Changes in the quality of cause-of-death statistics in Brazil: garbage codes among registered deaths in 1996-2016.

BACKGROUND: Registered causes in vital statistics classified as garbage codes (GC) are considered indicators of quality of cause-of-death data. Our aim was to describe temporal changes in this quality in Brazil, and the leading GCs according to levels assembled for the Global Burden of Disease (GBD) study. We also assessed socioeconomic differences in the burden of different levels of GCs at a regional level. METHODS: We extracted data from the Brazilian Mortality Information System from 1996 to 2016. All three- and four-digit ICD-10 codes considered GC were selected and classified into four categories, according to the GBD study proposal. GC levels 1 and 2 are the most damaging unusable codes, or major GCs. Proportionate distribution of deaths by GC levels according selected variables were performed. Age-standardized mortality rates after correction of underreporting of deaths were calculated to investigate temporal relationships as was the linear association adjusted for completeness between GC rates in states and the Sociodemographic Index (SDI) from the GBD study, for 1996-2005 and 2006-2016. We classified Brazilian states into three classes of development by applying tertiles cutoffs in the SDI state-level estimates. RESULTS: Age-standardized mortality rates due to GCs in Brazil decreased from 1996 to 2016, particularly level 1 GCs. The most important GC groups were ill-defined causes (level 1) in 1996, and pneumonia unspecified (level 4) in 2016. At state level, there was a significant inverse association between SDI and the rate of level 1-2 GCs in 1996-2005, but both SDI and completeness had a non-expected significant direct association with levels 3-4. In 2006-2016, states with higher SDIs tended to have lower rates of all types of GCs. Mortality rates due to major GCs decreased in all three SDI classes in 1996-2016, but GC levels 3-4 decreased only in the high SDI category. States classified in the low or medium SDI groups were responsible for the most important decline of major GCs. CONCLUSION: Occurrence of major GCs are associated with socioeconomic determinants over time in Brazil. Their reduction with decreasing disparity in rates between socioeconomic groups indicates progress in reducing inequalities and strengthening cause-of-death statistics in the country.

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.

Variations and particularities in cardiovascular disease mortality in Brazil and Brazilian states in 1990 and 2015: estimates from the Global Burden of Disease. / Variações e diferenciais da mortalidade por doença cardiovascular no Brasil e em seus estados, em 1990 e 2015: estimativas do Estudo Carga Global de Doença.

OBJECTIVE:: To analyze variations and particularities in mortality due to cardiovascular disease (CVD) in Brazil and in Brazilian states, in 1990 and 2015. METHODS:: We used data compiled from the Global Burden of Disease (GBD) 2015, obtained from the database of the Mortality Information System (SIM) of the Brazilian Ministry of Health. Correction of the sub-registry of deaths and reclassification of the garbage codes were performed using specific algorithms. The cardiovascular causes were subdivided into 10 specific causes. Age-standardized CVD mortality rates - in 1990 and 2015 - were analyzed according to sex and Brazilian state. RESULTS:: Age-standardized CVD mortality rate decreased from 429.5 (1990) to 256.0 (2015) per 100,000 inhabitants (40.4%). The proportional decrease was similar in both sexes, but death rates in males were substantially higher. The reduction of age-standardized mortality rate was more significant for rheumatic heart disease (44.5%), ischemic cardiopathy (43.9%), and cerebrovascular disease (46.0%). The decline in mortality was markedly different across states, being more pronounced in those of the southeastern and southern regions and the Federal District, and more modest in most states in the north and northeast regions. CONCLUSION:: Age-standardized CVD mortality has declined in Brazil in recent decades, but in a heterogeneous way across states and for different specific causes. Considering the burden magnitude and the Brazilian population aging, policies to prevent and manage CVD should continue to be prioritized.

Risk factors related to the global burden of disease in Brazil and its Federated Units, 2015. / Fatores de risco relacionados à carga global de doença do Brasil e Unidades Federadas, 2015.

