Analysis of Mortality from Asbestos-Related Diseases in Brazil Using Multiple Health Information Systems, 1996-2017.

Background: In Brazil, asbestos was intensively used from the 1960s until its ban in 2017. Mesothelioma, asbestosis, and pleural plaques are typical asbestos-related diseases (ARD-T). To create an ARD-T national database, death records from 1996-2017 were retrieved from several health information systems (HIS). Methods: All national HIS containing coded diagnoses (ICD-10) and death information were obtained. Linkage was performed to create a single database of ARD-T death records, either as underlying or contributory causes, in adults aged 30 years and older. Results: A total of 3,057 ARD-T death records were found, 2,405 (76.4%) of which being malignant mesotheliomas (MM). Pleural MM (n = 1,006; 41.8%) and unspecified MM (n = 792; 32.9%) prevailed. Male to female MM ratio (M:F) was 1.4:1, and higher ratios were found for non-malignant ARD-T: 3.5:1 for asbestosis and 2.4:1 for pleural plaques. Male crude annual mesothelioma mortality (CMmm x1,000,000) was 0.98 in 1996 and 2.26 in 2017, a 131.1% increment, while for females it was 1.04 and 1.25, a 20.2% increase, correspondingly. The small number of deaths with asbestosis and pleural plaques records precluded conclusive interpretations. Conclusions: Even with the linkage of several HIS, ARD-T in death records remained in low numbers. MM mortality in men was higher and showed a rapid increase and, along with non-malignant ARD-T, higher M:F ratios suggested a predominant pattern of work-related exposure. The monitoring of workplace and environmental asbestos exposure needs to be improved, as well as the workers surveillance, following the recent Brazilian ban.

Prevention of Asbestos Exposure in Latin America within a Global Public Health Perspective.

BACKGROUND: Asbestos consumption in Latin America (LA) amounts to 10% of yearly global production. Little is known about the impact of asbestos exposure in the region. OBJECTIVE: To discuss scientific and socio-economic issues and conflicts of interest and to summarize epidemiological data of asbestos health effects in LA. DISCUSSION: Recent data on chrysotile strengthened the evidence of its carcinogenicity and showed an excessive risk of lung cancer at cumulative exposure levels as low as 1.5 fibre-years/ml. Technology for substitution is available for all asbestos-containing products and ceasing asbestos production and manufacturing will not result in unemployment and loss of income, except for the mining industry. The flawed arguments used by the industry to maintain its market, both to the public and in courtrooms, strongly relies on the lack of local evidence of the ill effects and on the invisibility of asbestos-related diseases in LA, due to the limited number of studies and the exposed workers' difficulty accessing health services. The few epidemiological studies available show clear evidence of clusters of mesothelioma in municipalities with a history of asbestos consumption and a forecasted rise in its incidence in Argentina and Brazil for the next decade. In Brazil, non-governmental organizations of asbestos workers were pivotal to counterbalance misinformation and inequities, ending recently in a Supreme Court decision backing an asbestos ban. In parallel, continuous efforts should be made to stimulate the growth of competent and ethical researchers to convey adequate information to the scientific community and to the general public.

Recovering missing mesothelioma deaths in death certificates using hospital records.

BACKGROUND: In Brazil, underreporting of mesothelioma and cancer of the pleura (MCP) is suspected to be high. Records from death certificates (SIM) and hospital registers (SIH-SUS) can be combined to recover missing data but only anonymous databases are available. This study shows how common data can be used for linkage and as an assessment of accuracy. METHODS: Mesothelioma (all sites, ICD-10 codes C45.0-C45.9) and cancer of the pleura (C38.4) were retrieved from both information systems and combined using a linkage algorithm. Accuracy was examined with non-anonymous databases, limited to the state of São Paulo. RESULTS: We found 775 cases in death certificates and 283 in hospital registers. The linkage matched 57 cases, all accurately paired. Three cases, 0.4% in SIM and 1.3% in SIH-SUS, could not be matched because of data inconsistencies. CONCLUSIONS: A computer linkage can recover MCP cases from hospital records not found in death certificates in Brazil.

