Mortality and years of life lost to death or disability by interpersonal violence against women in Brazil: Global Burden of Disease Study, 1990 and 2019.

INTRODUCTION: Aggression against women is an important cause of morbidity and death. This study compares the variation of deaths and years of life lost to death or disability (DALY) caused by interpersonal violence against women in Brazil and its states. METHODS: This descriptive study analyzed estimates from the Global Burden of Disease Study (GBD) referring to interpersonal violence against women, aged 15 to 49 years, examining the mortality and DALY rates for Brazil and its states, in 1990 and 2019. RESULTS: In this study, 3,168 deaths of women between 15 and 49 years of age, caused by interpersonal violence, were estimated in 1990, and 4,262 in 2019, which represents an increase of 33.8%. Regardless of the Maria da Penha Law and the progress in policies for curbing violence against women, one can observe a stability in the mortality and DALY rates in most of the Brazilian states. Only Bahia had a significant increase in those rates, while Federal District, Rio de Janeiro, and São Paulo showed a significant decline. CONCLUSIONS: The rates of female homicide have remained stable when comparing 1990 and 2019. Although there were improvements in terms of women's rights in the early 2000's, the chauvinist and conservative society of Brazil has not been able to protect women, and the country might not reach the targets established by the UN's 2030 Agenda.

Mapping disparities in homicide trends across Brazil: 2000-2014.

BACKGROUND: Homicides are a major problem in Brazil. Drugs and arms trafficking, and land conflicts are three of the many factors driving homicide rates in Brazil. Understanding long-term spatiotemporal trends and social structural factors associated with homicides in Brazil would be useful for designing policies aimed at reducing homicide rates. METHODS: We obtained data from 2000 to 2014 from the Brazil Ministry of Health (MOH) Mortality Information System and sociodemographic data from the Brazil Institute of Geography and Statistics (IBGE). First, we quantified the rate of change in homicides at the municipality and state levels. Second, we used principal component regression and k-medoids clustering to examine differences in temporal trends across municipalities. Lastly, we used Bayesian hierarchical space-time models to describe spatio-temporal patterns and to assess the contribution of structural factors. RESULTS: There were significant variations in homicide rates across states and municipalities. We noted the largest decrease in homicide rates in the western and southeastern states of Sao Paulo, Rio de Janeiro and Espirito Santo, which coincided with an increase in homicide rates in the northeastern states of Ceará, Alagoas, Paraiba, Rio Grande Norte, Sergipe and Bahia during the fifteen-year period. The decrease in homicides in municipalities with populations of at least 250,000 coincided with an increase in municipalities with 25,000 people or less. Structural factors that predicted municipality-level homicide rates included crude domestic product, urbanization, border with neighboring countries and proportion of population aged fifteen to twenty-nine. CONCLUSIONS: Our findings support both a dissemination hypothesis and an interiorization hypothesis. These findings should be considered when designing interventions to curb homicide rates.

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.

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.

Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study.

BACKGROUND: Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017. METHODS: We used multiple cause-of-death data from 109 million individual death records to calculate mortality related to sepsis among each of the 282 underlying causes of death in GBD 2017. The percentage of sepsis-related deaths by underlying GBD cause in each location worldwide was modelled using mixed-effects linear regression. Sepsis-related mortality for each age group, sex, location, GBD cause, and year (1990-2017) was estimated by applying modelled cause-specific fractions to GBD 2017 cause-of-death estimates. We used data for 8·7 million individual hospital records to calculate in-hospital sepsis-associated case-fatality, stratified by underlying GBD cause. In-hospital sepsis-associated case-fatality was modelled for each location using linear regression, and sepsis incidence was estimated by applying modelled case-fatality to sepsis-related mortality estimates. FINDINGS: In 2017, an estimated 48·9 million (95% uncertainty interval [UI] 38·9-62·9) incident cases of sepsis were recorded worldwide and 11·0 million (10·1-12·0) sepsis-related deaths were reported, representing 19·7% (18·2-21·4) of all global deaths. Age-standardised sepsis incidence fell by 37·0% (95% UI 11·8-54·5) and mortality decreased by 52·8% (47·7-57·5) from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia. INTERPRETATION: Despite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa. FUNDING: The Bill & Melinda Gates Foundation, the National Institutes of Health, the University of Pittsburgh, the British Columbia Children's Hospital Foundation, the Wellcome Trust, and the Fleming Fund.

Prevalence of bullying and associated factors among Brazilian schoolchildren in 2015. / Prevalência de bullying e fatores associados em escolares brasileiros, 2015.

