Trends in mortality rates where alcohol was a necessary cause of death in Brazil, 2000-2013.

OBJECTIVE: To analyze trends in mortality due to diseases and conditions fully attributable to alcohol in Brazil. METHODS: This was an ecological time-series study. Proportional, specific, and age-standardized mortality rates between 2000 and 2013 that were due to underlying or contributing causes fully attributable to alcohol use were analyzed by sex, ethnicity/skin color, age group, and region of residence in the country. Data on deaths were obtained from the Brazilian Mortality Information System (SIM). Prais-Winsten regression was used to analyze trends. RESULTS: Deaths with underlying causes and/or conditions contributing to death fully attributable to alcohol accounted for 2.5% of total deaths in the period. There were more deaths among men (3.8%) than among women (0.7%). In both sexes, there was a higher proportion of deaths in those 40-49 years old (27.9%) and those of black or pardo (mixed race) skin color (48.8%). Between 2000 and 2013, there was an upward trend in specific mortality rates attributable to alcohol in the country as a whole (average annual growth rate (AAGR) = 5.59%; 95% confidence interval (CI) = 3.55%-7.68%), especially in people aged less than 20 years old, in pardos (AAGR = 13.42%; 95% CI = 9.70%-17.25%), and in residents of the North region (AAGR = 17.01%; 95% CI = 14.94%-19.13%), the Northeast region (AAGR = 15.49%; 95% CI = 10.61%-20.58%), and the Midwest region (AAGR = 8.40%; 95% CI = 5.57%-11.32%). CONCLUSION: Alcohol is an important and growing cause of premature death in Brazil, especially among men, black/pardo people, and the population living in the most disadvantaged regions. This overall increase in the harmful use of alcohol reflects ethnic and socioeconomic inequalities in Brazil, and it also points to the need for population-based policies to reduce the impact of morbidity and to prevent early mortality.

[Alcohol use as a necessary cause of death in Brazil, 2010-2012]. / Uso de álcool como causa necessária de morte no Brasil, 2010 a 2012.

OBJECTIVE: To describe mortality from diseases, conditions, and injuries for which alcohol consumption is a necessary cause during the 2010-2012 triennium in Brazil. METHODS: A descriptive study was conducted with data from the Brazilian Ministry of Health's Mortality Information System (SIM). The analysis included deaths whose primary cause was classified as any of the 78 codes of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) corresponding to the diseases, conditions, and injuries for which the use of alcohol is a necessary cause. RESULTS: Deaths with alcohol consumption as a necessary cause totaled 55 380 (88.5% in men). The crude mortality rate for the triennium was 9.6/100 000 people in the overall population, 17.35/100 000 men in males, and 2.15/100 000 women in females. Higher mortality rates were observed in the 50-59 year (28.45) and 60-69 year (27.23) age groups and among people with black or brown skin color (10.15). The Northeast (11.70) and Midwest (11.04) regions exhibited higher age-adjusted mortality rates. Liver diseases were the leading cause of death (55.3%). CONCLUSIONS: Mortality from causes related to alcohol consumption is high in Brazil, especially among men, people aged 50-69 years, and residents in the Northeast and Midwest regions.

Mortality in the Americas from 2013 to 2015 resulting from diseases, conditions and injuries which are 100% alcohol-attributable.

AIMS: To describe mortality in the Americas from 2013 to 2015 inclusive resulting from diseases, conditions and injuries which are 100% attributable to alcohol consumption. DESIGN AND SETTING: Mortality registry, population-based study. The data come from 30 of the 35 countries of the Americas for the triennium of 2013 to 2015. PARTICIPANTS AND CASES: A total of 18 673 791 deaths coded by three-digit ICD-10 codes were analyzed. MEASUREMENTS: Cause (underlying), and age-specific and age-adjusted mortality rates were calculated by sex and country. FINDINGS: From 2013 to 2015 inclusive, among 30 of the 35 countries of the Americas, an average of 85 032 deaths per year were entirely attributable to alcohol. Men accounted for 83.1% of all 100% alcohol-attributable deaths, and death rates were higher for men than for women across all countries; however, the ratios of 100% alcohol-attributable deaths by sex varied by country. The majority of all 100% alcohol-attributable deaths occurred among those aged under 60 years (64.9%) and were due to liver disease (63.9%) followed by neuropsychiatric disorders (27.4%). Age-adjusted 100% alcohol-attributable mortality rates were highest in Nicaragua (23.2 per 100 000) and Guatemala (19.0 per 100 000), although the majority of all 100% alcohol-attributable deaths occurred in the United States 36.9%), Brazil (24.8%), and Mexico (18.4%). CONCLUSIONS: From 2013 to 2015, more than 85 000 deaths in the Americas were 100% attributable to alcohol. Most of those occurred in people under 60 years and the highest mortality rates occurred in the United States, Brazil and Mexico.

