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.

Heterotopic Ossification After Stroke: Clinical Profile and Severity of Ossification.

BACKGROUND AND PURPOSE: The aim of this study was to evaluate heterotopic ossification (HO) prevalence after stroke, describing clinical features and investigating predictors of HO and its severity. METHODS: A cross-sectional study was carried out in 7 rehabilitation centers (Sarah Network) from 2004 to 2013. RESULTS: Among 17,794 stroke cases, 235 patients (1.3%) presented clinical and radiological evidence of HO. A log-binomial model with robust variance estimated the prevalence ratio of 1.3% in 10 years. A multinomial logistic regression was performed to investigate the predictors of HO and its severity. The presence of hemorrhagic stroke (prevalence ratio [PR] = 4.75; 95% confidence interval [CI] PR = 3.38; 6.68) and ischemic stroke with hemorrhagic transformation (PR = 3.08; 95% CI PR = 1.63; 5.81), male sex (PR = 1.60; 95% CI PR = 1.16; 2.22), spasticity (PR = 13.78; 95% CI PR = 8.59; 22.10), and cognitive impairment (PR = 1.88; 95% CI PR = 1.36; 2.60) were independently associated with HO. Patients with HO were younger (P < .0001) and presented a shorter time of disease (P = .013). Young adult patients were more likely to develop severe HO (odds ratio = 2.80, 95% CI 1.09; 7.20) than were elderly patients. Severe HO was also related to heavy alcohol consumption (2.45; 1.03-5.84) and involved 2 or more joints (5.34; 1.85-15.36). There was an association with use of invasive ventilation (6.30; 2.13-18.63) at the acute stroke phase and patients were dependent on activities of daily living after stroke (3.90; 1.00-15.19). CONCLUSIONS: Despite the small prevalence of HO after stroke, this 10-year multicenter study was able to identify several associated factors related to the management and severity of stroke as well as the hemorrhagic subtype.

Cause-specific mortality for 249 causes in Brazil and states during 1990-2015: a systematic analysis for the global burden of disease study 2015.

BACKGROUND: Reliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015. METHODS: We describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states. RESULTS: There was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country's Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI. CONCLUSIONS: A widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly.

Trend of the Burden of Larynx Cancer in Brazil, 1990 to 2019.

INTRODUCTION: Larynx cancer is one of the most common head and neck cancers, whose main risk factors are smoking and alcohol use, and its occurrence and prognosis depend on adequate and timely preventive measures. This study aimed to investigate the burden of larynx cancer in Brazil and its states. METHODS: Using estimates from the Global Burden of Disease Study 2019, this study analyzed the trends of incidence, mortality, and disability-adjusted life years (DALYs) for larynx cancer between 1990 and 2019, besides the mortality-to-incidence ratio and the socio demographic index. RESULTS: Incidence and mortality due to larynx cancer in Brazil, which are approximately eight-fold higher for men, showed a declining trend between 1990 and 2019 (APPC: -0.4% and -1.0%, respectively). The DALYs also showed negative variation between 1990 and 2019 for both sexes in Brazil, mainly due to the decrease in premature deaths, with the greatest reduction in the state of São Paulo. For the states of Brazil in 2019, the higher age-standardized incidence rate (Rio Grande do Sul, 3.83 cases per 100,000 inhabitants) is twice the lowest rate (Piauí, 1.56 cases per 100,000 inhabitants). CONCLUSIONS: A fall in the burden of larynx cancer was observed in Brazil over the past 30 years, which may be attributed to a reduction in smoking and to an improvement in treatment. However, the regional inequalities in the country remain evident, especially for males. This data can guide public policy priorities to control the disease in Brazil.

The increasing burden of pancreatic cancer in Brazil from 2000 to 2019: estimates from the Global Burden of Disease Study 2019.