Prevention of Asbestos-Related Disease in Countries Currently Using Asbestos.

More than 40 years of evaluation have consistently confirmed the carcinogenicity of asbestos in all of its forms. This notwithstanding, according to recent figures, the annual world production of asbestos is approximatively 2,000,000 tons. Currently, about 90% of world asbestos comes from four countries: Russia, China, Brazil and Kazakhstan; and the wide use of asbestos worldwide represents a global threat. The purpose of this paper is to present a review of the asbestos health impact and to discuss the role of epidemiological investigations in countries where asbestos is still used. In these contexts, new, "local" studies can stimulate awareness of the size of the problem by public opinion and other stakeholders and provide important information on the circumstances of exposure, as well as local asbestos-related health impacts. This paper suggests an agenda for an international cooperation framework dedicated to foster a public health response to asbestos, including: new epidemiological studies for assessing the health impact of asbestos in specific contexts; socio-cultural and economic analyses for contributing to identifying stakeholders and to address both the local and global implications of asbestos diffusion; public awareness on the health and socio-economic impact of asbestos use and banning.

Interaction between noise and cigarette smoking for the outcome of hearing loss among women: a population-based study.

BACKGROUND: We investigated the interaction between exposure to noise and smoking in relation to prevalence of hearing loss among women. METHODS: A sample of women aged 20-49 years (n = 1,723) from a population-based cross-sectional study carried out in Brazil in 2006 was examined. Hearing loss was assessed using a yes-no validated question. Biological interaction was analyzed using the additive scale and measured with interaction contrast ratio (ICR) and assessment of dose-response relationship. RESULTS: The combined effect of exposure to noise and cigarette smoking on hearing loss (adjusted prevalence ratio (PRadj) = 3.94, 95% confidence interval (CI): 2.81, 5.52) was greater than expected based on the additive single effects of smoking (PRadj = 1.39, 95% CI: 1.07, 1.81) and noise (PRadj = 2.66, 95% CI: 1.86, 3.82). ICR estimates were not statistically significant. The prevalence of hearing loss among noise-exposed women increased with duration of smoking (P trend = 0.026), number of cigarettes smoked per day (P trend = 0.034), cumulative tobacco use (P trend = 0.030), and early age at smoking initiation (P trend = 0.047). CONCLUSIONS: Noise and smoking may have a combined effect on hearing loss but further studies are still needed. A dose-response relation of smoking for the noise effect among women is suggested.

Workdays lost due to occupational injuries among young workers in Brazil.

BACKGROUND: The severity of non-fatal work-related injuries has seldom been examined among young workers. We estimated the extent and distribution of workdays lost due to non-fatal work injuries using compensation data. METHODS: Data are from the Brazilian Institute of Social Insurance, for 2006. The study population is comprised of all insured workers of age 16-24. Descriptive statistics reflect workdays lost due to health-related disability, according to sex, age group, wage, and trade. RESULTS: Out of 4.8 million insured workers ages 16-24 years, we estimated 1,282,940 workdays lost. We observed a larger number of median workdays lost among males age 20-24 in retail and service trades (83 days) and among 16-19-year-old females in the agriculture/fish/forestry/cattle (142 days). CONCLUSIONS: Young workers experience a heavy burden of work-related injuries. Disability workdays may compromise school attendance and performance. Other potential impacts affect productivity and social insurance costs.

Occupational exposure to acid mists and periodontal attachment loss.