OBJECTIVE:: To analyze the global burden of disease related to disability adjusted life years (DALYs) attributed to selected risk factors in Brazil and its 27 Federated Units. METHODS:: Databases from the Global Burden of Disease study in Brazil and its Federated Units were used, estimating the summary exposure value (SEV) for selected environmental, behavioral, and metabolic risk factors (RFs), and their combinations. The DALYs were used as the main metric. The ranking of major RFs between 1990 and 2015 was compiled, comparing data by sex and states. RESULTS:: The analyzed RFs account for 38.8% of the loss of DALYs in the country. Dietary risks was the main cause of DALYs in 2015. In men, dietary risks contributed to 12.2% of DALYs and in women, to 11.1%. Other RFs were high systolic blood pressure, high body mass index, smoking, high fasting plasma glucose and, among men, alcohol and drug use. The main RFs were metabolic and behavioral. In most states, dietary risks was the main RF, followed by high blood pressure. CONCLUSION:: Dietary risks leads the RF ranking for Brazil and its Federated Units. Men are more exposed to behavioral risk factors, and women are more exposed to metabolic ones.

Variações e diferenciais da mortalidade por doença cardiovascular no Brasil e em seus estados, em 1990 e 2015: estimativas do Estudo Carga Global de Doença / Variations and particularities in cardiovascular disease mortality in Brazil and Brazilian states in 1990 and 2015: estimates from the Global Burden of Disease

RESUMO: Objetivo: Analisar as variações e os diferenciais da mortalidade por doenças cardiovasculares (DCV) no Brasil e em seus estados, em 1990 e 2015. Métodos: Foram utilizados os dados de mortalidade compilados pelo Global Burden of Disease (GBD) 2015, obtidos da base de dados do Sistema de Informação sobre Mortalidade do Ministério da Saúde. Foram realizadas a correção do sub-registro de óbitos e a reclassificação dos códigos garbage por meio de algoritmos específicos. As causas cardiovasculares foram subdivididas em 10 causas específicas. As taxas de mortalidade - dos anos 1990 e 2015 - foram padronizadas pela idade, de acordo com o sexo e o estado brasileiro. Resultados: A taxa de mortalidade por DCV padronizada por idade caiu de 429,5 (1990) para 256,0 (2015) a cada 100 mil habitantes (40,4%). A redução proporcional foi semelhante em ambos os sexos, mas as taxas em homens são substancialmente mais altas do que nas mulheres. A redução da taxa padronizada por idade foi mais acentuada para a doença cardíaca reumática (44,5%), cardiopatia isquêmica (43,9%) e doença cerebrovascular (46,0%). A queda na mortalidade diferiu marcadamente entre os estados, sendo mais acentuada nos estados das regiões Sudeste e Sul do país e no Distrito Federal, e atenuada nos estados do Norte e Nordeste. Conclusão: A mortalidade por DCV padronizada por idade reduziu no Brasil nas últimas décadas, porém de forma heterogênea entre os estados e para diferentes causas específicas. Considerando a magnitude da carga de doença e o envelhecimento da população brasileira, as políticas de enfrentamento das DCV devem ser priorizadas.

ABSTRACT: Objective: To analyze variations and particularities in mortality due to cardiovascular disease (CVD) in Brazil and in Brazilian states, in 1990 and 2015. Methods: We used data compiled from the Global Burden of Disease (GBD) 2015, obtained from the database of the Mortality Information System (SIM) of the Brazilian Ministry of Health. Correction of the sub-registry of deaths and reclassification of the garbage codes were performed using specific algorithms. The cardiovascular causes were subdivided into 10 specific causes. Age-standardized CVD mortality rates - in 1990 and 2015 - were analyzed according to sex and Brazilian state. Results: Age-standardized CVD mortality rate decreased from 429.5 (1990) to 256.0 (2015) per 100,000 inhabitants (40.4%). The proportional decrease was similar in both sexes, but death rates in males were substantially higher. The reduction of age-standardized mortality rate was more significant for rheumatic heart disease (44.5%), ischemic cardiopathy (43.9%), and cerebrovascular disease (46.0%). The decline in mortality was markedly different across states, being more pronounced in those of the southeastern and southern regions and the Federal District, and more modest in most states in the north and northeast regions. Conclusion: Age-standardized CVD mortality has declined in Brazil in recent decades, but in a heterogeneous way across states and for different specific causes. Considering the burden magnitude and the Brazilian population aging, policies to prevent and manage CVD should continue to be prioritized.