This study analyzed the prevalence of bullying and associated factors among Brazilian schoolchildren using data produced by the 2015 National School Health Survey (PeNSE, acronym in Portuguese) consisting of a national sample of 102,301 eighth grade students. The prevalence of bullying was calculated and bivariate analysis was performed using a 95% confidence level to determine the association between victimization and socio-demographic variables and other variables relating to family background, mental health, and risk behaviors. Multivariate analysis was then conducted using the biologically plausible variables of interest. For the final model, variables that obtained p-values of < 0.05 were maintained. The prevalence of bullying was found to be 7.4%. The results of the multivariate analysis showed that boys aged 13 years studying in public schools who worked and whose mother did not have any schooling were more likely to be bullied, as were schoolchildren who felt lonely, had no friends, suffered from insomnia, skipped lessons without parental permission, and who smoked. Victims of bullying were predominantly 13-year-olds from an unfavorable social and family background, painting a picture of vulnerability that calls for support from social protection networks, schools and families alike .

O estudo analisou a prevalência de sofrer bullying e fatores associados em escolares brasileiros. Trata-se de análise da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2015 em amostra nacional com 102.301 alunos do 9º ano. Foi calculada a prevalência de sofrer bullying e foi feita inicialmente análise bivariada com estimativas de razões de chance (OR) e IC95% para estimar as associações entre vitimização e variáveis sociodemográficas, contexto familiar, violência familiar, saúde mental e comportamentos de risco. Posteriormente, procedeu-se ao modelo de regressão logística múltipla, inserindo as variáveis de interesse com (p < 0,20). No modelo final ajustado (ORa) permaneceram variáveis com p < 0,05. A prevalência de bullying foi de 7,4%. A análise multivariada mostrou que quem tem maior chance de sofrer bullying são os escolares do sexo masculino, com 13 anos, da escola pública, filhos de mães sem escolaridade, que trabalham, com relato de solidão, sem amigos, com insônia; que sofreram agressão física dos familiares, faltaram as aulas sem avisar aos pais, usaram tabaco. Predominaram vítimas de 13 anos, com contexto social e familiar desfavorável, mostrando cenário de vulnerabilidades, demandando apoio de redes de proteção social, escolar e famíliar.

Prevalência de bullying e fatores associados em escolares brasileiros, 2015 / Prevalence of bullying and associated factors among Brazilian schoolchildren in 2015

Resumo O estudo analisou a prevalência de sofrer bullying e fatores associados em escolares brasileiros. Trata-se de análise da Pesquisa Nacional de Saúde do Escolar (PeNSE) 2015 em amostra nacional com 102.301 alunos do 9º ano. Foi calculada a prevalência de sofrer bullying e foi feita inicialmente análise bivariada com estimativas de razões de chance (OR) e IC95% para estimar as associações entre vitimização e variáveis sociodemográficas, contexto familiar, violência familiar, saúde mental e comportamentos de risco. Posteriormente, procedeu-se ao modelo de regressão logística múltipla, inserindo as variáveis de interesse com (p < 0,20). No modelo final ajustado (ORa) permaneceram variáveis com p < 0,05. A prevalência de bullying foi de 7,4%. A análise multivariada mostrou que quem tem maior chance de sofrer bullying são os escolares do sexo masculino, com 13 anos, da escola pública, filhos de mães sem escolaridade, que trabalham, com relato de solidão, sem amigos, com insônia; que sofreram agressão física dos familiares, faltaram as aulas sem avisar aos pais, usaram tabaco. Predominaram vítimas de 13 anos, com contexto social e familiar desfavorável, mostrando cenário de vulnerabilidades, demandando apoio de redes de proteção social, escolar e famíliar.

Abstract This study analyzed the prevalence of bullying and associated factors among Brazilian schoolchildren using data produced by the 2015 National School Health Survey (PeNSE, acronym in Portuguese) consisting of a national sample of 102,301 eighth grade students. The prevalence of bullying was calculated and bivariate analysis was performed using a 95% confidence level to determine the association between victimization and socio-demographic variables and other variables relating to family background, mental health, and risk behaviors. Multivariate analysis was then conducted using the biologically plausible variables of interest. For the final model, variables that obtained p-values of < 0.05 were maintained. The prevalence of bullying was found to be 7.4%. The results of the multivariate analysis showed that boys aged 13 years studying in public schools who worked and whose mother did not have any schooling were more likely to be bullied, as were schoolchildren who felt lonely, had no friends, suffered from insomnia, skipped lessons without parental permission, and who smoked. Victims of bullying were predominantly 13-year-olds from an unfavorable social and family background, painting a picture of vulnerability that calls for support from social protection networks, schools and families alike .