This study investigated the hypotheses that occupational exposure to acid mists is positively associated with periodontal disease, assessed by periodontal attachment loss. The study sample included 530 male workers at a metal processing factory. Data were obtained from interviews and oral examinations. Periodontal attachment loss was defined as >or= 4mm at probing, in at least one tooth. A job exposure matrix was utilized for exposure evaluation. Exposure to acid mists was positively associated with periodontal attachment loss >or= 4mm at any time (prevalence ratio, PR(adjusted) = 2.17), past (PR(adjusted) = 2.11), and over 6 years of exposure (PR(adjusted) = 1.77), independently of age, alcohol consumption, and smoking, and these results were limited to workers who did not use dental floss. Exposure to acid mists is a potential risk factor for periodontal attachment loss, and further studies are needed, using longitudinal designs and more accurate exposure measures.

Occupational exposure to acid mists and periodontal attachment loss / Exposição ocupacional a névoas ácidas e perda de inserção periodontal

This study investigated the hypotheses that occupational exposure to acid mists is positively associated with periodontal disease, assessed by periodontal attachment loss. The study sample included 530 male workers at a metal processing factory. Data were obtained from interviews and oral examinations. Periodontal attachment loss was defined as > 4mm at probing, in at least one tooth. A job exposure matrix was utilized for exposure evaluation. Exposure to acid mists was positively associated with periodontal attachment loss > 4mm at any time (prevalence ratio, PRadjusted = 2.17), past (PRadjusted = 2.11), and over 6 years of exposure (PRadjusted = 1.77), independently of age, alcohol consumption, and smoking, and these results were limited to workers who did not use dental floss. Exposure to acid mists is a potential risk factor for periodontal attachment loss, and further studies are needed, using longitudinal designs and more accurate exposure measures.

Este estudo investigou a hipótese de que a exposição ocupacional a névoas ácidas está associada positivamente à doença periodontal, avaliada através da perda de inserção periodontal. O estudo foi conduzido com 530 trabalhadores do sexo masculino de uma metalúrgica. Os dados foram obtidos por meio de entrevistas individuais e de exames clínicos odontológicos. A perda de inserção periodontal foi avaliada durante a sondagem e definida em > 4mm, em pelo menos um dente. Uma matriz de exposição ocupacional foi utilizada para avaliação da exposição. A exposição a névoas ácidas foi associada positivamente à perda de inserção periodontal > 4mm para a ocorrência da exposição em algum momento (RPajustada = 2,17), exposição passada (RPajustada = 2,11) e duração da exposição maior que seis anos (RPajustada = 1,77), independentemente da idade, consumo de álcool e tabagismo; estes resultados foram observados apenas entre os trabalhadores que não usavam o fio dental. A exposição a névoas ácidas é um fator de risco potencial para a perda de inserção periodontal e são necessários outros estudos que utilizem desenhos longitudinais e medidas de exposição mais acuradas.

Nontraditional work factors in farmworker adolescent populations: implications for health research and interventions.

Agriculture has been documented to be one of the most hazardous work environments for both adults and children. Adolescents may be especially vulnerable to adverse health effects from agricultural exposures due to the rapid growth and development experienced during those years. Separating the occupational, economic, and social issues in this population is difficult. Weak regulatory protection, lack of compliance with existing regulations, and gaps in service provision characterize the working conditions of adolescent farmworkers. Although there is increasing research on the impact of work organization on mental and physical health in adult working populations, there is a scarcity of research focused on this concept in young workers--and it remains virtually unaddressed in young farmworkers. Work characteristics of the informal work sector, better delineated in international literature, should be considered when planning research or interventions in this at-risk population. Further, the population of adolescent farmworkers is diverse, and research strategies and interventions need to be targeted and tailored to the heterogeneous groups. This article addresses some of the nontraditional work factors associated with the less-than-formal work organization and environments in the farmworker adolescent population and how these factors may inform the planning of research and interventions. Specifically, mobility, cultural patterns and social networks, alternative sampling strategies, alternative delivery of health care and education, and involvement of a wide range of players in the work environment of adolescent farmworkers should all be considered when conducting research or planning programs for this population.

Adolescent students who work: gender differences in school performances and self-perceived health.