[The importance of falls on the same level among the elderly in São Paulo state]. / A importância das quedas no mesmo nível entre idosos no estado de São Paulo.

OBJECTIVE: To analyze characteristics of fall related injuries, with emphasis on falls on the same level, of those with 60 years or more of age,, resident in the state of Sao Paulo, based on three official information sources. METHODS: A total of 1,328 deaths registered in the Information Mortality System in 2007, 20,726 hospital admissions registered in the Hospitalization Information System in 2008 and 359 visits to 24 different emergency departments (ED) in 2007 were analyzed. A logistic regression model was used to test associations between some variables. RESULTS: B More fatal fall victims were male (51.2%), while females were predominant among hospital admissions (61.1 %) and ED visits (60.4 %). The mortality rate was 31.0/100,000, reaching 110.7/100,000 among those aged 80 years or more. Falls on the same level were responsible for the largest proportion of definite deaths (35.0 %), hospital admissions (47.5 %) and also ED visits (66.0 %), increasing with the age groups. Residences were the place of occurrence for 65.8 % of the cases in EDs. Head trauma was important among deaths; femur fractures were the most frequent injuries for hospital admissions and ED visits. Compared to men, women were 1.55 times significantly more likely to be attended for a fall than other external causes. Comparatively In comparison to people aged 60 to 69 years, those aged 70 to 79 years and 80 years old or more were 2.10 and 2.26 times, respectively more likely to be fall victims than victims of other external causes. There was no statistically significant difference among people who suffered falls on the same level and other types of falls, for gender and age groups when one compared individuals. CONCLUSION: It is urgent to implement fall prevention programs forto the elderly.

Profile of cases due to burn attended in emergency care units in Brazilian capitals in 2017. / Perfil dos casos de queimadura atendidos em serviços hospitalares de urgência e emergência nas capitais brasileiras em 2017.

OBJECTIVES: To describe the profile of burn victims attended in emergency services and to identify associations between the variables investigated. METHODS: Cross-sectional study based on data from the 2017 survey "Surveillance of violence and accidents in emergency units". We used descriptive analysis, according to demographic characteristics and aspects related to the burn injury, as well as the correspondence analysis technique, which allowed to verify possible associations between the variables investigated. RESULTS: Burns were more frequent: in adults aged between 20 and 39 years (40.7%); in men (57.0%); in the household (67.7%); due to hot substances (52.0%). Household accidents were more frequent in the age group 0-15 years (92.0%) and elderly (84.4%), and in women (81.6%). Accidents in commerce, services and industry affected individuals aged 16 to 59 years (73.6%). Referral to other hospitals was associated with cases in the elderly and hospitalization with the cases in individuals aged between 0 and 15 years old. Events in the working age population were associated with alcohol use and the workplace. Among women, it is suggested to associate burn accidents with household and hot substances. CONCLUSIONS: The results point to the need for oriented actions in the field of health education, as well as labor regulation and supervision.

[Treatment of injuries in emergency departments: characteristics of victims and place of injury, São Paulo State, Brazil, 2005]. / Atendimentos de emergência por lesões decorrentes de causas externas: características das vítimas e local de ocorrência, Estado de São Paulo, Brasil, 2005.

The objective of this study was to analyze the characteristics and place of occurrence of injuries treated in emergency departments. A total of 35,107 emergency department visits for injuries were analyzed, excluding traffic injuries, in São Paulo State, Brazil, 2005. The majority of victims were male (59.1%), and from 0 to 29 years of age (62.1%). Leading causes were falls (39.3%) and accidental blows (16.5%). Most injuries occurred in the home (64.7%), followed by public places (19.9%). Assaults were more frequent in public. Women were more likely to suffer injuries at home, as compared to men (OR = 0.51; 95% CI: 0.48-0.53). Men were 1.34 times more likely to be injured in public places, 3.22 times in bars, and 2.82 times in the workplace. A higher proportion of events among children aged 0 to 9 and individuals 60 years or older occurred at home. The results highlighted the home as an important place for the occurrence of injuries, which should be considered when planning injury prevention programs.

