UI: -48.9-128.0) have worsened. Those for smoking (-51.4%, UI: -54.7- - 47.8), diet low in fruits (-28.1%, UI: -39.1- -18.7) and vegetables (-19.6%, UI: -32.7 - -8.7), and household air pollution (-85.3%, UI: -92.9- -74.3) have improved. All mediating metabolic risk factors, except high blood pressure (0.7%, UI: -6.9-8.3), have worsened: BMI (110.2%, UI: 78.6-161.7), hyperglycemia (15.1%, UI: 9.3-21.2), kidney dysfunction (12.0%, UI: 8.4-17.2), and high LDL-c (11.8%, UI: 6.9-17.2). CONCLUSIONS: A variable pattern of progress and failure in controlling modifiable risk factors has been accompanied by major worsening in most metabolic risk factors. The mixed success in public health measures to control modifiable risk factors for NCDs, when gauged by the related trends in metabolic risk factors, alert to the need for stronger actions to control NCDs in the future.

Premature mortality due to four main non-communicable diseases and suicide in Brazil and its states from 1990 to 2019: A Global Burden of Disease Study.

INTRODUCTION: The goal of reducing the burden of non-communicable diseases (NCDs) requires close monitoring. Our objective is to characterize the decline of premature NCD mortality in Brazil based on Global Burden of Diseases (GBD) Study 2019 estimates. METHODS: We used GBD 2019 data to estimate death rates of the four main NCDs - cardiovascular diseases, neoplasms, diabetes, and chronic respiratory diseases. We estimated the unconditional probability of death between ages 30 to 69, as recommended by the World Health Organization, as well as premature crude- and age-standardized death rates and disability-adjusted life years (DALYs) lost for these conditions. We also estimated trends in suicide (self-harm) death rates. RESULTS: From 2010 to 2019, the age-standardized unconditional probability of premature death declined -1.4%/year (UI: -1.7%;-1.0%) . Age-standardized death rates declined -1.5%/year (UI: -1.9%; -1.2%), and crude death rates -0.6%/year (UI: (-1.0%; -0.2%). Level of development correlated strongly with the rate of decline, with greatest declines occurring in the Southeast, Center West and South regions. Age-standardized mortality from self-harm declined, most notably in the elderly. CONCLUSIONS: Premature mortality due to the main NCDs has declined from 1990 in Brazil, although at a diminishing rate over time. The unconditional probability of death and the age-standardized mortality rate produced similar estimates of decline for the four main NCDs, and mirror well decline in mortality from all NCDs. Declines, especially more recent ones, fall short of the international goals. Strategic public health actions are needed. The challenge to implement them will be great, considering the political and economic instability currently faced by Brazil.

Physical inactivity as a risk factor for all-cause mortality in Brazil (1990-2017).

BACKGROUND: The aim of this study was to estimate the mortality from all causes as a result of physical inactivity in Brazil and in Brazilian states over 28 years (1990-2017). METHODS: Data from the Global Burden of Disease (GBD) study for Brazil and states were used. The metrics used were the summary exposure value (SEV), the number of deaths, age-standardized mortality rates, and the fraction of population risk attributable to physical inactivity. RESULTS: The Brazilian population presented risk of exposure to physical inactivity of (age-standardized SEV) of 59% (95% U.I. 22-97) in 1990 and 59% in 2017 (95% U.I. 25-99). Physical inactivity contributed a significant number of deaths (1990, 22,537, 95% U.I. 12,157-34,745; 2017, 32,410, 95% U.I. 17,976-49,657) in the analyzed period. These values represented mortality rates standardized by age (per 100,000 inhabitants) of 31 (95% U.I. 17-48) in 1990 and 15 (95% U.I. 8-23) in 2017. From 1990 to 2017, a decrease in standardized death rate from all causes attributable to physical inactivity was observed in Brazil (- 52%, 95% U.I. - 54 to - 49). The Brazilian states with better socioeconomic conditions presented greater reductions in age-standardized mortality (male: rho = 0.80; female: rho 0.84) over the period of 28 years. CONCLUSIONS: These findings support the promotion of physical activity in the Brazilian population for the prevention of early mortality.

The burden of disease among Brazilian older adults and the challenge for health policies: results of the Global Burden of Disease Study 2017.