In a prospective cohort study, the hypotheses that adolescent students who work have poorer school performances, more sick days, and poor self-perceived health were examined. From a one-stage random cluster area sampling of 2512 households in Bahia, Brazil, 888 students 10-21 years of age were asked to answer questionnaires. School dropouts were more common among working students independently of gender. Both full-time (PRadjusted = 2.43; 95% CI: 1.49-3.96) and part-time (PRadjusted = 2.07; 95% CI: 1.28-3.35) working males were more likely to report frequent class skipping. Among females, paid jobs also were associated with poor self-perceived health, but not after adjustment for age and SES. Brazilian labor legislation for adolescent workers needs to be revised to take into account that jobs can compromise educational achievement.

[Health and work in the construction industry in an urban area of Brazil]. / Saúde e trabalho na construção civil em uma área urbana do Brasil.

This community-based survey in the city of Salvador, capital of Bahia State, Brazil, describes the occupational and health profile of construction workers. All 1,947 male individuals between 10 and 65 years of age identified in a random cluster area single-stage sample were individually interviewed. Narrative data about work injuries were also analyzed. Construction workers were older, more frequently black, poorer, and had less schooling and a higher proportion of informal job contracts than those in other trades. The majority (55.8%) reported wanting a formal job in order to be eligible for paid retirement. Smoking (prevalence ratio = 1.37; 95% CI: 1.08-1.72) and nonfatal work injuries (relative risk = 1.72; 95% CI: 1.49-7.42) were more common among construction workers. Narrative data show lack of information and lack of access to personal protective equipment. Prevention programs and the formalization of job contracts are strongly recommended for construction workers.

Saúde e trabalho na construção civil em uma área urbana do Brasil / Health and work in the construction industry in an urban area of Brazil

Neste inquérito populacional conduzido em Salvador, capital do Estado da Bahia, Brasil, analisa-se o perfil ocupacional e de saúde de trabalhadores da construção civil. Todos os 1.947 indivíduos do sexo masculino, com idade entre 10 e 65 anos, identificados em uma amostra de conglomerados de superfície de estágio único, foram entrevistados individualmente. Dados de narrativas sobre acidentes de trabalho foram também analisados. Trabalhadores da construção eram mais velhos, mais comumente negros, de menor escolaridade e nível sócio-econômico, e maior proporção de contratos de trabalho informais do que os demais. A maioria (55,8 por cento), referiu desejar um contrato formal de trabalho especialmente para dispor de aposentadoria remunerada. O hábito de fumar (razão de prevalência, RP = 1,37; 95 por cento intervalo de confiança, IC95 por cento:1,08-1,72) e os acidentes de trabalho não-fatais (risco relativo, RR = 1,72; IC95 por cento: 1,49-7,42) foram mais freqüentes entre os trabalhadores na construção civil. Com base nas narrativas, identificou-se existir falta de informação e de acesso a equipamentos de proteção. Medidas de proteção e regulamentação do contrato de trabalho necessitam ser rapidamente implantadas para esses trabalhadores.

Informal jobs and non-fatal occupational injuries.

OBJECTIVES: In Brazil, workers without a formal job contract represent approximately half of the labor force but there are no official statistics on occupational injuries for them. This study estimates the annual incidence of non-fatal work-related injuries for workers with and without job contracts and examines gender differences. METHODS: This is a community-based study carried out with a random cluster area sample of the residents of Salvador, a city with 2.7 million inhabitants, the capital of the state of Bahia, northeast Brazil. Individuals from 18 to 65 years of age who reported having a paid job comprise the study population (n=2907). Data were obtained in individual household interviews with questionnaires applied by trained field workers. RESULTS: The overall estimated annual incidence rate (IR) was 5.6/100 full-time equivalent workers (FTE). The incidence of injuries differed between workers with informal (IR=6.2/100 FTE) and formal jobs (IR=5.1/100 FTE), and according to gender (IR=5.8/100 FTE for female and 5.5/100 FTE for male), but these differences were not statistically significant. Statistically significant positive associations between informal jobs and non-fatal work injuries were observed among women with medium education [incident rate ratio (IRR) 2.02, 95% CI 1.00-4.00] and women with black skin (IRR 1.71, 95% CI 0.99-2.97) who perceived a job as dangerous (IRR 2.00; 95% CI 1.09-3.64) or who had no occupational training (IRR 2.08; 95% CI 1.05-4.20). CONCLUSIONS: This study shows that non-fatal work injuries are a common health problem among adults in urban Brazil, regardless of the type of job contract or gender, which points to a need to improve workers' health and safety programs for formal and informal hired workers.

