Explaining the increase of incidence and mortality from cardiovascular disease in Indonesia: A global burden of disease study analysis (2000-2019).

BACKGROUND: In the last two decades, there has been a discernible shift in the distribution of mortality attributed to cardiovascular disease (CVD) between developing and developed nations; in developed nations, the percentage of deaths caused by CVD decreased from 48% in 1990 to 43% in 2010, while in developing nations, they increased from 18% to 25%. In Indonesia, CVD death has increased substantially and remained elevated in the last ten years. Current behavioral and metabolic risk factors, including hyperglycemia, obesity, dyslipidemia, hypertension, and smoking, enhance the risk of CVD mortality, according to several studies. AIMS: We undertook a study to determine whether the increase in mortality and incidence of CVD can be attributed to changes in the most common metabolic and behavioral risk factors from 2000 to 2019 across 34 Indonesian provinces. MATERIALS AND METHODS: Data from 34 province for CVD incidence and mortality and data on changes in metabolic and behavioural risk factors between 2000 and 2019 in Indonesia were obtained from the Global Burden study (GBD) by The Institute of Health Metrics and Evaluation (IHME). A statistical model was applied to calculate the fatalities attributable to the risk factors change using Population attributable fractions (PAF) and baseline year death numbers. Furthermore, we ran multivariate regressions on Summary Exposure Value of risk factors associated with the increasing mortality, incidence rates in a lag year analysis. R software used to measure heteroscedasticity-consistent standard errors with coeftest and coefci. Covariates were added to adjusted models, including the Socio-demographic Index, Primary health care facilities coverage, and GDP per capita. RESULTS: The age-standardized mortality rate for CVD from 2000 to 2019 in Indonesia, increased from 356.05 to 412.46 deaths per 100,000 population among men and decreased from 357.52 to 354.07 deaths per 100,000 population among women, resulting in an increase of 270.928 per 100,0000 inhabitants of CVD deaths. In the same period, there was an increase in exposure to risk factors such as obesity by +9%, smoking by +1%, dyslipidemia by +1.3%, hyperglycemia by +2%, and hypertension by +1.2%. During this time span, an additional 14,517 men and 17,917 women died from CVD, which was attributable to higher obesity exposure. We apply multivariate regression with province-fixed and year-fixed analysis and find strong correlation between hyperglycemia in women (6; 95%CI 0 to 12, death per 1-point increase in hyperglycemia exposure) with an increasing death rate in ischemic heart disease. We also performed a year lag analysis and discovered a robust association between high low density lipoprotein (LDL) levels in men and women and the growing incidence of ischemic heart disease. The association between a 10-year lag of high LDL and the incidence of ischemic heart disease was five times stronger than that observed for other risk factors, particularly in men (5; 95%CI 2 to 8, incidence per 1-point increase in high LDL exposure). CONCLUSION: Hyperglycemia in women is an important risk factor associated with increasing mortality due to Ischemic Heart Disease (IHD) in Indonesia This study also revealed that the presence of high LDL in both men and women were associated with an increase incidence of IHD that manifested several years subsequent to exposure to the risk factor. Additionally, the highest cardiovascular death portion were attributed to obesity. These findings suggest that policymakers should control high LDL and hyperglycemia 10 years earlier prior to the occurrence of IHD and employ personalized therapy to regulate associated risks.

Analysing the impact of modifiable risk factors on cardiovascular disease mortality in Brazil.