INTRODUCTION: Pancreatic cancer is increasing worldwide. The burden of pancreatic cancer in Brazil and its states was analyzed and compared with that from the USA and China. METHODS: This is a descriptive study of the incidence and mortality estimates from the Global Burden of Disease 2019 study, from 2000 to 2019. The Brazilian states presenting the highest and lowest socio-demographic index (SDI) were selected from each of the five regions. The SDI consists of the per capita income, education, and fertility rate of each population. RESULTS: A significant increase was found in age-standardized incidence and mortality of pancreatic cancer in all three countries, with differences in magnitude and annual increases. In Brazil, this incidence rose from 5.33 [95% Uncertainty Interval (UI): 5.06- 5.51] to 6.16 (95% UI: 5.68- 6.53) per 100,000 inhabitants. China and the Brazilian states with the lowest SDI, such as Pará and Maranhão, showed lower incidence and mortality rates, although presenting the highest annual increases. No difference was found between the sexes. A higher mortality rate was observed for those individuals of 70+ years, which was three to four times higher than those aged 50 to 69 years. CONCLUSIONS: The increasing burden of pancreatic cancer in the studied countries, and the higher estimates for the elderly in a fast-aging country such as Brazil, indicates that more resources and health policies will be necessary. The greatest increase in the states with lower SDI reflects inequalities in the access to diagnosis and registries of this cancer.

Suicide mortality among older adults in Brazil between 2000 and 2019 - estimates from the Global Burden of Disease Study 2019.

INTRODUCTION: Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states. METHODS: This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI). RESULTS: During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states' rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50). CONCLUSIONS: The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.

Diabetes and hypertension are associated with lowered cognitive performance among middle-aged Brazilian adults: cross-sectional analyses nested in the longitudinal Pró-Saúde study.

BACKGROUND: Cardiovascular risk factors are frequently associated with lowered cognitive performance among elderly people, but rarely among middle-aged adults. OBJECTIVES: To investigate associations between cardiovascular risk factors (age, physical inactivity, smoking, alcohol use, hypertension and diabetes) and lower cognitive performance among middle-aged (45-64 years) Brazilian adults. DESIGN AND SETTING: Cross-sectional study nested within the Pró-Saúde cohort. From 2,876 baseline study participants (1999), we randomly selected 488 participants and gave them validated and standardized cognitive tests (2012). METHODS: We used multiple linear and logistic regression analyses to detect associations of cardiovascular risk factors with crude scores in cognitive tests on memory (word test) and executive function (verbal fluency tests), and with overall cognitive performance scores, respectively. RESULTS: All cognitive test scores presented statistically significant inverse associations with age and direct associations with education. There was no association between lower cognitive performance and smoking or alcohol use. In both 1999 and 2012, after adjusting for sex, age and schooling, being physically active was inversely associated with lower performance regarding late memory. For individuals with diabetes in 1999, there was an association with lower performance regarding executive function, while there was a borderline association for those reporting it only in 2012. Having a diagnosis of hypertension since 1999 was associated with lower performance regarding both memory and executive functions, while reporting hypertension in 2012 was associated with lower performance regarding executive function. CONCLUSIONS: Aging, low schooling and cardiovascular risk factors may represent life course disadvantages associated with cognitive decline even among middle-aged Brazilian adults.

The COVID-19 Pandemic in Brazil: Institute for Health Metrics and Evaluation projections and observed evolution, May-August, 2020. / A pandemia da COVID-19 no Brasil: a série de projeções do Institute for Health Metrics and Evaluation e a evolução observada, maio a agosto de 2020.

OBJECTIVE: To describe the Institute for Health Metrics and Evaluation (IHME) projections for the COVID-19 pandemic in Brazil and the Brazilian states, present their accuracy and discuss their implications. METHODS: The IHME projections from May to August 2020 for Brazil and selected states were compared with the ensuing reported number of cumulative deaths. RESULTS: The pandemic was projected to cause 182,809 deaths by December 1, 2020 in Brazil. An increase in mask use could reduce the projected death toll by ~17,000. The mean error in the cumulative number of deaths at 2, 4 and 6 weeks after the projections were made was 13%, 18% and 22%, respectively. CONCLUSION: Short and medium-term projections provide important and sufficiently accurate data to inform health managers, elected officials, and society at large. After following an arduous course up until August, the pandemic is projected to decline steadily although slowly, with ~400 deaths/day still occurring in early December.