Emprego em serviços domésticos e acidentes de trabalho näo fatais / Housemaids and non-fatal occupational injuries

OBJETIVO: Estimar a incidência anual de acidentes näo fatais de acordo com variáveis sociodemográficas e ocupacionais entre empregadas em serviços domésticos. MÉTODOS: Inquérito de base comunitária conduzido com 1.650 mulheres de 10 a 65 anos de idade, que referiram ter atividade remunerada e que compunham uma amostra aleatória por conglomerados dos domicílios da cidade de Salvador, capital da Bahia. Os dados foram obtidos por meio de questionários individuais sobre condiçöes de vida, trabalho e saúde. Foi utilizado o teste Exato de Fisher para diferenças de freqüências. RESULTADOS: Estimou-se a incidência anual de acidentes de trabalho näo fatais em 5,0 por cento, maior entre as empregadas em serviços domésticos (7,3 por cento) do que entre as demais trabalhadoras (4,5 por cento), diferença estatisticamente significante (p<0,05). Metade dos acidentes entre empregadas em atividades domésticas causou efeitos, freqüentemente näo incapacitantes, mas que levaram 38,1 por cento dessas mulheres a faltar ao trabalho. CONCLUSOES: Mulheres com emprego em atividades domésticas representam um contingente expressivo da força de trabalho e a alta incidência de acidentes ocupacionais näo fatais entre elas revela sua importância em saúde pública, o que requer açöes apropriadas de prevençäo

[Housemaids and non-fatal occupational injuries]. / Emprego em serviços domésticos e acidentes de trabalho não fatais.

OBJECTIVE: To estimate the annual incidence of non-fatal work injuries according to sociodemographic and occupational variables among housemaids. METHODS: A community-based survey was conducted in a population of 1,650 women aged 10 to 65 years who reported a paid occupation randomly selected in a household sample of the city of Salvador, Brazil. Data was collected through individual questionnaires on living and work conditions and health status. Fisher Exact test was performed for frequency analysis. RESULTS: It was estimated an overall annual incidence of non-fatal work injuries in the study population of 5.0%, which was statistically significant (p<0.05) higher among housemaids (7.3%) than in the group with other occupations (4.5%). Half of the injuries among housemaids were not related with long-term disabilities, and 38.1% women referred not being able to work for two weeks on average after the injury. CONCLUSIONS: Housemaids represent a major contingent of the work force in Brazil and other Latin America countries. The high incidence of non-fatal work injuries in this working group reveals its public health relevance and the need for preventive programs.