OBJECTIVES: We have examined the impact of changes in modifiable risk factors on CVD mortality in 26 Brazilian states from 2005 to 2017. METHODS: Data were acquired from the Global Burden of Diseases study (GBD) and official sources of the Brazilian government, totalling 312 state-year observations. Population attributable fractions (PAFs) were calculated to determine the number of deaths attributed to changes in each risk factor. Fixed-effects multivariable linear regression models were performed, adjusting for income, income inequality, poverty and access to healthcare. RESULTS: Between 2005 and 2017, CVD deaths reduced by 21.42%, accompanied by a decrease in smoking (-33%) and increases in hyperglycaemia (+9.5%), obesity (+31%) and dyslipidaemia (+5.2%). Reduction in smoking prevented or postponed almost 20,000 CVD deaths in this period, while increased hyperglycaemia exposure resulted in more than 6,000 CVD deaths. The association between hyperglycaemia and CVD mortality was 5 to 10 times higher than those found for other risk factors, especially in women (11; 95%CI 7 to 14, deaths per 1-point increase in hyperglycaemia exposure). Importantly, the association between hyperglycaemia and CVD mortality was independent of socioeconomic status and access to healthcare, while associations for other risk factors after the same adjustments. CONCLUSION: Reduction in smoking was the risk factor that led to the highest number of CVD deaths prevented or postponed, while hyperglycaemia showed the most deleterious association with CVD mortality. Health policies should aim to directly reduce the prevalence of hyperglycaemia to mitigate the population burden of CVD in Brazil in the future.

Socioeconomic Factors Associated With Reports of Domestic Violence in Large Brazilian Cities.

Background: Domestic violence is a traumatic experience that can lead to physical consequences, mental disorders and financial damage. Over 18 cases per 100,000 inhabitants were reported in Brazil between 2013 and 2014. The ministry of health poses a mandatory notification of all cases of domestic violence, which is essential, bearing in mind its systemic relation to various social issues and the extensive regional differences and high socioeconomic inequalities present in Brazil. Aim: To analyze the characteristics of the notification rates of domestic violence and investigate the correlation of these with health and socioeconomic characteristics of large Brazilian cities. Methods: Retrospective data on notifications of domestic violence was collected from the National Information System for Notifiable Diseases for Brazil, 2017. Dependent variables were collected from the Brazilian Institute of Geography and Statistics and Ministry of Citizenship. Inclusion criteria were: cities larger than 100.000 habitants and that had at least 20 reports, totaling 68.313 reports in 259 cities. These were stratified by age, race and sex of victim, type of violence used, violence perpetrator, place of occurrence and means of aggression. Proportional number of notified cases was calculated for each city to expose different characteristics of reports. A multiple linear regression model was used to investigate the correlation between report rates and different socioeconomic and health variables. Results: The analysis showed a high proportion of repeated violence, use of body strength and over 50% were perpetrated by a partner or boyfriend. Report rates were higher for women, black individuals and children under four, highlighting subgroups of the population that were more vulnerable. Indeed, these groups were correlated differently with socioeconomic variables. Poverty, assessed as Bolsa Família investment, was correlated with domestic violence report rates across vulnerable groups. Conclusion: The study showed that black women and children are more vulnerable to domestic violence, highlighting deleterious effects of patriarchy and structural racism within Brazilian society. Altogether, we suggest that reducing poverty, patriarchy and structural racism could lead to fewer cases of domestic violence.

[Trends in reporting of sexual violence in Brazil from 2009 to 2013]. / Evolução da notificação de violência sexual no Brasil de 2009 a 2013.

The objective was to analyze the trends in reporting of sexual violence in Brazil from 2009 to 2013, with special emphasis on rape. An observational times series study was conducted, analyzing data from 2009 to 2013 coming from a secondary database of the Brazilian National Information System for Notificable Diseases (SINAN). The independent variable was the number of reports of sexual violence from 2009 to 2013, which was compared to several sociodemographic, violence-related, and health-related variables. The data were analyzed with a Prais-Winsten generalized linear regression model, determining the variations as stable, upward, or downward by analysis of the coefficient of determination (Pearson's R2) and level of significance set at p < 0.05. The reports of sexual violence showed greater positive variation in the 10-19-year age bracket (364%), indigenous individuals (520%), in the South of Brazil (414%), females (331%), and individuals with low schooling (343%). More than 70% of the reports were rapes, while one-third were repeat offenses, with a downward trend in reports of sexual violence accompanied by beating. The aggressors' characteristics remained stable. The site of violence changed, with fewer cases occurring on public byways. Finally, the reporting rate for rape increased by 590%, with a similar trend in rapes in the household and an increase in case resolutions. The study reveals the sociodemographic profile of cases of sexual violence reported in Brazil and an increase in reported rapes, especially inside the household. There was also an increase in case resolution.