The burden of injury in Brazil, 2003.

CONTEXT AND OBJECTIVE: Since 1980, injuries have been the second biggest cause of death among the Brazilian population. This study aimed to analyze national data on fatal injuries and nonfatal injury hospitalization in Brazil, for 2003. DESIGN AND SETTING: This was a population-based descriptive study, Brazil, 2003. METHODS: Data from 126,520 fatal injuries and 733,712 nonfatal injuries seen at public hospitals were analyzed. The data were stratified by sex, age, intent and injury mechanism. Raw and age- and sex-specific rates were calculated per 100,000 individuals. RESULTS: The raw injury mortality rate was 71.5/100,000 (122.6/100,000 for male and 22.0/100,000 for female). For fatal injuries, the proportions of unintentional and intentional injuries were equal (44.3% and 46.9%, respectively). Homicides were the leading cause, 40.3% overall (28.8/100,000), followed by transport-related deaths, 26.2% overall (17.0/100,000). For nonfatal injuries, the rate was 414.8/100,000 and unintentional injuries were predominant (88.9%). Overall, the leading cause was unintentional falls, accounting for 42.6% of victims treated in public hospitals (176.8/100,000). Transport-related injuries were second: 15.0% overall; 62.0/100,000. Fractures comprised 46.7% of principal diagnoses at hospitals. The injury types in the fatal and nonfatal datasets varied according to sex and age. The highest rates were found among young males and elderly people. CONCLUSIONS: Injury prevention activities need to be developed. To prevent deaths, homicide has to be addressed. Among hospitalized cases, falls are the most important problem. Traffic-related injuries play an important role in morbidity and mortality.

[Social inequality and homicide rates in Sao Paulo City, Brazil]. / Homicídios e desigualdades sociais no Município de São Paulo.

OBJECTIVE: The relation between income and mortality due to violence has been studied in recent years. The Synthesis of Social Indicators of 2002 [Sintese de Indicadores Sociais, 2002], published by The Brazilian Institute of Geography and Statistics (IBGE), states that one of the most outstanding characteristic of Brazilian society is inequality. The proposal of this ecological study was to test the association between homicide rates, and some health and socioeconomic indicators. METHODS: This is an ecological cross-sectional study. Data regarding Sao Paulo City, Brazil in the year 2000 was analyzed. The association between homicide coefficients and the following five indicators were tested: infant mortality rates, monthly average income of household heads, percentage of adolescents aged 15 to 17 years not attending school, proportion of pregnant adolescent women aged 14 to 17 years and demographic density. Pearson's correlation coefficient and a multiple linear regression model were utilized to test these associations. RESULTS: The municipal homicide rate was 57.3/100,000. The correlation between homicide rates and average monthly income was strong and negative (r=-0.65). Higher homicide rates were found in the districts whose inhabitants had lower incomes and lower rates were found in those districts whose inhabitants had higher incomes. The correlation between homicide rates and proportion of adolescents not attending school was positive and strong (r=0.68). The correlation between homicide rates and the proportion of pregnant adolescent women was positive and strong (r=0.67). The correlation between homicides and the rate of infant mortality was r=0.24 (for all: p<0.05). The correlation between demographic density and homicides was not significant. Although the univariate regression was positive for four indicators, the multivariate regression test was only significant for average monthly income (negative) and proportion of adolescents not attending school (positive) (for both indicators: p<0.01). CONCLUSIONS: The findings highlight the problem of homicides and socioeconomic disparities in S. Paulo City. Economic development and reducing socioeconomic inequality may have an impact on the rates of mortality due to violence.

[Linking of information from health and security databases on homicides]. / Informações sobre homicídios e sua integração com o setor saúde e segurança pública.

OBJECTIVE: Increased homicide rates in the city of Sao Paulo, Brazil, in the last two decades points out to the need for better understanding this subject. The purpose of the present study was to link information about homicide from different sources of data. METHODS: Homicide data from death certificates, medical examiners and police records of residents in the city of Sao Paulo was linked for the second semester of 2001. Variables about victims, risk factors and homicide circumstances were analyzed using absolute numbers, proportions and coefficients. Statistical differences were tested using Pearson's Chi-square test. RESULTS: Homicide crude rate was 57.2/100,000. Higher rates were observed among men aged 15 to 29 years (56.0% of all cases). The proportion of firearm-related homicides was 88.6%, higher among men than women. Most injuries were to the head (68.9%). Among the victims who underwent to drug screening, 42.5% had high blood alcohol concentrations (44.0% for men and 24.0% for women). Most events occurred at night during weekends and it was found a high correlation (74.6%) between the victim's place of residence and event location. CONCLUSIONS: The study findings highlight that linking information provides better quality of data and allows for better understanding of homicides.