BACKGROUND: Brazil is the world's fifth most populous nation, and is currently experimenting a fast demographic aging process in a context of scarce resources and social inequalities. To understand the health profile of older adults in Brazil is fundamental for planning public policies. METHODS: The estimates were derived from data obtained through the collaboration between the Brazilian Ministry of Health and the Institute of Health Metrics and Evaluation of the University of Washington. The Brazilian Institute of Geography and Statistics provided the population estimates. Data on causes of death came from the Mortality Information System. To calculate morbidity, population-based studies on the prevalence of diseases in Brazil were comprehensively searched, in addition to information obtained from national databases such as the Hospital Information System, the Outpatient Information System, and the Injury Information System. We presented the Global Burden of Disease (GBD) 2017 estimates among Brazilian older adults (60+ years old) for life expectancy at birth (LE), healthy life expectancy (HALE), cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), from 2000 to 2017. RESULTS: LE at birth significantly increased from 71.3 years (95% UI to 70.9-71.8) to 75.2 years (95% UI 74.7-75.7). There was a trend of increasing HALE, from 62.2 years (95% UI 59.54-64.5) to 65.5 years (95% UI 62.6-68.0). The proportion of DALYs among older adults increased from 7.3 to 10.3%. Chronic noncommunicable diseases are the leading cause of death among middle aged and older adults, while Alzheimer's disease is a leading cause only among older adults. Mood disorders, musculoskeletal pain, and hearing or vision losses are among the leading causes of disability. CONCLUSIONS: The increase in LE and the decrease of the DALYs rates are probably results of the improvement of social conditions and health policies. However, the smaller increase of HALE than LE means that despite living more, people spend a substantial time of their old age with disability and illness. Preventable or potentially controllable diseases are responsible for most of the burden of disease among Brazilian older adults. Health investments are necessary to obtain longevity with quality of life in Brazil.

The burden of low back pain in Brazil: estimates from the Global Burden of Disease 2017 Study.

BACKGROUND: The prevalence and burden of musculoskeletal (MSK) conditions are growing around the world, and low back pain (LBP) is the most significant of the five defined MSK disorders in the Global Burden of Disease (GBD) study. LBP has been the leading cause of non-fatal health loss for the last three decades. The objective of this study is to describe the current status and trends of the burden due to LBP in Brazil based on information drawn from the GBD 2017 study. METHODS: We estimated prevalence and years lived with disability (YLDs) for LBP by Brazilian federative units, sex, age group, and age-standardized between 1990 and 2017 and conducted a decomposition analysis of changes in age- and sex-specific YLD rates attributable to total population growth and population ageing for the purpose of understanding the drivers of changes in LBP YLDs rates in Brazil. Furthermore, we analyzed the changes in disability-adjusted life years (DALYs) rankings for this disease over the period. RESULTS: The results show high prevalence and burden of LBP in Brazil. LBP prevalence increased 26.83% (95% UI 23.08 to 30.41) from 1990 to 2017. This MSK condition represents the most important cause of YLDs in Brazil, where the increase in burden is mainly related to increase in population size and ageing. The LBP age-standardized YLDs rate are similar among Brazilian federative units. LBP ranks in the top three causes of DALYs in Brazil, even though it does not contribute to mortality. CONCLUSIONS: Findings from this study show LBP to be the most important cause of YLDs and the 3rd leading cause of DALYs in Brazil. The Brazilian population is ageing, and the country has been experiencing a rapid epidemiological transition, which generates an increasing number of people who need chronic care. In this scenario, more attention should be paid to the burden of non-fatal health conditions.

The burden of diabetes and hyperglycemia in Brazil: a global burden of disease study 2017.