O objetivo foi analisar a evolução das notificações de violência sexual no Brasil entre 2009 e 2013, dando especial enfoque ao estupro. Realizou-se um estudo observacional de série temporal, analisando dados entre 2009 e 2013, provenientes do banco de dados secundários coletados do Sistema de Informação de Agravos de Notificação (SINAN). A variável independente referiu-se ao número de notificações de violência sexual entre 2009 e 2013, sendo esta comparada a diversas variáveis sociodemográficas, de violência e de saúde. Os dados foram analisados por modelo de regressão linear generalizada de Prais-Winsten, determinando as variações como estável, crescente ou decrescente pela análise do coeficiente de determinação (R2 de Pearson) e nível de significância (p < 0,05). As notificações de violência sexual tiveram maior variação positiva em: 10-19 anos (364%), indígenas (520%), da Região Sul (414%), sexo feminino (331%) e baixa escolaridade (343%). Mais de 70% das notificações foram estupros, enquanto um terço foi casos de repetição, com decréscimo de notificações acompanhadas de espancamento. As características do agressor mantiveram-se estáveis. O local de ocorrência modificou-se, com menos casos ocorridos em via pública. Por fim, a taxa de notificação estupro aumentou em 590%, com tendência semelhante aos estupros dentro de casa e aumento da resolutividade dos atendimentos. O presente estudo evidencia o perfil sociodemográfico das vítimas de violência sexual notificadas no Brasil e o aumento da notificação de estupros atrelado aos casos em domicílio. Ainda, houve aumento da resolutividade das notificações.

El objetivo de este trabajo fue analizar la evolución de las notificaciones sobre violencia sexual en Brasil entre 2009 y 2013, otorgando especial relevancia a la violación. Se realizó un estudio observacional de carácter temporal, analizando datos entre 2009 y 2013, provenientes de un banco de datos secundarios, recabados por el Sistema de Información Nacional sobre Enfermedades de Notificación Obligatoria (SINAN por sus siglas en portugués). La variable independiente se refirió al número de notificaciones sobre violencia sexual entre 2009 y 2013, siendo esta última comparada con diversas variables sociodemográficas, de violencia y de salud. Los datos se analizaron mediante un modelo de regresión lineal generalizado de Prais-Winsten, determinando las variaciones como estables, crecientes o decrecientes por el análisis del coeficiente de determinación (R2 de Pearson) y el nivel de significancia (p < 0,05). Las notificaciones de violencia sexual contaron con una mayor variación positiva en: 10-19 años (364%), indígenas (520%), de la región Sur (414%), sexo femenino (331%) y baja escolaridad (343%). Más del 70% de las notificaciones fueron violaciones, mientras que un tercio fueron casos de repetición, con un descenso de las notificaciones acompañadas de palizas. Las características del agresor se mantuvieron estables. El lugar de ocurrencia fue modificado, hubo menos casos que se produjeron en vía pública. Finalmente, la tasa de notificación de violación aumentó un 590%, con una tendencia semejante a las violaciones dentro de casa y al aumento de la resolutividad de las atenciones. El presente estudio evidencia el perfil sociodemográfico de las víctimas de violencia sexual notificadas en Brasil y el aumento de la notificación de violaciones, relacionado con casos en domicilios. Asimismo, hubo un aumento de la resolutividad de las notificaciones.

Evolução da notificação de violência sexual no Brasil de 2009 a 2013 / Trends in reporting of sexual violence in Brazil from 2009 to 2013 / Evolución de notificaciones sobre violencia sexual en Brasil de 2009 a 2013