Higher mortality during the COVID-19 pandemic in socially vulnerable areas in Belo Horizonte: implications for vaccine prioritization. / Maior mortalidade durante a pandemia de COVID-19 em áreas socialmente vulneráveis em Belo Horizonte: implicações para a priorização da vacinação.

OBJECTIVE: To assess mortality during the COVID-19 pandemic according to social vulnerability by areas of Belo Horizonte (BH), aiming at strategies for vaccination. METHODS: Ecological study with mortality analysis according to census tracts classified by the Health Vulnerability Index, a composite indicator that includes socioeconomic and sanitation variables. Deaths by natural causes and by COVID-19 were obtained from the "Mortality Information System", between the 10th and 43rd epidemiological weeks (EW) of 2020. Excess mortality was calculated in a time series model, considering observed and expected deaths per EW, between 2015 and 2019, per census tracts. Mortality rates (MR) were calculated and age-standardized using population estimates from the 2010 census, by the Brazilian Institute of Geography and Statistics (IBGE). RESULTS: Excess mortality in BH was 16.1% (n = 1,524): 11, 18.8 and 17.3% in low, intermediate and high vulnerability areas, respectively. The differences between observed and expected age-standardized MR by natural causes were equal to 59/100,000 inhabitants in BH, increasing from 31 to 77 and 95/100,000 inhabitants in the areas of low, intermediate and high vulnerability, respectively. There was an aging gradient in MR by COVID-19, ranging from 4 to 611/100,000 inhabitants among individuals aged 20-39 years and 75+ years. The COVID-19 MR per 100,000 older adults (60+ years) was 292 in BH, increasing from 179 to 354 and 476, in low, intermediate and high vulnerability areas, respectively. CONCLUSION: Inequalities in mortality, particularly among older adults, combined with the limited supply of doses, demonstrate the importance of prioritizing socially vulnerable areas during vaccination against COVID-19.

OBJETIVO: Avaliar a mortalidade por áreas de Belo Horizonte (BH) durante a pandemia de COVID-19 conforme a vulnerabilidade social, visando a uma estratégia de vacinação. MÉTODOS: Estudo ecológico com análise de mortalidade, segundo setores censitários classificados pelo índice de vulnerabilidade da saúde, composto de indicadores de saneamento e socioeconômicos. Óbitos por causas naturais e COVID-19 foram obtidos do Sistema de Informação sobre Mortalidade, entre a 10ª e a 43ª semanas epidemiológicas (SE) de 2020. Calculou-se o excesso de mortalidade por modelo de série temporal, considerando-se as mortes observadas por SE entre 2015 e 2019, por setor censitário. Taxas de mortalidade (TM) foram calculadas e padronizadas por idade com base em estimativas populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). RESULTADOS: Houve 16,1% (n = 1.524) de excesso de mortalidade em BH: 11, 18,8 e 17,3% nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. As diferenças entre TM observadas e esperadas por causas naturais, padronizadas por idade, foi igual a 59/100 mil habitantes em BH, aumentando de 31 para 77 e 95/100 mil, nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. Houve gradiente de aumento com a idade nas TM por COVID-19, variando de 4 a 611/100 mil habitantes entre as idades de 20-39 anos e 75+ anos. A TM por COVID-19 por 100 mil idosos (60+ anos) foi igual a 292, aumentando de 179 para 354 e 476 nos setores de baixa, média e elevada vulnerabilidade, respectivamente. CONCLUSÃO: Desigualdades na mortalidade, mesmo entre idosos, aliadas à baixa oferta de doses, demonstram a importância de priorizar áreas socialmente vulneráveis durante a vacinação contra COVID-19.

Dementias in Brazil: increasing burden in the 2000-2016 period. Estimates from the Global Burden of Disease Study 2016.