Perfil dos casos de queimadura atendidos em serviços hospitalares de urgência e emergência nas capitais brasileiras em 2017 / Profile of cases due to burn attended in emergency care units in Brazilian capitals in 2017

RESUMO: Objetivos: Definir o perfil das vítimas de queimadura atendidas nos serviços de emergência e identificar possíveis associações entre as variáveis investigadas. Métodos: Estudo transversal com base nos dados do inquérito "Vigilância de Violências e Acidentes em Unidades Sentinelas de Urgência e Emergência", de 2017. Procedeu-se à análise descritiva segundo características demográficas e aspectos relativos ao acidente por queimadura, bem como à técnica de análise de correspondência, que permitiu verificar possíveis associações entre as variáveis investigadas. Resultados: Os casos de queimadura foram mais frequentes: em adultos com idade entre 20 e 39 anos (40,7%); em homens (57%); no domicílio (67,7%); em decorrência do manuseio de substâncias quentes (52%). Acidentes no domicílio foram mais frequentes nas faixas etárias de 0 a 15 anos (92%) e idosos (84,4%) e em mulheres (81,6%). Acidentes no comércio, serviços e indústria acometeram indivíduos com idades entre 16 e 59 anos (73,6%). O encaminhamento para outros hospitais esteve associado aos casos ocorridos em idosos e a internação aos eventos que acometeram indivíduos na faixa de 0 a 15 anos de idade. Eventos na população em idade produtiva apresentaram associação com o uso de álcool e o local de trabalho. Entre as mulheres, sugere-se associação dos acidentes com o domicílio e substâncias quentes. Conclusão: Os resultados apontam para a necessidade de ações orientadas no campo da educação em saúde, bem como da regulamentação e da fiscalização trabalhistas.

ABSTRACT: Objectives: To describe the profile of burn victims attended in emergency services and to identify associations between the variables investigated. Methods: Cross-sectional study based on data from the 2017 survey "Surveillance of violence and accidents in emergency units". We used descriptive analysis, according to demographic characteristics and aspects related to the burn injury, as well as the correspondence analysis technique, which allowed to verify possible associations between the variables investigated. Results: Burns were more frequent: in adults aged between 20 and 39 years (40.7%); in men (57.0%); in the household (67.7%); due to hot substances (52.0%). Household accidents were more frequent in the age group 0-15 years (92.0%) and elderly (84.4%), and in women (81.6%). Accidents in commerce, services and industry affected individuals aged 16 to 59 years (73.6%). Referral to other hospitals was associated with cases in the elderly and hospitalization with the cases in individuals aged between 0 and 15 years old. Events in the working age population were associated with alcohol use and the workplace. Among women, it is suggested to associate burn accidents with household and hot substances. Conclusions: The results point to the need for oriented actions in the field of health education, as well as labor regulation and supervision.

[Morbidity and mortality from external causes in Brazil, 2000]. / As causas externas no Brasil no ano 2000: comparando a mortalidade e a morbidade.

Since the early 1980s, external causes have been the second greatest cause of death in Brazil. They also place a growing demand on health care services. The current study analyzes morbidity and mortality from external causes in Brazil. The study material consists of 118,367 deaths and 652,249 hospitalizations due to external causes during the year 2000. The data are from the National Mortality Information System and Hospital Information System. The mortality coefficient from external causes was 69.7/ 100 thousand (119.0/100 thousand for males and 21.8/100 thousand for women). Homicides were the leading cause of death (38.3% of the total), with a high coefficient of 26.7/100 thousand, while falls were the leading cause of hospitalizations (42.8% of the total). Motor vehicle accidents were a major cause of both morbidity and mortality. Fractures, mostly occurring in the upper and lower limbs, accounted for 42.6% of hospitalizations. Based on the findings, preventive programs should aim to decrease both mortality and morbidity, with special emphasis on homicides, traffic accidents, and falls.

[Injury among the elderly: the challenge to integrate preventive activities in public and individual levels]. / Mortes e internações por causas externas entre os idosos no Brasil: o desafio de integrar a saúde coletiva e atenção individual.