BACKGROUND: The Global Burden of Diseases (GBD) 2017 database permits an up-to-date evaluation of the frequency and burden of diabetes at the state level in Brazil and by type of diabetes. The objective of this report is to describe, using these updated GBD data, the current and projected future burden of diabetes and hyperglycemia in Brazil, as well as its variation over time and space. METHODS: We derived all estimates using the GBD 2016 and 2017 databases to characterize disease burden related to diabetes and hyperglycemia in Brazil, from 1990 to 2040, using standard GBD methodologies. RESULTS: The overall estimated prevalence of diabetes in Brazil in 2017 was 4.4% (95%UI 4.0-4.9%), with 4.0% of those with diabetes being identified as having type 1 disease. While the crude prevalence of type 1 disease has remained relatively stable from 1990, type 2 prevalence has increased 30% for males and 26% for females. In 2017, approximately 3.3% of all disability-adjusted life years lost were due to diabetes and 5.9% to hyperglycemia. Diabetes prevalence and mortality were highest in the Northeast region and growing fastest in the North, Northeast, and Center-West regions. Over this period, despite a slight decrease in age-standardized incidence of type 2 diabetes, crude overall burden due to hyperglycemia has increased 19%, with population aging being a main cause for this rise. Cardiovascular diseases, responsible for 38.3% of this burden in 1990, caused only 25.9% of it in 2017, with premature mortality attributed directly to diabetes causing 31.6% of the 2017 burden. Future projections suggest that the diabetes mortality burden will increase 144% by 2040, more than twice the expected increase in crude disease burden overall (54%). By 2040, diabetes is projected to be Brazil's third leading cause of death and hyperglycemia its third leading risk factor, in terms of deaths. CONCLUSIONS: The disease burden in Brazil attributable to diabetes and hyperglycemia, already large, is predicted by GBD estimates to more than double to 2040. Strong actions by the Ministry of Health are necessary to counterbalance the major deleterious effects of population aging.

Trends in mortality due to non-communicable diseases in the Brazilian adult population: national and subnational estimates and projections for 2030.

BACKGROUND: Monitoring and reducing premature mortality due to non-communicable diseases (NCDs) is a global priority of Agenda 2030. This study aimed to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and to project those for 2030 as well as the risk factors (RFs) attributed deaths according to estimates of the Global Burden of Disease Study. METHODS: We analyzed cardiovascular diseases, chronic respiratory diseases, neoplasms, and diabetes, and compared the mortality rates in 1990 and 2017 for all of Brazil and states. The study used the definition of premature mortality (30-69 years) that is used by the World Health Organization. The number of deaths, mortality rates, DALYs, and years of life lost (YLL) were used to compare 1990 and 2017. We analyzed the YLL for NCDs attributable to RFs. RESULTS: There was a reduction of 35.3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCDs in 2017. The DALY rate decreased by 33.6%, and the YLL rate decreased by 36.0%. There were reductions in NCDs rates in all 27 states. The main RFs related to premature deaths by NCDs in 2017 among women were high body mass index (BMI), dietary risks, high systolic blood pressure, and among men, dietary risks, high systolic blood pressure, tobacco, and high BMI. Trends in mortality rates due to NCDs declined during the study period; however, after 2015, the curve reversed, and rates fluctuated and tended to increase. CONCLUSION: Our findings highlighted a decline in premature mortality rates from NCDs nationwide and in all states. There was a greater reduction in deaths from cardiovascular diseases, followed by respiratory diseases, and we observed a minor reduction for those from diabetes and neoplasms. The observed fluctuations in mortality rates over the last 3 years indicate that if no further action is taken, we may not achieve the NCD Sustainable Development Goals. These findings draw attention to the consequences of austerity measures in a socially unequal setting with great regional disparities in which the majority of the population is dependent on state social policies.

The burden of non-communicable diseases attributable to high BMI in Brazil, 1990-2017: findings from the Global Burden of Disease Study.