INTRODUCTION: Dementia is a globally relevant health problem, which places a great burden on patients and their families. This study aimed to estimate the burden associated with Alzheimer's disease (AD) and other dementias in Brazil. METHODS: In this descriptive study, we investigated the estimates obtained by the Global Burden of Disease study. We described the prevalence of AD and other dementias, years lived with disability (YLDs), age-standardized mortality, years of life lost (YLLs), and disability-adjusted life years (DALYs) among individuals aged 60 years or older between 2000 and 2016, with their respective 95% uncertainty intervals (95%UI). RESULTS: During this period, the age-standardized prevalence of AD and other dementias per 100,000 people increased by 7.8%, from 961.7 (95%UI 828.3-1,117.5) to 1,036.9 (95%UI 882.0-1,219.5), with approximately 1.5 million people living with dementia in Brazil. The incidence increased by 4.5%. Similarly, all age-standardized rates had an upward trend (mortality: 3.1%; YLLs: 5.8%; YLDs: 7.9%; and DALYs: 6.3%). Mortality profiles increased with age in both years. Dementias were ranked fourth among the leading causes of death in people aged ≥70 years in 2000, rising to second place in 2016. In 2016, it also represented the second and third leading causes of disability among older women and men, respectively. CONCLUSION: Population growth and aging have resulted in an increased burden of AD and other dementias in Brazil. Preventive and early diagnostic measures are essential to mitigate the burden associated with these diseases.

Mortalidade e carga do câncer de laringe atribuíveis aos riscos ocupacionais no Brasil: estudo da Carga Global de Doença, 2019 / Laryngeal cancer mortality and burden attributable to occupational risks in Brazil: 2019 Global Burden of Disease

Resumo Objetivo: descrever a mortalidade e os anos de vida ajustados pela incapacidade disability-adjusted life years - DALYs) para câncer de laringe no Brasil atribuíveis a fatores de risco ocupacionais e comportamentais. Métodos: estudo ecológico com dados do estudo Global Burden of Disease 2019. Foram obtidas taxas de mortalidade e de DALYs para o câncer de laringe atribuíveis aos riscos ocupacionais (ácido sulfúrico e amianto) e comportamentais (tabaco e álcool), de 1990 e 2019. Resultados: no Brasil, em 2019, a taxa de mortalidade por câncer de laringe atribuível aos riscos ocupacionais (ácido sulfúrico e amianto) foi 0,28 (II95%: 0,17;0,43) no sexo masculino e 0,03 (II95%: 0,02;0,04) no feminino, e a de DALYs foi 7,33 (II95%: 4,28;11,44) e 0,64 (II95%: 0,35;0,03), respectivamente. O ácido sulfúrico foi o principal risco ocupacional para a doença. Houve redução das taxas atribuíveis ao tabaco (mortalidade:-45,83%; DALYs:-47,36%) e aos riscos ocupacionais (mortalidade:-23,20%; DALYs:-26,31%), no Brasil, com aumento em alguns estados das regiões Norte e Nordeste. Conclusão: houve redução na mortalidade e na carga do câncer de laringe atribuível aos fatores ocupacionais no período, porém menor em comparação ao tabagismo, reforçando a importância de ações para reduzir o impacto dos riscos ocupacionais, como as medidas regulatórias aplicadas ao tabaco.

Abstract Objective: to describe mortality and disability-adjusted life years (DALYs) due to laryngeal cancer attributable to occupational and behavioral risk factors in Brazil. Methods: this is an ecological study with data from the 2019 Global Burden of Disease. Mortality and DALY rates for laryngeal cancer attributable to occupational (sulfuric acid and asbestos) and behavioral (tobacco and alcohol) risks were obtained from 1990 and 2019. Results: in 2019, the mortality rate from laryngeal cancer attributable to occupational hazards (sulfuric acid and asbestos) totaled 0.28 (95%UI: 0.17; 0.43) and 0.03 (95%UI: 0.02; 0.04), whereas and DALY rates, 7.33 (95%UI: 4.28; 11.44) and 0.64 (95%UI: 0.35; 0.03) in men and women in Brazil, respectively. Sulfuric acid configured the main occupational risk for the disease. The rates attributable to tobacco (mortality: −45.83%; DALYs: −47.36%) and occupational hazards (mortality: −23.20%; DALYs: −26.31%) decreased in Brazil but increased in some Northern and Northeastern states. Conclusion: laryngeal cancer mortality and burden attributable to occupational factors decreased in the period (although less than that for smoking), reinforcing the importance of actions to reduce the impact of occupational risks, such as the regulatory measures applied to tobacco.