Fatores de risco relacionados à carga global de doença do Brasil e Unidades Federadas, 2015 / Risk factors related to the global burden of disease in Brazil and its Federated Units, 2015

RESUMO: Objetivo: Analisar a carga global de doença, quanto aos anos de vida ajustados por incapacidade (disability adjusted life years - DALYs) atribuídos a fatores de risco (FRs) selecionados, para Brasil e 27 Unidades Federadas (UFs). Métodos: Foram utilizadas bases de dados do estudo Carga Global de Doença (Global Burden of Disease - GBD) para Brasil e UFs estimando a síntese de exposição de risco (summary exposure value - SEV) para FRs selecionados, incluindo os ambientais, comportamentais, metabólicos e suas combinações. Os DALYs foram usados como métrica principal do estudo. Construiu-se o ranking dos principais FRs entre 1990 e 2015, com comparações por sexo e UF. Resultados: Os FRs analisados explicariam 38,8% da perda de DALYs no país. A dieta inadequada foi a principal causa de DALYs em 2015. Em homens, a dieta inadequada contribuiu com 12,2% dos DALYs, e, em mulheres, com 11,1% deles. Outros FRs importantes foram: pressão arterial sistólica elevada, índice de massa corporal (IMC) elevado, tabagismo, glicose sérica elevada; entre homens, destaca-se o uso de álcool e drogas. Os principais FRs foram metabólicos e comportamentais. Na maioria das UFs, predominou a dieta inadequada, seguida da pressão arterial elevada. Conclusão: A dieta inadequada lidera o ranking de FRs para Brasil e UF. Os homens estão mais expostos aos FRs comportamentais, e as mulheres, aos metabólicos.

ABSTRACT: Objective: To analyze the global burden of disease related to disability adjusted life years (DALYs) attributed to selected risk factors in Brazil and its 27 Federated Units. Methods: Databases from the Global Burden of Disease study in Brazil and its Federated Units were used, estimating the summary exposure value (SEV) for selected environmental, behavioral, and metabolic risk factors (RFs), and their combinations. The DALYs were used as the main metric. The ranking of major RFs between 1990 and 2015 was compiled, comparing data by sex and states. Results: The analyzed RFs account for 38.8% of the loss of DALYs in the country. Dietary risks was the main cause of DALYs in 2015. In men, dietary risks contributed to 12.2% of DALYs and in women, to 11.1%. Other RFs were high systolic blood pressure, high body mass index, smoking, high fasting plasma glucose and, among men, alcohol and drug use. The main RFs were metabolic and behavioral. In most states, dietary risks was the main RF, followed by high blood pressure. Conclusion: Dietary risks leads the RF ranking for Brazil and its Federated Units. Men are more exposed to behavioral risk factors, and women are more exposed to metabolic ones.

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.

Inequities in intraurban areas in the distribution of risk factors for non communicable diseases, Belo Horizonte, 2010.

OBJECTIVE: In order to identify intraurban differentials, the prevalence of major protection and risk factors for non communicable chronic diseases were analyzed in nine health districts of Belo Horizonte, Minas Gerais, Brazil. METHODS: Analysis of data from a telephone survey conducted with 2,000 adults in Belo Horizonte, in 2010, using the average linkage method for cluster analysis among the health districts, using sociodemographic variables (education, race and marital status). The study compared the prevalence of risk factors for non communicable diseases among the health districts. RESULTS: Four clusters were identified. The best socio-demographic indicators were found in cluster 4 (South Central health district), which also showed a higher prevalence of protective factors such as higher consumption of fruits and vegetables, higher frequency of physical activity practice in the free time, use of ultraviolet protection, higher proportion of ex-smokers, and lower prevalence of whole milk and high-fat meat consumption. As a risk factor, cluster 4 showed a higher proportion of alcohol abuse. Cluster 1, with the worst socio-demographic indicators, concentrated more risk factors such as consumption of whole milk, low regular consumption of fruit and vegetables, and lower practice of physical activity in the free time. The most frequent protective indicators in cluster 1 were the regular consumption of beans, having breakfast at home, and lower alcohol abuse. CONCLUSION: Intra-urban differences were found in the distribution of risk and protection factors or non transmissible diseases, these differences can support planning aimed at actions for greater equity in health.

