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1.
Hypertension ; 77(2): 672-681, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33307849

RESUMO

Hypertension, particularly in middle age, has been associated with worse cognitive function, but evidence is inconclusive. This study investigated whether hypertension, prehypertension, age, and duration of diagnosis, as well as blood pressure control, are associated with a decline in cognitive performance in ELSA-Brasil participants. This longitudinal study included 7063 participants, mean age 58.9 years at baseline (2008-2010), who attended visit 2 (2012-2014). Cognitive performance was measured in both visits and evaluated by the standardized scores of the memory, verbal fluency, trail B tests, and global cognitive score. The associations were investigated using linear mixed models. Hypertension and prehypertension at baseline were associated with decline in global cognitive score; being hypertension associated with reduction in memory test; and prehypertension with reduction in fluency test. Hypertension diagnose ≥55 years was associated with lower global cognitive and memory test scores, and hypertension diagnose <55 years with lower memory test scores. Duration of hypertension diagnoses was not associated with any marker of cognitive function decline. Among treated individuals, blood pressure control at baseline was inversely associated with the decline in both global cognitive and memory test scores. In this relatively young cohort, hypertension, prehypertension, and blood pressure control were independent predictors of cognitive decline in distinct abilities. Our findings suggest that both lower and older age of hypertension, but not duration of diagnosis, were associated with cognitive decline in different abilities. In addition to hypertension, prehypertension and pressure control might be critical for the preservation of cognitive function.

2.
Heart ; 2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33361354

RESUMO

OBJECTIVE: Cardiovascular diseases (CVDs) are highly preventable non-communicable diseases. ECG is a potential tool for risk stratification with respect to CVD. Our aim was to evaluate ECG's role in all-cause and cardiovascular mortality prediction. METHODS: Participants from the Brazilian Longitudinal Study of Adult Health, free of known CVD at baseline were included. A 12-lead ECG was obtained at baseline (2008-2010). Participants were followed up to 2018 by annual interviews. Deaths were independently reviewed. Cox as well as Fine and Grey multivariable regression models were applied to evaluate if the presence of any major electrocardiographic abnormality (MEA), defined according to the Minnesota Code system, would predict total and cardiovascular deaths. We also evaluated the Net Reclassification Index of adding MEA to the Systematic Coronary Risk Evaluation (SCORE). RESULTS: The 13 428 participants (median age 51 years, 45% men) were followed up for 8±1 years. All-cause and cardiovascular mortality occurred in 2.8% and 1.2% of the population, respectively. Prevalent MEA was an independent predictor of overall (HR=2.3, 95% CI 1.7 to 2.9) and cardiovascular mortality (HR=4.6, 95% CI 3.0 to 7.0) after adjustments for age, race, education and traditional cardiovascular risk factors. Adding MEA to the SCORE resulted in 9% mis-reclassification in the non-event subgroup and 33% correct reclassification in those with a fatal cardiovascular event. CONCLUSION: Presence of MEA was an independent predictor of overall and cardiovascular mortality. ECG may have a role in risk prediction of cardiovascular mortality in primary care.

3.
Preprint em Português | SciELO Preprints | ID: pps-1614

RESUMO

Objective: The main objective of this paper is to analyze the relationship between GDP and three variables related to traffic accidents in Brazilian municipalities: traffic accident mortality, deaths per vehicle; and vehicles per inhabitant. Methods: 2005, 2010 and 2015 terrestrial traffic accident (ATT) mortality rates were estimated using a three years moving average and were standardized, then, we applied the empirical Bayes estimator (EBE). Fatality rates (deaths per vehicle) also were based on EBE. Vehicles per inhabitant considered the ratio between vehicle fleet and the population at municipal level. For every studied year, we estimated linear regression models between GDP and the interest variables.  Results: Variables distribution indicates that, between 2005 and 2015, GDP and vehicles per inhabitant kept the same rising relationship. Fatality rates show a decreasing association with GDP. TA mortality distribution with GDP presented a pattern close to an inverted-U. Model coefficients practically did not change for the vehicle per inhabitant. Estimated association between deaths per vehicle and GDP kept the same sign, but diminished between 2005 and 2015. Model coefficient sign changed in 2015 for TA mortality. Conclusion: Similarly to what was observed in developed countries, the relationship between mortality from traffic accidents and GDP changed in the analyzed period.