BACKGROUND: In Brazil and all over the world the elderly are increasing as a result of the raise in life expectancy. This group still faces a significant risk for some diseases as well as injuries. The proposal of this study was to describe fatal and nonfatal injuries among people aged 60 years and older in Brazil. SETTING: Brazil, the last year available was 2000. METHODS: The data from 13,383 injury deaths and 87,177 outcomes among people aged 60 years and older were analyzed. The data sets were obtained from Federal Health Department of Brazil from Mortality System Information (from death certificates) and Hospitalization Information System (from discharges registered in public hospitals). RESULTS: The mortality rate is 92.1/100,000 (135.3/100,000 for male and 56.8/100,000 for female) that are higher than overall population rates, especially for women. The lead cause is transport accidents (27.5% of total injury deaths) which mortality rate is 25.3/100,000 and 48.2% are pedestrian. Homicides rate is 9.5/100,000, it is almost three times lower than for total population in Brazil. Falls rate is 14.0/100,000, it is the third place in injury deaths for men and women and suicide rate is 6.9/100,000, lower than developed countries. Opposite to mortality, falls are the major cause of nonfatal injuries hospitalization for both men and women, accounting for 48,940 discharges (56.1%). Fractures are 52.8% of all injuries, especially in falls and transport accidents. CONCLUSIONS: It is crucial to develop injury preventive activities in both public and individual level. Falls should receive emphasis in injury prevention efforts.

Mortality from diseases, conditions and injuries where alcohol is a necessary cause in the Americas, 2007-09.

AIMS: To describe mortality from diseases, conditions and injuries where alcohol was a necessary cause in selected countries in the Americas. DESIGN: A descriptive, population-based study. SETTING: The data come from 16 countries in North, Central and South America for the triennium 2007-09 (latest available data). PARTICIPANTS/CASES: A total of 238 367 deaths were analyzed. MEASUREMENTS: We calculated age-adjusted and age-specific mortality rates by sex and country using the Pan American Health Organization (PAHO) mortality database. FINDINGS: The annual average of deaths where alcohol was a necessary cause in the 16 countries was 79, 456 (men comprised 86% and women 14%). People aged 40-59 years represented 55% overall. Most deaths were due to liver diseases (63% overall) and neuropsychiatric disorders (32% overall). Overall age-adjusted rates/100,000 were higher in El Salvador (27.4), Guatemala (22.3), Nicaragua (21.3) and Mexico (17.8) and lower in Colombia (1.8), Argentina (4.0) and Canada (5.7). The age groups at the highest risk were 54-59 to 64-69 years in most countries. In Guatemala, El Salvador and Nicaragua the rates increased earlier, among those aged 30-49 years. Male rates were higher than female rates in all countries, but the male : female ratio varied widely. CONCLUSIONS: Diseases, conditions or injuries where alcohol is a necessary cause are an important cause of premature mortality in the Americas, especially among men. Some countries show high risk of dying from this group of causes.

Mortality due to cardiovascular diseases in the Americas by region, 2000-2009.

CONTEXT AND OBJECTIVE: Cardiovascular diseases are the leading cause of death worldwide. The aim here was to evaluate trends in mortality due to cardiovascular diseases in three different regions of the Americas. DESIGN AND SETTING: This was a time series study in which mortality data from three different regions in the Americas from 2000 to the latest year available were analyzed. METHODS: The source of data was the Mortality Information System of the Pan-American Health Organization (PAHO). Data from 27 countries were included. Joinpoint regression analysis was used to analyze trends. RESULTS: During the study period, the age-adjusted mortality rates for men were higher than those of females in all regions. North America (NA) showed lower rates than Latin America countries (LAC) and the Non-Latin Caribbean (NLC). Premature deaths (30-69 years old) accounted for 22.8% of all deaths in NA, 38.0% in LAC and 41.8% in NLC. The trend analysis also showed a significant decline in the three regions. NA accumulated the largest decline. The average annual percentage change (AAPC) and 95% confidence interval was -3.9% [-4.2; -3.7] in NA; -1.8% [-2.2; -1.5] in LAC; and -1.8% [-2.7; -0.9] in NLC. CONCLUSION: Different mortality rates and reductions were observed among the three regions.

