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.

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.

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.

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

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.

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.

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

Objetivo. Descrever a mortalidade por doenças, condições e lesões para as quais o consume de álcool é causa necessária durante o triênio de 2010 a 2012 no Brasil. Métodos. Foi realizado um estudo descritivo com dados do Sistema de Informações sobre Mortalidade (SIM) do Ministério da Saúde do Brasil. Foram considerados os óbitos cujas causas básicas foram classificadas em qualquer um dos 78 códigos da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10) correspondentes às doenças, condições e lesões para as quais o uso de álcool é causa necessária. Resultados. Foram registrados 55 380 óbitos pelas causas consideradas, sendo 88,5% de homens. A taxa de mortalidade bruta (TMB) no triênio foi de 9,6 por 100 000 habitantes na população geral, 17,35 por 100 000 homens para o sexo masculino e 2,15 por 100 000 mulheres para o sexo feminino. TMB mais elevadas foram observadas nos grupos de 50 a 59 (28,45) e de 60 a 69 (27,23) anos de idade e em pessoas de cor da pele preta ou parda (10,15). As regiões Nordeste (11,70) e Centro-Oeste (11,04) exibiram as taxas de mortalidade ajustadas mais elevadas. As doenças do fígado foram as principais causas de morte (55,3%). Conclusões. A mortalidade por causas associadas ao consumo de álcool é elevada no Brasil, especialmente entre os homens, na faixa etária de 50 a 69 anos e nos residentes das regiões Nordeste e Centro-Oeste.

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.

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

OBJETIVO:Descrever a mortalidade por doenças, condições e lesões para as quais o consumo de álcool é causa necessária durante o triênio de 2010 a 2012 no Brasil. MÉTODOS: Foi realizado um estudo descritivo com dados do Sistema de Informações sobre Mortalidade (SIM) do Ministério da Saúde do Brasil. Foram considerados os óbitos cujas causas básicas foram classificadas em qualquer um dos 78 códigosda Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10) correspondentes às doenças, condições e lesões para as quais o uso de álcool é causa necessária. RESULTADOS: Foram registrados 55 380 óbitos pelas causas consideradas, sendo 88,5% de homens. A taxa de mortalidade bruta (TMB) no triênio foi de 9,6 por 100 000 habitantes na população geral, 17,35 por 100 000 homens para o sexo masculino e 2,15 por 100 000 mulheres para o sexo feminino. TMB mais elevadas foram observadas nos grupos de 50 a 59 (28,45) e de 60 a 69 (27,23) anos de idade e em pessoas de cor da pele preta ou parda (10,15). As regiões Nordeste (11,70) e Centro-Oeste (11,04) exibiram as taxas de mortalidade ajustadas mais elevadas. As doenças do fígado foram as principais causas de morte (55,3%). CONCLUSÕES: A mortalidade por causas associadas ao consumo de álcool é elevada no Brasil, especialmente entre os homens, na faixa etária de 50 a 69 anos e nos residentes das regiões Nordeste e Centro-Oeste.

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.

[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 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.

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 / Mortalidade por doenças cardiovasculares nas Américas segundo região, 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. .

CONTEXTO E OBJETIVO: As doenças cardiovasculares são as causas principais de morte em todo o mundo. O objetivo do estudo foi avaliar as tendências na mortalidade decorrente das doenças cardiovasculares em três diferentes regiões das Américas. TIPO DE ESTUDO E LOCAL: Este é um estudo de série temporal que analisa dados de mortalidade em três diferentes regiões das Américas, de 2000 até o último ano disponível. MÉTODOS: A fonte de dados foi a Sistema de Informação de Mortalidade da Organização Pan-Americana da Saúde (OPAS). Dados de 27 países foram incluídos. Utilizou-se joinpoint regression para analisar as tendências. RESULTADOS: Durante o período de estudo, as taxas ajustadas por idade padronizadas de mortalidade dos homens foram mais altas que a das mulheres em todas as regiões. As taxas da América do Norte (AN) foram inferiores que as dos países da América Latina (AL) e do Caribe Não Latino (CNL). As mortes prematuras (30-69 anos) foram 22,8% do total de mortes na AN, 38,0% na AL e 41,8% no CNL. A análise das tendências mostrou diminuição significativa nas três regiões. A AN acumulou a maior diminuição. A porcentagem média de mudança anual (AAPC) e respectivos intervalos de confiança de 95% foram -3,9% [-4,2; -3,7] na AN; na AL foi -1.8% [-2.2; -1.5]; e -1,8% [-2,7; -0,9] no CNL. CONCLUSÕES: Foram observadas diferentes taxas de mortalidade e diferentes reduções nas três regiões.

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.

Maus-tratos contra a criança e o adolescente no Estado de São Paulo, 2009 / Child and adolescent abuse in the state of São Paulo, Brazil, 2009

OBJETIVO: Descrever o perfil das notificações em crianças e adolescentes no Estado de São Paulo em 2009 e analisar possíveis fatores associados. MÉTODOS: Foram analisadas 4.085 notificações em menores de 15 anos, registradas no Sistema de Vigilância de Violências e Acidentes (VIVA); um teste de regressão logística foi utilizado. RESULTADOS: O sexo feminino foi 61,4% do total. A faixa etária mais frequente entre as meninas foi a de 10 a 14 anos (38,8%) e entre os meninos foi < 5 anos (35,8%). A violência física representou 43,3% dos casos em meninos e a sexual 41,7% em meninas. Os principais autores das agressões foram os pais (43,8% do total) e conhecidos (29,4%). Agressores homens representaram 72,0%. A residência foi o local de ocorrência de 72,9% dos casos; violência de repetição foi referida em 51,4% das notificações. Diferenças encontradas entre os casos de violência física e sexual: a) violência física - maioria meninos (50,9%), pais como autores (48,4%) e mulheres como autoras (42,8%); b) violência sexual - maioria meninas (77,2%), conhecidos como autores (48,4%) e homens como autores (96,1%). Variáveis associadas à violência física: sexo masculino (OR: 2,22), idade 10-14 anos (OR: 1,68) e pais como autores (OR: 2,50). A violência sexual foi associada ao sexo feminino (OR: 2,84), idade 5-9 anos (OR: 1,66) e desconhecidos como autores (OR: 1,53). CONCLUSÃO: As políticas públicas deveriam garantir o direito de toda criança ter uma vida saudável e livre de violência. A análise das notificações é importante instrumento para estabelecer estratégias de prevenção.