BACKGROUND: The prevalence and burden of disease resulting from obesity have increased worldwide. In Brazil, more than half of the population is now overweight. However, the impact of this growing risk factor on disease burden remains inexact. Using the 2017 Global Burden of Disease (GBD) results, this study sought to estimate mortality and disability-adjusted life years (DALYs) lost to non-communicable diseases caused by high body mass index (BMI) in both sexes and across age categories. This study also aimed to describe the prevalence of overweight and obesity throughout the states of Brazil. METHODS: Age-standardized prevalence of overweight and obesity were estimated between 1990 and 2017. A comparative risk assessment was applied to estimate DALYs and deaths for non-communicable diseases and for all causes linked to high BMI. RESULTS: The prevalence of overweight and obesity increased during the period of analysis. Overall, age-standardized prevalence of obesity in Brazil was higher in females (29.8%) than in males (24.6%) in 2017; however, since 1990, males have presented greater rise in obesity (244.1%) than females (165.7%). Increases in prevalence burden were greatest in states from the North and Northeast regions of Brazil. Overall, burden due to high BMI also increased from 1990 to 2017. In 2017, high BMI was responsible for 12.3% (8.8-16.1%) of all deaths and 8.4% (6.3-10.7%) of total DALYs lost to non-communicable diseases, up from 7.2% (4.1-10.8%), and 4.6% (2.4-6.0%) in 1990, respectively. Change due to risk exposure is the leading contributor to the growth of BMI burden in Brazil. In 2017, high BMI was responsible for 165,954 deaths and 5,095,125 DALYs. Cardiovascular disease and diabetes have proven to be the most prevalent causes of deaths, along with DALYs caused by high BMI, regardless of sex or state. CONCLUSIONS: This study demonstrates increasing age-standardized prevalence of obesity in all Brazilian states. High BMI plays an important role in disease burdens in terms of cardiovascular diseases, diabetes, and all causes of mortality. Assessing levels and trends in exposures to high BMI and the resulting disease burden highlights the current priority for primary prevention and public health action initiatives focused on obesity.

Association between firearms and mortality in Brazil, 1990 to 2017: a global burden of disease Brazil study.

BACKGROUND: Brazil leads the world in number of firearm deaths and ranks sixth by country in rate of firearm deaths per 100,000 people. This study aims to analyze trends in and burden of mortality by firearms, according to age and sex, for Brazil, and the association between these deaths and indicators of possession and carrying of weapons using data from the global burden of diseases, injuries, and risk factors study (GBD) 2017. METHODS: We used GBD 2017 estimates of mortality due to physical violence and self-harm from firearms for Brazil to analyze the association between deaths by firearms and explanatory variables. RESULTS: Deaths from firearms increased in Brazil from 25,819 in 1990 to 48,493 in 2017. Firearm mortality rates were higher among men and in the 20-24 age group; the rate was 20 times higher than for women in the same age group. Homicide rates increased during the study period, while mortality rates for suicides and accidental deaths decreased. The group of Brazilian federation units with the highest firearm collection rate (median = 7.5) showed reductions in the rate of total violent deaths by firearms. In contrast, the group with the lowest firearm collection rate (median = 2.0) showed an increase in firearm deaths from 2000 to 2017. An increase in the rate of voluntary return of firearms was associated with a reduction in mortality rates of unintentional firearm deaths (r = -0.364, p < 0.001). An increase in socio-demographic index (SDI) was associated with a reduction in all firearm death rates (r = -0.266, p = 0.008). An increase in the composite index of firearms seized or collected was associated with a reduction in rates of deaths by firearm in the subgroup of females, children, and the elderly (r = -0.269, p = 0.005). CONCLUSIONS: There was a change in the trend of firearms deaths after the beginning of the collection of weapons in 2004. Federation units that collected more guns have reduced rates of violent firearm deaths.

Epidemiology and burden of chronic respiratory diseases in Brazil from 1990 to 2017: analysis for the Global Burden of Disease 2017 Study.

INTRODUCTION: In Brazil, little is known about the trends of chronic respiratory diseases, which was estimated as the third leading cause of deaths in 2017 worldwide. METHODS: We analyzed Global Burden of Disease (GBD) 2017 estimates for prevalence, incidence, mortality, disability-adjusted life years (DALY), a summary measure of years of life lost (YLLs) and years lived with disability (YLDs), and risk factors attributable to chronic respiratory diseases in Brazil from 1990 to 2017. RESULTS: The overall estimates have decreased for all ages and both sexes, and for age-standardized rates. For age-adjusted prevalence, there was a 21% reduction, and nearly 16% reduction for incidence. There was a 42% reduction in mortality for both sexes, though the rate of deaths for men was 30% greater than the rate in women. The increase in the number of DALY was essentially due to the population growth and population ageing. We observed a 34% increase in the absolute number of DALY in Brazil over the study period. The majority of the DALY rates were due to Chronic Obstructive Pulmonary Disease (COPD). For all ages and both sexes, smoking was the main attributable risk factor. CONCLUSION: In Brazil, although mortality, prevalence and incidence for chronic respiratory diseases have decreased over the years, attention should be taken to the DALYs increase. Smoking remained as the main risk factor, despite the significant decrease of tobacco use, reinforcing the need for maintenance of policies and programs directed at its cessation.