Inequities in intraurban areas in the distribution of risk factors for non communicable diseases, Belo Horizonte, 2010 / Desigualdades intraurbanas na distribuição dos fatores de risco para doenças crônicas não transmissíveis, Belo Horizonte, 2010

Objective: In order to identify intraurban differentials, the prevalence of major protection and risk factors for non communicable chronic diseases were analyzed in nine health districts of Belo Horizonte, Minas Gerais, Brazil. Methods: Analysis of data from a telephone survey conducted with 2,000 adults in Belo Horizonte, in 2010, using the average linkage method for cluster analysis among the health districts, using sociodemographic variables (education, race and marital status). The study compared the prevalence of risk factors for non communicable diseases among the health districts. Results: Four clusters were identified. The best socio-demographic indicators were found in cluster 4 (South Central health district), which also showed a higher prevalence of protective factors such as higher consumption of fruits and vegetables, higher frequency of physical activity practice in the free time, use of ultraviolet protection, higher proportion of ex-smokers, and lower prevalence of whole milk and high-fat meat consumption. As a risk factor, cluster 4 showed a higher proportion of alcohol abuse. Cluster 1, with the worst socio-demographic indicators, concentrated more risk factors such as consumption of whole milk, low regular consumption of fruit and vegetables, and lower practice of physical activity in the free time. The most frequent protective indicators in cluster 1 were the regular consumption of beans, having breakfast at home, and lower alcohol abuse. Conclusion: Intra-urban differences were found in the distribution of risk and protection factors or non transmissible diseases, these differences can support planning aimed at actions for greater equity in health. .

Objetivo: Visando identificar diferenciais intraurbanos, foram analisadas prevalências dos principais fatores de risco e proteção para doenças crônicas não transmissíveis nos nove distritos sanitários de Belo Horizonte, Minas Gerais. Métodos: Análise dos dados de inquérito telefônico realizado com 2.000 adultos em Belo Horizonte em 2010, empregando-se average linkage para análise de clusters entre os distritos sanitários, com base em variáveis sociodemográficas (escolaridade, cor da pele e estado civil). O estudo comparou as prevalências dos fatores de risco para doenças crônicas não transmissíveis entre os distritos sanitários. Resultados: Foram identificados quatro clusters. O cluster 4 (distrito sanitário Centro Sul) apresentou as melhores condições sociodemográficas, além de maior prevalência de fatores de proteção, como maior consumo de frutas, legumes e verduras, maior frequência de atividade física no tempo livre, uso de proteção de raios ultravioleta, maior proporção de ex-fumantes e menor prevalência de consumo de leite com gordura integral e carne com gordura aparente. Como fator de risco, o cluster 4 apresentou maior proporção de consumo abusivo de álcool. O cluster 1, com piores indicadores sociodemográficos, concentrou mais fatores de risco, como maior consumo de leite com gordura, baixo consumo de frutas, legumes e verduras regular e menos atividade física no tempo livre. Os indicadores de proteção mais frequentes no cluster 1 foram: consumo regular de feijão, café da manhã em casa e menor consumo abusivo de álcool. Conclusão: Foram encontradas diferenças intraurbanas na distribuição dos fatores de risco e proteção para doenças crônicas ...

[Socioeconomic inequalities and premature mortality due to cardiovascular diseases in Brazil]. / Desigualdade social e mortalidade precoce por doenças cardiovasculares no Brasil.