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.

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

O objetivo do estudo foi descrever a magnitude e a distribuição da mortalidade por homicídios nas Américas e analisar suas tendências. Foram analisados óbitos por homicídios (X85 a Y09 e Y35) de 32 países das Américas, período 1999-2009, registrados no Sistema de Informações de Mortalidade/Organização Pan Americana da Saúde. Utilizou-se modelo binomial negativo para estudar as tendências. Cerca de 121.297 mortes por homicídios (89% homens e 11% mulheres) ocorreram anualmente nas Américas, predominando as idades de 15 a 24 e de 25 a 39 anos. Em 2009, a taxa padronizada de homicídios da região foi 15,5/100.000. Os países com taxas/100.000 baixas foram Canadá (1,8), Argentina (4,4), Cuba (4,8), Chile (5,2) e Estados Unidos (5,8); e com taxas/100.000 altas foram El Salvador (62,9), Guatemala (51,2), Colômbia (42,5), Venezuela (33,2) e Porto Rico (25,8). Entre 1999-2009 as taxas da região permaneceram estáveis; aumentaram em nove países, como Venezuela (p < 0,001), Panamá (p < 0,001), El Salvador (p < 0,001) e Porto Rico (p < 0,001); diminuíram em quatro países, especialmente na Colômbia (p < 0,001); e permaneceram estáveis no Brasil, Estados Unidos, Equador e Chile. O aumento no México ocorreu no período mais recente. Apesar dos esforços empreendidos, diversos países têm taxas altas de homicídios e crescimento nas mesmas.

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.

[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.

[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.

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

O objetivo foi analisar os atendimentos por queimaduras em serviços de emergência, e fatores associados. Estudo transversal de 761 atendimentos coletados pelo Sistema de Vigilância de Violências e Acidentes em 2009. A maioria foi do sexo masculino (58,6%); adultos de 30 a 49 anos (23,1%) e crianças de 0 a 9 anos (23%). A residência foi o local de ocorrência mais frequente (62,1%), especialmente para crianças e mulheres; em seguida comércio, serviços, indústria e construção (19,1%), especialmente entre homens de 20 a 49 anos. Queimaduras no trabalho foram 29,1% do total. Uso de álcool chegou a 5,1%. Agentes causadores em todas as idades: substância quente (43,6%) e fogo/chama (24,2%); na faixa produtiva: substâncias químicas. As queimaduras entre 0 e 14 anos foram associadas com residência, substância e objeto quente e internação hospitalar; entre os de 15 a 49 anos associaram-se com fogo/chama e choque elétrico, via pública e alta da emergência. Estratégias de prevenção para crianças e trabalhadores devem ser implantadas.

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.

Atendimentos por acidentes de transporte em serviços públicos de emergência em 23 capitais e no Distrito Federal – Brasil, 2009 / Traffic accident emergency medical care by emergency services in 23 state capitals and the Federal District – Brazil, 2009

Objetivo: descrever o perfil das vítimas de acidentes de transporte (AT) atendidas em serviços públicos de emergência em 23 capitais brasileiras e no Distrito Federal, em 2009. Métodos: utilizaram-se os dados sobre AT obtidos no inquérito sobre atendimentos de emergência por causas externas em serviços públicos de saúde (Inquérito VIVA 2009). Resultados: entre 35.646 tendimentos de emergência por acidentes, identificaram-se 9.934 (27,9 por cento) atendimentos por AT nos 74 serviços de emergência participantes; predominaram vítimas do sexo masculino (71,6 por cento), jovens de 20 a 29 anos de idade (35,0 por cento) e pardos (52,4 por cento); cerca de 27,0 por cento dos AT estavam relacionados ao trabalho; houve suspeita/declaração de consumo de bebida alcoólica antes do evento em 17,2 por cento dos atendimentos; a maioria dos atendimentos referia-se a acidentes envolvendo motocicleta (50,9 por cento) e bicicleta (18,4 por cento). Conclusão: considerando a magnitude das lesões do trânsito nos serviços de emergência, torna-se necessário avançar em medidas direcionadas à redução dos acidentes de transporte.

Objective: the study aims to describe the estimates of land traffic accident (TA) events seen in emergency services at the Federal District and 23 Brazilian State capitals in 2009. Methods: data on TA were used, obtained from survey on emergency medical care for external causes in public health services (VIVA Survey 2009). Results: among 35,646 emergency visits for unintentional injuries, 9,934 (27.9 per cent) visits were identified as TA, in 74 emergency services included in the survey; there were a greater number of male victims (71.6 per cent), young from 20 to 29 years of age (35.0 per cent) and mulattos (52.4 per cent); about 27.0 per cent of the TA was work related; there was suspicion/report of alcohol consumption before the event in 17.2 per cent of the visits; most of the visits referred to accidents involving motorcycles (50.9 per cent) and bicycles (18.4 per cent). Conclusion: considering the magnitude of the traffic injuries in emergency services, it becomes necessary to advance in measures directed to reducing traffic accidents.