Epidemiology and burden of chronic respiratory diseases in Brazil from 1990 to 2017: analysis for the Global Burden of Disease 2017 Study / Epidemiologia e carga das doenças respiratórias crônicas no Brasil de 1990 a 2017: análise do Estudo Global Burden of Disease 2017

ABSTRACT: Introduction: In Brazil, little is known about the trends of chronic respiratory diseases, which was estimated as the third leading cause of deaths in 2017 worldwide. Methods: We analyzed Global Burden of Disease (GBD) 2017 estimates for prevalence, incidence, mortality, disability-adjusted life years (DALY), a summary measure of years of life lost (YLLs) and years lived with disability (YLDs), and risk factors attributable to chronic respiratory diseases in Brazil from 1990 to 2017. Results: The overall estimates have decreased for all ages and both sexes, and for age-standardized rates. For age-adjusted prevalence, there was a 21% reduction, and nearly 16% reduction for incidence. There was a 42% reduction in mortality for both sexes, though the rate of deaths for men was 30% greater than the rate in women. The increase in the number of DALY was essentially due to the population growth and population ageing. We observed a 34% increase in the absolute number of DALY in Brazil over the study period. The majority of the DALY rates were due to Chronic Obstructive Pulmonary Disease (COPD). For all ages and both sexes, smoking was the main attributable risk factor. Conclusion: In Brazil, although mortality, prevalence and incidence for chronic respiratory diseases have decreased over the years, attention should be taken to the DALYs increase. Smoking remained as the main risk factor, despite the significant decrease of tobacco use, reinforcing the need for maintenance of policies and programs directed at its cessation.

RESUMO: Introdução: No Brasil, pouco se sabe sobre as tendências das doenças respiratórias crônicas, que foram estimadas como a terceira principal causa de mortes em 2017 em todo o mundo. Métodos: Analisamos as estimativas do Global Burden of Disease (GBD) 2017 para prevalência, incidência, mortalidade, anos de vida ajustados por incapacidade (DALY), uma medida resumida de anos de vida perdidos (YLL) e anos vividos com deficiência (YLD), e fatores de risco atribuíveis a doenças respiratórias crônicas no Brasil, de 1990 a 2017. Resultados: As estimativas gerais diminuíram para todas as idades e ambos os sexos, assim como para as taxas padronizadas por idade. Para a prevalência ajustada pela idade, houve uma redução de 21% e, aproximadamente, 16% para a incidência. Houve uma redução de 42% na mortalidade para ambos os sexos, embora a taxa de mortes para homens tenha sido 30% maior do que a taxa para mulheres. O aumento no número de DALY deveu-se ao crescimento e envelhecimento da população. Observamos um aumento de 34% no número absoluto de DALYs no Brasil durante o período do estudo. A maioria das taxas de DALY foi devido a Doença Pulmonar Obstrutiva Crônica (DPOC). Para todas as idades e ambos os sexos, tabagismo foi o principal fator de risco atribuível. Conclusão: No Brasil, embora a mortalidade, a prevalência e a incidência de doenças respiratórias crônicas tenham diminuído ao longo dos anos, maior atenção deve ser dada ao aumento dos DALYs. O tabagismo permaneceu como principal fator de risco, apesar da redução significativa do seu uso, reforçando a necessidade de manutenção de políticas e programas direcionados à sua cessação.

The burden of diabetes and hyperglycemia in Brazil and its states: findings from the Global Burden of Disease Study 2015.

