RESUMO
Background: To understand if migrants living in poverty in low and middle-income countries (LMICs) have mortality advantages over the non-migrant population, we investigated mortality risk patterns among internal and international migrants in Brazil over their life course. Methods: We linked socio-economic and mortality data from 1st January 2011 to 31st December 2018 in the 100 Million Brazilian Cohort and calculated all-cause and cause-specific age-standardised mortality rates according to individuals' migration status for men and women. Using Cox regression models, we estimated the age- and sex-adjusted mortality hazard ratios (HR) for internal migrants (i.e., Brazilian-born individuals living in a different Brazilian state than their birth) compared to Brazilian-born non-migrants; and for international migrants (i.e., people born in another country) compared to Brazilian-born individuals. Findings: The study followed up 45,051,476 individuals, of whom 6,057,814 were internal migrants, and 277,230 were international migrants. Internal migrants had similar all-cause mortality compared to Brazilian non-migrants (aHR = 0.99, 95% CI = 0.98-0.99), marginally higher mortality for ischaemic heart diseases (aHR = 1.04, 95% CI = 1.03-1.05) and higher for stroke (aHR = 1.11, 95% CI = 1.09-1.13). Compared to Brazilian-born individuals, international migrants had 18% lower all-cause mortality (aHR = 0.82, 95% CI = 0.80-0.84), with up to 50% lower mortality from interpersonal violence among men (aHR = 0.50, 95% CI = 0.40-0.64), but higher mortality from avoidable causes related to maternal health (aHR = 2.17, 95% CI = 1.17-4.05). Interpretation: Although internal migrants had similar all-cause mortality, international migrants had lower all-cause mortality compared to non-migrants. Further investigations using intersectional approaches are warranted to understand the marked variations by migration status, age, and sex for specific causes of death, such as elevated maternal mortality and male lower interpersonal violence-related mortality among international migrants. Funding: The Wellcome Trust.
RESUMO
Pesquisa epidemiológica descritiva que objetivou descrever o perfil demográfico das famílias de pacientes em Tratamento Diretamente Observado em um serviço de saúde de Ribeirão Preto-SP, analisar o contexto em que estavam inseridas, no que refere ao grau de parentesco e aspectos clínico-epidemiológicos do familiar portador da tuberculose, e avaliar o conhecimento e a percepção dessas famílias em relação à tuberculose. Os dados foram coletados em julho de 2010, utilizando-se um questionário semiestruturado com 16 familiares, sendo analisados por meio da estatística descritiva. O perfil demográfico dos familiares corrobora com a associação da tuberculose às condições de pobreza e má distribuição de renda. Verificou-se um número substancial de comunicantes no domicílio, sendo a tuberculose pulmonar a forma clínica predominante. O conhecimento das famílias foi satisfatório, entretanto, alguns sujeitos associam a transmissão da doença, ao uso compartilhado de utensílios domésticos. Os resultados apontam fragilidades relacionadas à gestão do cuidado às famílias.
The aim of this descriptive and epidemiological research was to describe the demographic profile of patients' families who are under Directly Observed Treatment at a health service, in Ribeirão Preto, Brazil. To analyze the context they were inserted in by considering parenthood and clinical-epidemiological aspects of the family member with tuberculosis, and to assess these families' knowledge and perception about tuberculosis. Data were collected in July 2010, by using a semistructured questionnaire that was applied to 16 family members. Descriptive statistics were used for data analysis. The families' demographic profile supports the association among tuberculosis, conditions of poverty and low income distribution. A substantial number of patients with pulmonary tuberculosis as the predominant clinical form was found at their homes. The families' knowledge was satisfactory, but some subjects associate the transmission of the disease with the shared use of domestic utensils. The results appoint weaknesses related to the families' care management.
Investigación epidemiológica con objetivo de describir el perfil demográfico de familias de pacientes en Tratamiento Directamente Observado en un servicio de salud de Ribeirão Preto, Brazil, analizar el contexto en que estaban inseridas, respecto al grado de parentesco y aspectos clínico-epidemiológicos del familiar con tuberculosis, y evaluar el conocimiento y la percepción de esas familias respecto a la tuberculosis. Los datos fueron recolectados en julio del 2010, utilizándose un cuestionario semi-estructurado con 16 familiares, siendo analizados mediante estadística descriptiva. El perfil demográfico corrobora la asociación de la tuberculosis con condiciones de pobreza y mala distribución de renta. Se verificó un número substancial de comunicantes en domicilio, siendo la tuberculosis pulmonar la forma clínica predominante. El conocimiento de las familias fue satisfactorio, pero algunos sujetos asocian la transmisión de la enfermedad al uso compartido de utensilios domésticos. Los resultados indican fragilidades en la gestión del cuidado a las familias.