O objetivo foi analisar a evolução das notificações de violência sexual no Brasil entre 2009 e 2013, dando especial enfoque ao estupro. Realizou-se um estudo observacional de série temporal, analisando dados entre 2009 e 2013, provenientes do banco de dados secundários coletados do Sistema de Informação de Agravos de Notificação (SINAN). A variável independente referiu-se ao número de notificações de violência sexual entre 2009 e 2013, sendo esta comparada a diversas variáveis sociodemográficas, de violência e de saúde. Os dados foram analisados por modelo de regressão linear generalizada de Prais-Winsten, determinando as variações como estável, crescente ou decrescente pela análise do coeficiente de determinação (R2 de Pearson) e nível de significância (p < 0,05). As notificações de violência sexual tiveram maior variação positiva em: 10-19 anos (364%), indígenas (520%), da Região Sul (414%), sexo feminino (331%) e baixa escolaridade (343%). Mais de 70% das notificações foram estupros, enquanto um terço foi casos de repetição, com decréscimo de notificações acompanhadas de espancamento. As características do agressor mantiveram-se estáveis. O local de ocorrência modificou-se, com menos casos ocorridos em via pública. Por fim, a taxa de notificação estupro aumentou em 590%, com tendência semelhante aos estupros dentro de casa e aumento da resolutividade dos atendimentos. O presente estudo evidencia o perfil sociodemográfico das vítimas de violência sexual notificadas no Brasil e o aumento da notificação de estupros atrelado aos casos em domicílio. Ainda, houve aumento da resolutividade das notificações.

The objective was to analyze the trends in reporting of sexual violence in Brazil from 2009 to 2013, with special emphasis on rape. An observational times series study was conducted, analyzing data from 2009 to 2013 coming from a secondary database of the Brazilian National Information System for Notificable Diseases (SINAN). The independent variable was the number of reports of sexual violence from 2009 to 2013, which was compared to several sociodemographic, violence-related, and health-related variables. The data were analyzed with a Prais-Winsten generalized linear regression model, determining the variations as stable, upward, or downward by analysis of the coefficient of determination (Pearson's R2) and level of significance set at p < 0.05. The reports of sexual violence showed greater positive variation in the 10-19-year age bracket (364%), indigenous individuals (520%), in the South of Brazil (414%), females (331%), and individuals with low schooling (343%). More than 70% of the reports were rapes, while one-third were repeat offenses, with a downward trend in reports of sexual violence accompanied by beating. The aggressors' characteristics remained stable. The site of violence changed, with fewer cases occurring on public byways. Finally, the reporting rate for rape increased by 590%, with a similar trend in rapes in the household and an increase in case resolutions. The study reveals the sociodemographic profile of cases of sexual violence reported in Brazil and an increase in reported rapes, especially inside the household. There was also an increase in case resolution.

El objetivo de este trabajo fue analizar la evolución de las notificaciones sobre violencia sexual en Brasil entre 2009 y 2013, otorgando especial relevancia a la violación. Se realizó un estudio observacional de carácter temporal, analizando datos entre 2009 y 2013, provenientes de un banco de datos secundarios, recabados por el Sistema de Información Nacional sobre Enfermedades de Notificación Obligatoria (SINAN por sus siglas en portugués). La variable independiente se refirió al número de notificaciones sobre violencia sexual entre 2009 y 2013, siendo esta última comparada con diversas variables sociodemográficas, de violencia y de salud. Los datos se analizaron mediante un modelo de regresión lineal generalizado de Prais-Winsten, determinando las variaciones como estables, crecientes o decrecientes por el análisis del coeficiente de determinación (R2 de Pearson) y el nivel de significancia (p < 0,05). Las notificaciones de violencia sexual contaron con una mayor variación positiva en: 10-19 años (364%), indígenas (520%), de la región Sur (414%), sexo femenino (331%) y baja escolaridad (343%). Más del 70% de las notificaciones fueron violaciones, mientras que un tercio fueron casos de repetición, con un descenso de las notificaciones acompañadas de palizas. Las características del agresor se mantuvieron estables. El lugar de ocurrencia fue modificado, hubo menos casos que se produjeron en vía pública. Finalmente, la tasa de notificación de violación aumentó un 590%, con una tendencia semejante a las violaciones dentro de casa y al aumento de la resolutividad de las atenciones. El presente estudio evidencia el perfil sociodemográfico de las víctimas de violencia sexual notificadas en Brasil y el aumento de la notificación de violaciones, relacionado con casos en domicilios. Asimismo, hubo un aumento de la resolutividad de las notificaciones.