Objetivo: O artigo pretende analisar a relação entre o PIB per capita e três variáveis relacionadas aos acidentes de transporte nos municípios brasileiros: a mortalidade por acidentes de transporte terrestre (ATT); as mortes por veículo; e o número de veículos por pessoa.  Métodos: As taxas de mortalidade por ATT foram estimadas (2005, 2010 e 2015) por meio do estimador bayesiano empírico (EBE). A taxa de mortalidade por veículo foi também estimada pelo EBE. O número de veículos por pessoa foi baseado na razão entre a frota de automóveis e a população residente.  Para os três anos em análise, estimamos um modelo de regressão linear entre o PIB per capita municipal e as três variáveis de interesse.  Resultados: A distribuição das variáveis mostra que a relação entre o PIB e número de veículos por pessoa se manteve crescente ao longo dos anos, e foi sempre negativa considerando  as mortes por veículo. A taxa mortalidade por ATT apresentou distribuição próxima a um U-invertido.  Os coeficientes do modelo de regressão praticamente não variaram para a relação entre PIB e os veículos por habitante. O sinal para o modelo com a taxa de mortalidade por veículo se manteve o mesmo (negativo), mas apresentou diminuição. A taxa mortalidade por ATT, por sua vez, apresentou inversão do sinal em 2015.  Conclusões: De modo similar ao observado nos países desenvolvidos, parece ter havido uma inversão na relação entre mortalidade por ATT e PIB nos municípios brasileiros entre 2005 e 2015.

5.
Preprint em Português | SciELO Preprints | ID: pps-1610

RESUMO

Objective: To estimate premature mortality due to Noncommunicable Diseases in Brazilian municipalities. Methods: This ecological study estimated premature mortality rates due to cardiovascular, chronic respiratory diseases, neoplasms and diabetes in Brazilian municipalities, for the three-year periods of 2010 to 2012 and 2015 to 2017, and analyzed spatial and temporal distribution of these rates. Data treatment combined proportional redistribution of the missing data and ill-defined causes, and the application of coefficients for under-registration correction. Local empirical Bayesian estimator was used to calculate municipal mortality rates. Results: Rates for the set of chronic diseases reduced in Brazil between the three-year periods. The average rates for the total of NCDs declined in the South, Southeast and Midwest regions, stabilized in North and increased in Northeast. Mortality rates due to cardiovascular diseases were the highest in all regions, but showed the greatest declines between the periods. Neoplasms were the second leading group of causes of death. North and Northeast stood out for the increase in the average rates for this group of causes between the periods analyzed and for concentrating the highest averages of premature mortality rates due to diabetes in the 2015 to 2017 period. Conclusions: Spatial and temporal distribution of premature mortality rates due to NCDs differed among Brazilian municipalities and regions in the three-year periods evaluated. South and Southeast perceived a reduction in the rates due to cardiovascular, chronic respiratory diseases and diabetes, while North and Northeast had an increase in the rates due to neoplasms and Midwest due to diabetes.


Objetivo: Estimar mortalidade prematura por Doenças Crônicas Não Transmissíveis nos municípios brasileiros. Métodos: Estudo ecológico com estimativa das taxas de mortalidade prematura por doenças cardiovasculares, respiratórias crônicas, neoplasias e diabetes nos municípios brasileiros, nos triênios de 2010 a 2012 e 2015 a 2017, e análise da distribuição espacial e temporal dessas taxas. Realizou-se redistribuição proporcional dos dados faltantes e das causas mal definidas, e aplicou-se coeficientes para correção de sub-registro. As taxas municipais de mortalidade foram calculadas pelo estimador bayesiano empírico local. Resultados: No Brasil, houve redução das médias das taxas municipais para o conjunto das doenças crônicas entre os triênios. No Sul, Sudeste e Centro-Oeste houve declínio das médias das taxas para o total das DCNTe acréscimo no Nordeste. As médias das taxas de mortalidade por doenças cardiovasculares foram as mais altas em todas as regiões, mas apresentaram os maiores declínios entre os períodos. As neoplasias representaram o segundo principal grupo de causas. Norte e Nordeste se destacaram pelo aumento das taxas médias por esse grupo de causas entre os períodos analisados e por concentrarem as taxas mais altas de mortalidade prematura por diabetes no triênio 2015 a 2017. Conclusões: Diferenças na distribuição espaço-temporal das taxas de mortalidade prematura por DCNT foram identificadas entre municípios e regiões brasileiras. Houve redução das taxas por doenças cardiovasculares, respiratórias crônicas e diabetes no Sul e no Sudeste e aumento das taxas por neoplasias no Norte e no Nordeste, e por diabetes no Norte e no Centro-Oeste.