OBJECTIVE: To investigate the relationship between some indicators of socioeconomic status and adult mortality due to cardiovascular diseases in Brazil. METHODS: Adult deaths (aged between 35 and 64 years) due to cardiovascular diseases and subgroups of ischemic heart disease and cerebrovascular-hypertensive diseases were assessed during the period from 1999 to 2001. Data was obtained from the National Mortality Information System. Ninety-eight Brazilian municipalities with the best quality of information were included in the study. Simple and multiple linear regression methods were used to assess the association between socioeconomic indicators and mortality due to cardiovascular diseases. RESULTS: Univariate analysis revealed a negative association between mortality due to cardiovascular and cerebrovascular-hypertensive diseases and income and education and a direct association with poverty rates and poor housing conditions. In regard to ischemic heart disease, there was an inverse association with poverty rates and education indicators and a direct association with poor housing conditions. After adjusting to other variables, education still remained associated to mortality due to cardiovascular disease and its subgroups. For each percent point increase in adults with high level of education, there was a decrease of 3.25 per 100,000 inhabitants in the mortality rate due to cardiovascular diseases. CONCLUSIONS: The analysis of mortality in those municipalities has shown there is an inverse association between cardiovascular diseases and social and economic factors, especially education. Is it likely that better education can improve life conditions and thus have a positive impact on premature mortality.

Desigualdade social e mortalidade precoce por doenças cardiovasculares no Brasil / Socioeconomic inequalities and premature mortality due to cardiovascular diseases in Brazil

OBJETIVO: Investigar associação entre alguns indicadores de nível socioeconômico e mortalidade de adultos por doenças cardiovasculares no Brasil. MÉTODOS: Foram analisados os óbitos de adultos (35 a 64 anos), ocorridos entre 1999 a 2001, por doenças cardiovasculares, e pelos subgrupos das doenças isquêmicas do coração e doenças cerebrovasculares-hipertensivas, obtidos no Sistema de Informação sobre Mortalidade. Foram selecionados para análise 98 municípios brasileiros, com melhor qualidade de informação. Para analisar a associação entre indicadores socioeconômicos e a mortalidade por doenças cardiovasculares, foi utilizada a regressão linear simples e múltipla. RESULTADOS: Na análise univariada, verificou-se associação negativa para a mortalidade por doenças cardiovasculares e o subgrupo das cerebrovasculares-hipertensivas com renda e escolaridade, e associação direta com taxa de pobreza e condições precárias de moradia. Quanto às doenças isquêmicas, houve associação inversa com taxa de pobreza e escolaridade, e direta com condições precárias de moradia. A escolaridade, após ajuste pelo modelo de regressão linear múltipla, permaneceu associada à mortalidade pela doença investigada e seus subgrupos. A cada ponto percentual de aumento na proporção de adultos com alta escolaridade, a taxa de mortalidade por doenças cardiovasculares diminui em 3,25 por 100.000 habitantes. CONCLUSÕES: A análise da mortalidade dos municípios mostrou que a associação entre doenças cardiovasculares e fatores socioeconômicos é inversa, destacando-se a escolaridade. É provável que melhor escolaridade possibilite melhores condições de vida e, conseqüentemente, impacto positivo na mortalidade precoce.

OBJECTIVE: To investigate the relationship between some indicators of socioeconomic status and adult mortality due to cardiovascular diseases in Brazil. METHODS: Adult deaths (aged between 35 and 64 years) due to cardiovascular diseases and subgroups of ischemic heart disease and cerebrovascular-hypertensive diseases were assessed during the period from 1999 to 2001. Data was obtained from the National Mortality Information System. Ninety-eight Brazilian municipalities with the best quality of information were included in the study. Simple and multiple linear regression methods were used to assess the association between socioeconomic indicators and mortality due to cardiovascular diseases. RESULTS: Univariate analysis revealed a negative association between mortality due to cardiovascular and cerebrovascular-hypertensive diseases and income and education and a direct association with poverty rates and poor housing conditions. In regard to ischemic heart disease, there was an inverse association with poverty rates and education indicators and a direct association with poor housing conditions. After adjusting to other variables, education still remained associated to mortality due to cardiovascular disease and its subgroups. For each percent point increase in adults with high level of education, there was a decrease of 3.25 per 100,000 inhabitants in the mortality rate due to cardiovascular diseases. CONCLUSIONS: The analysis of mortality in those municipalities has shown there is an inverse association between cardiovascular diseases and social and economic factors, especially education. Is it likely that better education can improve life conditions and thus have a positive impact on premature mortality.