Trends in mortality rates where alcohol was a necessary cause of death in Brazil, 2000-2013 / Tendencias en las tasas de mortalidad donde el alcohol fue una causa necesaria de muerte en Brasil, 2000-2013 / Tendências nas taxas de mortalidade onde o álcool foi uma causa necessária de morte no Brasil, 2000-2013

ABSTRACT Objective To analyze trends in mortality due to diseases and conditions fully attributable to alcohol in Brazil. Methods This was an ecological time-series study. Proportional, specific, and age-standardized mortality rates between 2000 and 2013 that were due to underlying or contributing causes fully attributable to alcohol use were analyzed by sex, ethnicity/skin color, age group, and region of residence in the country. Data on deaths were obtained from the Brazilian Mortality Information System (SIM). Prais-Winsten regression was used to analyze trends. Results Deaths with underlying causes and/or conditions contributing to death fully attributable to alcohol accounted for 2.5% of total deaths in the period. There were more deaths among men (3.8%) than among women (0.7%). In both sexes, there was a higher proportion of deaths in those 40-49 years old (27.9%) and those of black or pardo (mixed race) skin color (48.8%). Between 2000 and 2013, there was an upward trend in specific mortality rates attributable to alcohol in the country as a whole (average annual growth rate (AAGR) = 5.59%; 95% confidence interval (CI) = 3.55%-7.68%), especially in people aged less than 20 years old, in pardos (AAGR = 13.42%; 95% CI = 9.70%-17.25%), and in residents of the North region (AAGR = 17.01%; 95% CI = 14.94%-19.13%), the Northeast region (AAGR = 15.49%; 95% CI = 10.61%-20.58%), and the Midwest region (AAGR = 8.40%; 95% CI = 5.57%-11.32%). Conclusion Alcohol is an important and growing cause of premature death in Brazil, especially among men, black/pardo people, and the population living in the most disadvantaged regions. This overall increase in the harmful use of alcohol reflects ethnic and socioeconomic inequalities in Brazil, and it also points to the need for population-based policies to reduce the impact of morbidity and to prevent early mortality.

RESUMEN Objetivo Analizar las tendencias en la mortalidad debido a enfermedades y condiciones totalmente atribuibles al alcohol en Brasil. Métodos Se realizó un estudio ecológico de series temporales. Las tasas de mortalidad proporcionales, específicas y estandarizadas por edad entre 2000 y 2013 que se debieron a causas subyacentes o contribuyentes totalmente atribuibles al consumo de alcohol se analizaron por sexo, raza/ color de piel, grupo de edad y región de residencia en el país. Los datos sobre muertes se obtuvieron del Sistema Brasileño de Información de Mortalidad (SIM). Se utilizó la regresión de Prais-Winsten para analizar las tendencias. Resultados Las muertes por causas subyacentes y / o condiciones que contribuyeron a causar la muerte totalmente atribuibles al alcohol representaron el 2,5% del total de muertes en el período en estudio. Hubo más muertes entre los hombres (3.8%) que entre las mujeres (0.7%). En ambos sexos hubo una mayor proporción de muertes entre los 40-49 años (27.9%) y en las personas de piel negra o parda (mestizos) (48.8%). Entre 2000 y 2013, hubo una tendencia ascendente en las tasas de mortalidad específicas atribuibles al alcohol en el país en general (Tasa de Crecimiento Anual Promedio (TCAP) = 5,59%, Intervalo de Confianza(IC) 95% = 3,55% −7,68%), especialmente en personas menores de 20 años, de tez pardos (TCAP = 13.42%, IC 95% = 9.70% −17.25%), y en residentes de la región Norte (TCAP= 17.01%, IC 95% = 14.94% −19.13%), Región Nordeste (AAGR = 15.49%, IC 95% = 10.61% −20.58%) y la región Medio Oeste (AAGR = 8.40%, IC 95% = 5.57% −11.32%). Conclusión El alcohol es una causa importante y creciente de muerte prematura en Brasil, especialmente entre hombres, personas de raza negra y parda y la población que viven en las regiones más desfavorecidas. Este aumento general en el uso nocivo de alcohol refleja las desigualdades étnicas y socioeconómicas en Brasil, y también señala la necesidad de políticas basadas en la población para reducir el impacto de la morbilidad y prevenir la mortalidad temprana.