Improvement of data quality on the underlying cause of death from external causes using Health, Public Security and Press sector database linkage in the State of Rio de Janeiro, Brazil, 2014. / Melhoria da qualidade do registro da causa básica de morte por causas externas a partir do relacionamento de dados dos setores Saúde, Segurança Pública e imprensa, no estado do Rio de Janeiro, 2014.

OBJECTIVE: to describe improvement of the quality of data on the underlying cause of death from external causes, after performing Health, Public Security and Press sector database linkage in the State of Rio de Janeiro, Brazil, 2014. METHODS: deterministic data linkage on deaths from external causes of undetermined intent and deaths from undetermined natural causes held on the Mortality Information System (SIM), Forensic Institute, Civil Police, Urgent Mobile Care Service (SAMU) and press databases. RESULTS: of the 13,916 deaths from external causes, deaths from causes of undetermined intent were reduced from 5,836 (41.9%) to 958 (6.9%); while 222 (10.7%) of the 2,069 deaths from undetermined natural causes were reclassified to external causes; there was an increase in mortality due to traffic accidents (93.0%), assault (71.6%), legal intervention (744.7%), intentional self-harm (112%) and other accidents (29.9%). CONCLUSION: there was an improvement in the quality of the information by type of underlying cause of death from external causes, using a strategy that can be reproduced by other services.

First stages chronic kidney disease have mild effects on cognitive performance. Results of a 15,105 brazilian adult baseline cohort.

INTRODUCTION: The aging of the population may lead to an increased prevalence of dementia and chronic kidney disease (CKD) and their overlap. OBJECTIVE: We investigated the association between CKD and cognitive performance among Brazilian adults (35-74 years). METHODS: Baseline data analysis of the Longitudinal Study of Adults (ELSA-Brasil), a multicenter cohort comprising 15,105 civil servants, was performed. Kidney function was defined by the CKD-Epi-estimated GRF and albumin creatinin ratio (ACR). Cognitive performance was measured across tests that included the word memory tests, verbal fluency tests and Trail Making Test B. Multiple logistic and linear regressions were used to investigate the association between CKD and global as well as test-specific lowered cognitive performance. RESULTS: More than 90% of participants did not present CKD even considering reduced GFR or increased ACR simultaneously. Lowered cognitive performance was detected among 15.8% of the participants and mean values of GFR were slightly higher among those with normal than with lowered cognitive performance (86 ± 15 mL/min/1.73 m2 x 85 ± 16 mL/min/1.73 m2, p < 0.01). Age, education, skin-color, smoking, drinking, hypertension, and diabetes were associated with lowered cognition. After adjustment for these variables, there was no association between CKD and lowered cognitive performance. Negligibly small beta values were observed when analyzing CKD and the scores of all tests. CONCLUSION: These results suggest that cognitive performance remains preserved until renal function reaches significant worsening. Preventive measures to maintain renal function may contribute to the preservation of cognitive function.

The Burden of disease attributable to mental and substance use disorders in Brazil: Global Burden of Disease Study, 1990 and 2015. / A carga dos transtornos mentais e decorrentes do uso de substâncias psicoativas no Brasil: Estudo de Carga Global de Doença, 1990 e 2015.