Housework, paid work and psychiatric symptoms

Objetivo: Avaliar a hipótese de que a dupla carga de trabalho é um fator de risco potencial para sintomas psiquiátricos em mulheres. Métodos: Estudo transversal realizado com 460 mulheres aleatoriamente selecionadas de uma área pobre da cidade de Salvador, BA, Brasil. Foram selecionadas mulheres entre 18 e 70 anos de idade, que referiram ter ocupação paga ou estar envolvidas com trabalho doméstico não remunerado para as suas famílias. A sobrecarga de trabalho foi analisada como: a) dupla jornada de trabalho, i.e., envolvimento simultâneo em trabalho pago e trabalho não pago para a família; e b) duração da jornada diária total de trabalho. Os sintomas psiquiátricos foram registrados por meio de um questionário psiquiátrico devidamente validado, o Questionário de Morbidade Psiquiátrica de Adultos (QMPA). Resultados: Foram encontradas associações positivas, ajustadas por idade, estado civil e filhos em idade pré-escolar, entre escores altos do QMPA (>7 sintomas) e dupla jornada de trabalho (razão de prevalência, RP=2,04, 95 por cento intervalo de confiança, IC: 1,16, 2,29) e mais que 10 horas de jornada de trabalho (RP=2,29, 95 por cento IC: 1,96, 3,43). Conclusões: Os mais importantes fatores em associação com escores altos do QMPA foram as variáveis relacionadas ao trabalho. Ser casada ou ter crianças em idade pré-escolar na família estavam associadas a escores altos do QMPA apenas quando em combinação com a sobrecarga de trabalho

Mortalidade por câncer em militares da Marinha do Brasil / Cancer mortality among service men in the Brazilian Navy

Objetivo: Verificar se existe excesso na mortalidade por câncer em militares da Marinha do Brasil em comparaçäo com uma populaçäo geral de referência e fatores de risco ocupacionais potenciais. Métodos: Utilizaram-se dados de mortalidade extraídos de certidöes de óbitos e históricos ocupacionais de militares da Marinha do Brasil, de idade acima de 19 anos, no período de 1991 a 1995. A populaçäo de referência escolhida foi a do Estado do Rio de Janeiro, onde concentram 70 por cento dos militares da Marinha. Resultados: Razöes de mortalidade ajustadas por idade mostraram que câncer de cérebro, próstata e linfomas näo Hodgkin foram mais comuns em militares do que na populaçäo de referência. A análise de ocupaçäo, restrita ao grupo militar, evidenciou o câncer de cérebro e de fígado em associaçäo com as funçöes do grupo saúde; cólon-reto com funçöes dos oficiais da Armada e da administraçäo; e câncer de laringe com o grupo de manutençäo e reparos. Conclusöes: A mortalidade por tipo de câncer entre os militares da Marinha difere da populaçäo geral de referência e se associa a certas ocupaçöes, em cujas populaçöes os fatores de riscos para neoplasias necessitam ser avaliados, especificando-se os tipos histopatológicos e também as exposiçöes ocupacionais

Migração, trabalho na indústria petroquímica e consumo de bebidas alcoólicas / Recent migration, petrochemical industry jobs and alcohol consumption

Objetivou-se testar testar a hipótese de uma associação entre migração recente, trabalho na indústria petroquímica e o consumo excessivo de bebidas alcoólicas, avaliando o papel de variáveis socioeconômicas e demográficas como confundidores ou modificadores de efeito. Foi empregada uma amostra aleatória de 452 chefes de família entre 18 e 60 anos de idade, proveniente de um inquérito de saúde conduzido com famílias que residiam em uma área industrial da Região Metropolitana de Salvador, Bahia, Brasil. Apenas os trabalhadores do setor industrial foram incluídos na análise (n = 299). Consumidores de bebidas alcoólicas foram identificados com o Questionário de Morbidade Psiquiátrica de Adultos, QMPA, aplicado por entrevistadores treinados a informantes chave de cada família selecionada. Migrantes recentes foram definidos como aqueles que tinham até dois anos de residência no local. A prevalência de consumo exagerado de álcool foi maior entre trabalhadores da indústria petroquímica e entre migrantes recentes, em comparação aos trabalhadores de outras indústrias e não migrantes recentes, respectivamente. Petroquímicos migrantes recentes apresentaram uma prevalência de consumo de bebidas alcoólicas 3,4 vezes superior ao grupo de referência. Migração recente e trabalho na indústria petroquímica são fatores de risco potenciais para o consumo de bebidas alcoólicas, por um efeito sinérgico entre essas duas variáveis. Os resultados sugerem a escolaridade como fator de proteção para o consumo de álcool, apenas entre não migrantes recentes nessa população de estudo.