RESUMO Objetivo Analisar tendências de mortalidade por doenças e condições totalmente atribuíveis ao álcool no Brasil. Métodos Este foi um estudo ecológico de séries temporais. As taxas de mortalidade proporcionais, específicas e padronizadas por idade entre 2000 e 2013, decorrentes de causas subjacentes ou contribuintes, totalmente atribuíveis ao consumo de álcool foram analisadas por sexo, etnia / cor da pele, faixa etária e região de residência no país. Os dados sobre óbitos foram obtidos do Sistema Brasileiro de Informações sobre Mortalidade (SIM). A regressão Prais-Winsten foi usada para analisar as tendências. Resultados Mortes com causas subjacentes e / ou condições que contribuíram para a morte, totalmente atribuíveis ao álcool, representaram 2,5% do total de mortes no período. Houve mais mortes entre homens (3,8%) do que entre mulheres (0,7%). Em ambos os sexos houve uma maior proporção de óbitos entre 40-49 anos (27,9%) e na cor da pele negra ou pardo (mestiço) (48,8%). Entre 2000 e 2013, houve uma tendência ascendente nas taxas de mortalidade específicas atribuíveis ao álcool no país como um todo (Taxa de Crescimento Anual Média (TCAM) = 5,59%; Intervalo de Confiança (IC) 95% = 3,55% −7,68%), especialmente em pessoas com idade com menos de 20 anos, em pardos (TCAM = 13,42%; IC 95% = 9,70% −17,25%) e em residentes da região Norte (TCAM = 17,01%; IC 95% = 14,94% −19,13%), Região Nordeste (TCAM= 15,49%; IC 95% = 10,61% −20,58%) e região Centro-Oeste (TCAM= 8,40%; IC 95% = 5,57% −11,32%). Conclusão O álcool é uma causa importante e crescente de morte prematura no Brasil, especialmente entre homens, negros / pardos e a população que vive nas regiões mais desfavorecidas. Esse aumento geral do uso prejudicial do álcool reflete desigualdades étnicas e socioeconômicas no Brasil e também aponta a necessidade de políticas baseadas na população para reduzir o impacto da morbidade e prevenir a mortalidade precoce.

Child and adolescent abuse in the state of São Paulo, Brazil, 2009.

OBJECTIVE: To describe the profile of the reports of child and adolescent abuse in the state of São Paulo in 2009, and to analyze possible associated factors. METHODS: A total of 4,085 reports regarding children and adolescents younger than 15 years recorded by the Domestic, Sexual, and Other Interpersonal Violence Surveillance System (Sistema de Vigilância de Violência Doméstica, Sexual e Outras Violências Interpessoais - VIVA) were analyzed using a logistic regression model. RESULTS: The females comprised 61.4% of the total cases. The most common age group among females was 10 to 14 years (38.8%) and among males was < 5 years (35.8%). Physical abuse accounted for 43.3% of cases in males, and sexual abuse cases accounted for 41.7% of cases in females. The main perpetrators of the abuse were parents (43.8% of the total) and acquaintances (29.4%). Male aggressors were 72.0% of the total. The abuse occurred at home in 72.9% of cases; repeated abuse was reported in 51.4% of cases. Differences between the cases of physical and sexual abuse: a) physical abuse - mostly males (50.9%), parents as perpetrators (48.4%), and women as perpetrators (42.8%), b) sexual abuse - mostly females (77.2%), known aggressors (48.4%), and men as perpetrators (96.1%). Variables associated with physical abuse: male gender (OR: 2.22), age 10-14 years (OR: 1.68), and parents as perpetrators (OR: 2.50). Sexual abuse was associated with female gender (OR: 2.84), age 5-9 years (OR: 1.66), and unknown authors (OR: 1.53). CONCLUSION: Public policies should guarantee that children and adolescents have a healthy and violence-free life. The analysis of the notifications is an important tool to establish prevention strategies.

[Homicides in the Americas region: magnitude, distribution and trends, 1999-2009]. / Homicídios na região das Américas:magnitude, distribuição e tendências, 1999-2009

The scope of this study was to describe the magnitude and distribution of deaths by homicide in the Americas and to analyze the prevailing trends. Deaths by homicide (X85 to Y09 and Y35) were analyzed in 32 countries of the Americas Region from 1999 to 2009, recorded in the Mortality Information System/Pan American Health Organization. A negative binomial model was used to study the trends. There were around 121,297 homicides (89% men and 11% women) in the Americas, annually, predominantly in the 15 to 24 and 25 to 39 year age brackets. In 2009 the homicide age-adjusted mortality rate was 15.5/100,000 in the region. Countries with lower rates/100,000 were Canada (1.8), Argentina (4.4), Cuba (4.8), Chile (5.2), and the United States (5.8), whereas the highest rates/100,000 were in El Salvador (62.9), Guatemala (51.2), Colombia (42.5), Venezuela (33.2), and Puerto Rico (25.8). From 1999-2009, the homicide trend in the region was stable. They increased in nine countries: Venezuela (p<0.001), Panama (p<0.001), El Salvador (p<0.001), Puerto Rico (p<0.001); decreased in four countries, particularly in Colombia (p<0.001); and were stable in Brazil, the United States, Ecuador and Chile. The increase in Mexico occurred in recent years. Despite all efforts, various countries have high homicide rates and they are on the increase.