INTRODUCTION:: Mental and substance use disorders (MD) are highly prevalent and have a high social and economic cost. OBJECTIVE:: To describe the burden of disease attributable to mental and substance use disorders in Brazil and Federated Units in 1990 and 2015. METHODS:: Descriptive study of the burden of mental and substance use disorders, using age-standardized estimates from the Global Burden of Disease Study 2015: years of life lost due to premature mortality (YLL); years lived with disability (YLD); and disability-adjusted life year (DALY=YLL+YLD). RESULTS:: In Brazil, despite low mortality rates, there has been a high burden for mental and substance use disorders since 1990, with high YLD. In 2015, these disorders accounted for 9.5% of all DALY, ranking in the third and first position in DALY and YLD, respectively, with an emphasis on depressive and anxiety disorders. Drug use disorders had their highest increase in DALY rates between 1990 and 2015 (37.1%). The highest proportion of DALY occurred in adulthood and in females. There were no substantial differences in burden of mental and substance use disorders among Federated Units. CONCLUSION:: Despite a low mortality rate, mental and substance use disorders are highly disabling, which indicates the need for preventive and protective actions, especially in primary health care. The generalization of estimates in all the Federated Units obtained from studies conducted mostly in the south and southeast regions probably does not reflect the reality of Brazil, indicating the need for studies in all regions of the country.

Mortality and disability from tobacco-related diseases in Brazil, 1990 to 2015. / Mortalidade e incapacidade por doenças relacionadas à exposição ao tabaco no Brasil, 1990 a 2015.

INTRODUCTION:: The global tobacco epidemic has taken pandemic proportions, with about 1.3 billion users and 6 million annual deaths. This study aimed to analyze the trends in mortality from chronic obstructive pulmonary disease (COPD) and lung, lips, oral cavity, pharynx, and esophagus cancer in Brazil between 1990 and 2015. METHODS:: The study was made possible through a partnership between the Metrics and Health Assessment Institute (IHME), University of Washington, Ministry of Health and the GBD Brazil technical group, using estimates from the Global Disease Charge 2015 study. RESULTS:: The mortality rates due to COPD fell; in 1990, it was 64.5/100,000 inhabitants and in 2015, 44.5, a decrease of 31%. For the various types of cancer related to smoking, the decrease was in a lower proportion than for COPD. For lung cancer, rates were 18.7/100,000 inhabitants in 1990 to 18.3 in 2015. For women, there is an upward curve for lung cancer from 1990 to 2015, with an increase of 20.7%. DISCUSSION:: The study points to smoking as a risk factor for premature mortality and disability due to COPD and cancer. The significant reduction in tobacco prevalence in recent decades could explain reductions in tobacco-related disease trends. The higher mortality from lung cancer in women may express the delayed increase in smoking in this gender. CONCLUSION:: Nationwide actions taken in the last decades have had a great effect on reducing mortality from tobacco-related diseases, but there are still major challenges, especially when it comes to women and young people.

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.

Burden of disease by lower respiratory tract infections in Brazil, 1990 to 2015: estimates of the Global Burden of Disease 2015 study. / Carga de doença por infecções do trato respiratório inferior no Brasil, 1990 a 2015: estimativas do estudo Global Burden of Disease 2015.

INTRODUCTION:: Lower respiratory tract infections (LRTIs) present significant incidence and mortality in the world. This article presents the impact of LRTIs in the burden of disease, according to the metrics used in the Global Burden of Disease study (GBD 2015) for Brazil in 1990 and 2015. METHODS:: Analysis of estimates from the GBD 2015: years of life lost due to premature death (YLLs), years lived with disability (YLDs), years of life lost due to death or disability (DALYs = YLLs + YLDs). RESULTS:: LRTIs were the third cause of mortality in Brazil in 1990 and 2015, with 63.5 and 47.0 deaths/100,000 people, respectively. Although the number of deaths increased 26.8%, there was a reduction of 25.5% in mortality rates standardized by age, with emphasis on children under 5 years of age. The disability indicators, as measured by the DALYs, demonstrate a progressive reduction of the disease burden by LRTIs. DISCUSSION:: Despite the reduction in mortality rates in the period, LRTIs were an important cause of disability and still the third cause of death in Brazil in 2015. The increase in the number of deaths occurred due to the increase in population and its aging. The reduction in mortality rates accompanied the improvement of socioeconomic conditions, broader access to health care, national availability of antibiotics, and vaccination policies adopted in the country. CONCLUSION:: Despite the current socioeconomic difficulties, there has been a progressive reduction of the LRTIs load effect in Brazil, mostly in mortality and disability, and among children under 5 years of age.