Sintomas psicológicos e trabalho na indústria petroquímica: um estudo com moradores de Camaçari, Bahia, Brasil / Psychological symptoms and petrochemical industry work: a study with inhabitants of Camaçari, Bahia, Brazil

Com dados recuperados e revisados de um inquérito populacional realizado na zona urbana de Camaçari, município da Regiäo Metropolitana de Salvador - Bahia, estimou-se a prevalência de sintomas psicológicos entre trabalhadores do setor industrial, enfocando-se o Pólo Petroquímico localizado nesta área. Através de uma amostra aleatória de superfície, 510 domicílios foram selecionados e identificados 709 indivíduos do sexo masculino, maiores de 18 anos. Destes, selecionou-se os chefes de família (308) que referiram trabalhar no setor industrial, sendo que 153 (49,6 por cento) mencionaram trabalhar em indústrias do Pólo, que à época encontra-se em vias de implantaçäo, com algumas empresas já totalmente instaladas. identificou-se que os trabalhadores das indústrias do Pólo eram mais jovens, tinham melhores níveis de escolaridade, apresentavam mais migrantes recentes (menos de dois anos de residência na área) e indivíduos em regime de trabalho de turno do que os demais trabalhadores do setor industrial. Em geral, prevalências de sintomas psicológicos foram elevadas, embora näo se tenha verificado diferenças significativas entre os dois grupos. Nota-se, entretanto, um predomínio entre os trabalhadores do Pólo de tratamento para nervosismo , preocupaçäo excessiva com doenças e o consumo excessivo de bebidas alcoólicas. Entre os trabalhadores de outras indústrias a maior diferença entre as prevalências estimadas foi para idéias de suicídio . Estes dados revelam desigualdades sociais e de saúde relacionadas ao processo de admissäo e seleçäo de trabalhadores em empresas de alta tecnologia. Maior aprofundamento dessa questäo, com a comparaçäo com dados recentes, encontra-se em investigaçäo

Razöes de proporçöes e uso do método delta para intervalos de confiança em regressäo logística / Ratio of proportions and the use of the delta method for confidence interval estimation in logistic regression

Apresentar uma aplicaçäo da regressäo logística para estimar razöes de prevalência ou risco relativo, e o uso do método delta para a estimativa de intervalos de confiança. Utilizou-se o método delta, visto que esta técnica é adequada para estimar variâncias de funçöes näo lineares de variáveis aleatórias, do tipo razäo de proporçöes. O método baseia-se na expansäo da funçäo em série de Taylor, provendo uma aproximaçäo para o cálculo das variâncias. Para estimar as razöes de proporçöes e as respectivas variâncias, que permitem a estimaçäo dos intervalos de confiança, desenvolveu-se programa utilizando-se o módulo matricial do SAS. A aplicaçäo prática do modelo proposto é feita utilizando-se dados de um estudo transversal com uma amostra de 611 mulheres, parra testar a hipótese de que a falta de compartilhamento do trabalho doméstico associa-se com altos escores de sintomas psicológicos medios através de um questionário validado. As razöes de prevalência calculadas através da regressäo logística, e os intervalos de confiança estimados pelo método delta foram comparadas com os resultados obtidos pela técnica de Mantel-Haenszel. As estimativas pontuais das razöes de prevalência brutas, cruas ou ajustadas, obtidas através da regressäo logística, foram semelhantes às encontradas na análise tabular. Também os limites dos intervalos de confianças para as razöes de prevalência através do método delta foram praticamente iguais em relaçäo aos encontrados através da técnica de Mantel-Haenszel. Os resultados apóiam o uso do método delta para estimar intervalos de confiança para razões de proporçäo. Esse método deve ser visto como uma alternativa para situaçöes em que o efeito em estudo (variável dependente) näo é raro, situaçäo onde a "odds ratio" se afasta das medidas epidemiológicas caracterizadas como razäo de proporçöes.