6.
Preprint em Português | SciELO Preprints | ID: pps-1609

RESUMO

Objective: To estimate the prevalence of hypertension and diabetes for small areas in Belo Horizonte, using the Health Vulnerability Index (HVI). Methods: Ecological study with data from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) conducted in Belo Horizonte, from 2006 to 2013. The self-reported diagnosis of diabetes and hypertension were evaluated. The estimates of prevalence and the 95% confidence interval (95% CI) were calculated using the direct and indirect method by HVI grouped into four categories: low, medium, high and very high health risk. Results: During the period evaluated, 26.0% (95% CI 25.2 - 26.8) and 6.1% (95% CI 6.7% - 6.5%) of the adult population in Belo Horizonte reported being hypertensive and diabetic, respectively. According to the indirect method to obtain estimates of hypertension and diabetes due to HVI, it was found that areas of very high risk had a higher prevalence of adults with hypertension (38.6; 95% CI: 34.8 - 42.4) and diabetes (16.2%; 95% CI: 13.1 - 19.3) when compared to the low risk (28.2; 95% CI: 27.0­ 29.4) and (6.0%; 95% CI: 5.4 - 6.7), respectively. Conclusions: The adult population living in areas at high risk for health had a higher prevalence of hypertension and diabetes compared to those with a lower risk.


Objetivo: Estimar as prevalências de hipertensão e diabetes para pequenas áreas em Belo Horizonte, utilizando o índice de vulnerabilidade à Saúde (IVS). Métodos:  Estudo ecológico com dados do sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico realizado em Belo Horizonte, nos anos de 2006 a 2013. Foram avaliados o diagnóstico autorreferido de diabetes e hipertensão. As estimativas de prevalências e o intervalo de 95% de confiança (IC95%) foram calculadas usando o método de estimação direto e indireto por IVS agrupado em quatro categorias: baixo, médio, alto e muito alto risco à saúde. Resultados:  Durante o período avaliado, 26,0 % (IC95% 25,2 ­ 26,8) e 6,1 % (IC95% 6,7% ­ 6,5%) da população adulta de Belo Horizonte reportaram ser hipertensos e diabéticos, respectivamente. Segundo o método indireto para obtenção das estimativas de hipertensão e diabetes por IVS, verificou-se que as áreas de risco muito elevado apresentaram maior prevalência de adultos com hipertensão (38,6; IC95%: 34,8 - 42,4) e diabetes (16,2%; IC95%:13,1 ­ 19,3) quando comparados com o de baixo risco  (28,2; IC95%: 27,0­ 29,4) e (6,0%; IC95%: 5,4 ­ 6,7), respectivamente. Conclusões: A população de adultos residentes em áreas com risco elevado à saúde apresentou maiores prevalências de hipertensão e diabetes em comparação àquelas com menor risco.

7.
Preprint em Português | SciELO Preprints | ID: pps-1608

RESUMO

Objective: To estimate the prevalence of fruit and vegetable consumption, practice of leisure time physical activity and excessive drinking of alcoholic beverages for small areas of Belo Horizonte, Minas Gerais. Methods: Ecological study conducted with data from the telephone survey of Surveillance System of Risk and Protective Factors for Chronic Diseases. The prevalence of risk and protection factors from 2006 to 2013 were estimated and the 95% confidence intervals calculated. The small areas corresponded to the municipality division into four strata of health risk classification given by the Health Vulnerability Index 2012. Results: The average prevalences for the period were: about 42% of regular intake of fruit and vegetable, 34.7% of leisure time activity and 20.4% of excessive drinking. The prevalence of fruit and vegetable consumption was higher in low-risk areas (58.5%; 95% CI: 56.8 - 60.2) and lower in very high-risk areas (32.3%; 95% CI: 27, 7 - 36.9). The practice of leisure time activity was higher in low-risk areas (40.8%; 95% CI: 38.9 - 42.8) and lower in very high risk (25.2%; 95% CI: 20.6 - 29.9). Excessive drinking was higher in low-risk areas (22.9%; 95% CI: 21.7 - 24.2) compared to very high-risk areas (14.3%; 95% CI: 11.4 - 17.3). Conclusions: It was identified a gradient in the distribution of risk and protection factors for noncommunicable diseases in Belo Horizonte according to the risk classification. This information can support programs aimed at reducing health inequalities, especially in the most vulnerable areas.