Mortalidade por homicídios em bairros e favelas da região rentro rul de Belo Horizonte / Deaths by homicides in the districts and slums in the center-south region in Belo Horizonte

Este estudo aborda as desigualdades nas mortes por homicídios em bairros e favelas da Região Centro-sul de Belo Horizonte. Foram analisados os 221 óbitos por homicídios ocorridos no período de 1993 a 1997. A maior proporção de óbitos ocorreu no sexo masculino e em jovens. Evidenciaram grandes desigualdades socioespaciais; o risco de morrer por homicídios foi 16 vezes maior nas favelas do que em bairros. O principal tipo de agressão foi por arma de fogo, envolvendo 72% dos óbitos. Os resultados demonstram a necessidade de enfrentamento dos homicídios numa perspectiva multiciplinar.

The differences in the death rates by homicides between city districts and slums in the Center-South region of Belo Horizonte were analised. There were 221 deaths by homicides in the period between 1993 to 1997. The highest percentage of deaths involved males and young populations. Great social-spacial inequalities were identified, being the risk of dying by homicide 16 times higher in the slums than in the districts. the use of firearm was the most important type of aggression reported in 72% of the deaths. The results point to the need of facing the homicides in multidisciplinar perspective.

Desigualdades socioespaciais e mortes precoces de adultos na regiäo centro-sul do município de Belo Horizonte em 1996 / Social inequalities and early deaths of adults of the Center-South Region of the city of Belo Horizonte in 1996

Com o objetivo de estudar a mortalidade diferencial de adultos de Belo Horizonte, foram analisados os óbitos referentes a homens e mulheres de 20 a 69 anos, residentes na região Centro-sul do município. Calcularam-se as taxas de mortalidade padronizadas, os anos potenciais de vida perdidos (APVP) e o índice razão de risco padronizado (RRP) para a população da região, segundo residência em bairros e favelas e causas básicas de óbito. Tanto na região como no município de Belo Horizonte, as três principais causas de óbito foram as doenças cardiovasculares, as neoplasias e as causas externas. Entretanto, o risco de morrer por esssas doenças foi maior em favelas que em bairros: 3,0 vezes para as doenças cardiovasculares, 1,4 para as neoplasias e 3,1 para as causas externas. Em relação ao APVP, observou-se que as causas externas foram importantes causas de mortes precoces. O maior risco de mortalidade por doenças crônicos degenerativas e causas externas na população favelada evidencia importantes diferenças sociais em saúde. Conclui-se que é preciso o envolvimento do Estado e da sociedade civil, numa perspectiva multidisciplinar, tanto para enfrentar as mortes violentas, quanto também para buscar soluções que provoquem mudanças na estrutura social e econômica para amenizar as desiguldades sociais

Aiming at studying the differential mortality among adults in Belo Horizonte, deaths of both, me¼ and women, aged 20 to 69 living in the Center-South region of the city were analyzed. Standardized mortality rates as well as the Potential Years of Life Lost (PYLL) and the standardized risk ratio were calculated for the local population according to their place of residence, whether districts or slums, and underlying cause of death. The three main causes of death were cardiovascular diseases, neoplasms and external causes for both, the Center- South region and the city of Belo Horizonte. Howevel:; the risks of death by these diseases were higher in slums as compared to the districts: 3.0 times for cardiovascular diseases, 1.4 for neoplasms and 3.1 for external causes. Concerning the PYLL, external causes were observed to be important causes of early deaths. The greater mortality risk by chronic-degenerative diseases and external causes among the slum population indicates important social differences in health. It is concluded that the involvement of the State and of the civil society is needed in a multidisciplinary approach, not only to face violent deaths but also to search for solutions that may lead to changes in the social and economic structure in order to minimize social inequalities.