Cardiovascular disease mortality in the Americas: current trends and disparities.

OBJECTIVE: To describe the current situation and trends in mortality due to cardiovascular disease (CVD) in the Americas and explore their association with economic indicators. DESIGN AND SETTING: This time series study analysed mortality data from 21 countries in the region of the Americas from 2000 to the latest available year. MAIN OUTCOMES MEASURES: Age-adjusted death rates, annual variation in death rates. Regression analysis was used to estimate the annual variation and the association between age-adjusted rates and country income. RESULTS: Currently, CVD comprised 33.7% of all deaths in the Americas. Rates were higher in Guyana (292/100 000), Trinidad and Tobago (289/100 000) and Venezuela (246/100 000), and lower in Canada (108/100 000), Puerto Rico (121/100 000) and Chile (125/100 000). Male rates were higher than female rates in all countries. The trend analysis showed that CVD death rates in the Americas declined -19% overall (-20% among women and -18% among men). Most countries had a significant annual decline, except Guatemala, Guyana, Suriname, Paraguay and Panama. The largest annual declines were observed in Canada (-4.8%), the USA (-3.9%) and Puerto Rico (-3.6%). Minor declines were in Mexico (-0.8%) and Cuba (-1.1%). Compared with high-income countries the difference between the median of death rates in lower middle-income countries was 56.7% higher and between upper middle-income countries was 20.6% higher. CONCLUSIONS: CVD death rates have been decreasing in most countries in the Americas. Considerable disparities still remain in the current rates and trends.

The characteristics and factors of emergency service visits for falls.

OBJECTIVE: To analyze the characteristics of visits to the emergency services that result from falls and to identify the factors associated with these visits. METHOD: A cross-sectional study of 12,617 visits that resulted from falls, recorded in the National Injury Surveillance System, was carried out. The data were collected in 23 Brazilian capitals and the Federal District between September and November 2009 using cluster sampling. Correspondence analysis was used, which allowed for the joint observation of a large number of qualitative variables. RESULTS: Most of the victims were male (56.5%), aged 0 to 19 years (45.7%), and identified as non-white skin color (62.2%). The majority of the falls occurred at home (54.6%) and in the street (17.4%); 14.3% were work-related. The predominant types were "falls on the same level" (57.0%) and "falls from a ladder/step" (15.6%). Most of the injuries were classified as sprains, dislocations, bruises, cuts, or lacerations (68.3%). Falls among children occurred mostly at home; among adolescents at school; and among young people at sports facilities. Falls among adults were associated with the work place, including falls from scaffolding, roofs, stairs/steps, and holes and were linked to alcohol use. Falls on the same level resulted in less serious injuries, mostly on the upper and lower limbs, and falls from scaffolding and roofs were associated with more severe injuries and hospitalization. CONCLUSIONS: The results show that strategies to prevent falls should target residences, schools, and work environments.

[Public hospital emergency department visits due to burns in Brazil, 2009]. / Atendimentos decorrentes de queimaduras em serviços públicos de emergência no Brasil, 2009.

The objective was to analyze the characteristics of burn injuries treated in emergency departments (ED) and associated factors. This was a cross-sectional study of 761 ED visits collected through the National Injury Surveillance System in 2009. The majority of patients were males (58.6%), and the most prevalent age brackets were 30-49 years (23.1%) and 0-4 years (23%). Most burns occurred at home (62.1%), especially among females and children, and in commerce/services/industry/construction (19.1%), mainly among males 20-49 years. Work-related burns comprised 29.1% of the overall sample. Alcohol use prior to the injury was reported in 5.1% of cases. Causal agents across all age brackets were: contact with hot substances (43.6%) and exposure to fire and flames (24.2%); among the economically productive age groups, association with chemicals substances was common. Burns in children 0-14 years were associated with injuries at home, contact with heat and hot substances, and subsequent hospitalization; burns in the 15-49-year bracket were associated with exposure to fire/flames and electrical current, injuries occurring in public places, and outpatient treatment and discharge. The study highlights the importance of burn prevention strategies targeting children and workers.