INTRODUCTION AND OBJECTIVE:: The global burden of disease (GBD) 2015 project, extends GBD analyses to include Brazilian federative units separately. We take advantage of GBD methodological advances to describe the current burden of diabetes and hyperglycemia in Brazil. METHODS:: Using standard GBD 2015 methods, we analyzed the burden of diabetes, chronic kidney disease due to diabetes and high fasting plasma glucose in Brazil and its states. RESULTS:: The age-standardized rate of disability-adjusted life years (DALYs) which was lost to high fasting plasma glucose, a category which encompasses burdens of diabetes and of lesser hyperglycemia, were 2448.85 (95% UI 2165.96-2778.69) /100000 for males, and 1863.90 (95% UI 1648.18-2123.47) /100000 for females in 2015. This rate was more than twice as great in states with highest burden, these being overwhelmingly in the northeast and north, compared with those with lowest rates. The rate of crude DALYs for high fasting plasma glucose, increased by 35% since 1990, while DALYs due to all non-communicable diseases increased only by 12.7%, and DALYs from all causes declined by 20.5%. DISCUSSION:: The worldwide pandemic of diabetes and hyperglycemia now causes a major and growing disease burden in Brazil, especially in states with greater poverty and a lesser educational level. CONCLUSION:: Diabetes and chronic kidney disease due to diabetes, as well as high fasting plasma glucose in general, currently constitute a major and growing public health problem in Brazil. Actions to date for their prevention and control have been slow considering the magnitude of this burden.

The burden of diabetes and hyperglycemia in Brazil and its states: findings from the Global Burden of Disease Study 2015 / A carga de doença devido ao diabetes e à hiperglicemia no Brasil e seus estados: achados do Global Burden of Disease Study 2015

ABSTRACT: Introduction and objective: The global burden of disease (GBD) 2015 project, extends GBD analyses to include Brazilian federative units separately. We take advantage of GBD methodological advances to describe the current burden of diabetes and hyperglycemia in Brazil. Methods: Using standard GBD 2015 methods, we analyzed the burden of diabetes, chronic kidney disease due to diabetes and high fasting plasma glucose in Brazil and its states. Results: The age-standardized rate of disability-adjusted life years (DALYs) which was lost to high fasting plasma glucose, a category which encompasses burdens of diabetes and of lesser hyperglycemia, were 2448.85 (95% UI 2165.96-2778.69) /100000 for males, and 1863.90 (95% UI 1648.18-2123.47) /100000 for females in 2015. This rate was more than twice as great in states with highest burden, these being overwhelmingly in the northeast and north, compared with those with lowest rates. The rate of crude DALYs for high fasting plasma glucose, increased by 35% since 1990, while DALYs due to all non-communicable diseases increased only by 12.7%, and DALYs from all causes declined by 20.5%. Discussion: The worldwide pandemic of diabetes and hyperglycemia now causes a major and growing disease burden in Brazil, especially in states with greater poverty and a lesser educational level. Conclusion: Diabetes and chronic kidney disease due to diabetes, as well as high fasting plasma glucose in general, currently constitute a major and growing public health problem in Brazil. Actions to date for their prevention and control have been slow considering the magnitude of this burden.

RESUMO: Introdução e objetivo: O projeto Global Burden of Disease (GBD) 2015 estendeu suas análises para incluir unidades federativas brasileiras de maneira separada. Aproveitamos os avanços metodológicos do GBD para descrever a carga atual de diabetes e hiperglicemia no Brasil. Métodos: Utilizando os métodos padrão GBD 2015, analisamos a carga de diabetes, de doença renal crônica por diabetes e de glicemia de jejum elevada no Brasil e seus estados. Resultados: A taxa padronizada por idade de anos de vida ajustados por morte ou incapacidade (DALYs) perdidos devido à glicemia de jejum elevadafoi de 2448,85 (95% IU 2165,96-2778,69)/100000 para homens e 1863,90 (95% IU 1648,18-2123,47)/100.000 para as mulheres em 2015. Esta taxa foi mais do que o dobro em estados com maior carga, quase sempre no Nordeste e Norte, em comparação com aqueles com as taxas mais baixas. A taxa bruta de DALYs devido à glicose de jejum elevada aumentou 35% desde 1990, enquanto que a dos DALYs devido a todas as doenças não transmissíveis aumentou apenas 12,7% e a taxa dos DALYs devido a todas as causas diminuiu 20,5%. Discussão: A pandemia mundial de diabetes e hiperglicemia atualmente causa uma grande e crescente carga de doenças no Brasil, especialmente em estados com maior pobreza e menor escolaridade. Conclusão: O diabetes e a doença renal crônica por diabetes, bem como a glicemia de jejum elevada constituem atualmente um grande e crescente problema de saúde pública no Brasil. As ações até o momento para sua prevenção e controle tem sido tímidas considerando a magnitude dessa carga.