Objetivo: Estimar a prevalência de consumo de frutas e hortaliças, de prática de atividade física no tempo livre (AFTL) e de consumo abusivo de bebida alcóolica para pequenas áreas de Belo Horizonte, Minas Gerais. Métodos: Estudo ecológico realizado com dados do inquérito telefônico de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas. Estimou-se a prevalência de fatores de risco e proteção para o período de 2006 a 2013 e intervalos de confiança de 95%. Considerou-se como "pequenas áreas" a divisão do município em estratos de classificação de risco à saúde dada pelo Índice de Vulnerabilidade à Saúde 2012. Resultados: As prevalências médias para o período foram: cerca de 42% de consumo regular de frutas e hortaliças, 34,7% de atividade no tempo livre e 20,4% de consumo abusivo de bebidas. A prevalência de consumo de frutas e hortaliças foi maior nas áreas de baixo risco (58,5%; IC95%:56,8 ­ 60,2) e menor nas de risco muito elevado (32,3%; IC95%: 27,7 ­ 36,9). A prática de AFTL foi maior nas áreas de baixo risco (40,8%; IC95%:38,9 ­ 42,8) e menor no muito elevado risco (25,2%; IC95%: 20,6 ­ 29,9). O consumo abusivo de bebidas alcóolicas foi maior nas áreas de baixo risco (22,9%; IC95%: 21,7 ­ 24,2) em comparação com as de risco muito elevado (14,3%; IC95%: 11,4 ­ 17,3). Conclusões: Evidenciou-se gradiente na distribuição de fatores de risco e proteção em Belo Horizonte segundo o índice de vulnerabilidade. Estas informações podem apoiar programas destinados a reduzir as desigualdades em saúde, em especial, em áreas mais vulneráveis.

8.
PLoS Negl Trop Dis ; 14(11): e0008782, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33166280

RESUMO

BACKGROUND: Care to patients with Chagas disease (CD) is still a challenge for health systems in endemic and non-endemic countries. In the Brazilian public health system, the expansion of Primary Health Care (PHC) services to remote and disadvantaged areas has facilitated the access of patients with CD to medical care, however this is in a context where care gaps remain, with insufficient public funding and inadequate distribution of services. Considering the need for studies on care to patients with CD in different settings, this study explored the challenges of family doctors to provide care to patients with CD in an endemic region in Brazil with high coverage of public PHC services. METHODS AND FINDINGS: This is a qualitative study. A focus group with 15 family doctors was conducted in a municipality participating in a multicenter cohort that monitors almost two thousand patients with CD in an endemic region in Brazil. The data were analyzed using a thematic content analysis technique. The family doctors pointed out the following challenges for care to patients with CD: unsatisfactory medical training (academic education not suitable for the clinical management of the disease, and lack of training on CD in PHC); uncertainties regarding antiparasitic treatment in the chronic phase of the disease; difficulty in patients' access to specialized care when necessary, especially to the cardiologist; and trivialization of the disease by patients as a barrier to seeking care. CONCLUSION: The access of CD patients to adequate medical care, even in regions with high coverage of public PHC services, still represents an important challenge for health systems. The results of this study may contribute to the development of strategies to improve the clinical management of CD in PHC.

9.
Heart ; 106(24): 1898-1905, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33060261

RESUMO

INTRODUCTION: During the COVID-19 pandemic, excess mortality has been reported, while hospitalisations for acute cardiovascular events reduced. Brazil is the second country with more deaths due to COVID-19. We aimed to evaluate excess cardiovascular mortality during COVID-19 pandemic in 6 Brazilian capital cities. METHODS: Using the Civil Registry public database, we evaluated total and cardiovascular excess deaths, further stratified in specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular deaths in the 6 Brazilian cities with greater number of COVID-19 deaths (São Paulo, Rio de Janeiro, Fortaleza, Recife, Belém, Manaus). We compared observed with expected deaths from epidemiological weeks 12-22 of 2020. We also compared the number of hospital and home deaths during the period. RESULTS: There were 65 449 deaths and 17 877 COVID-19 deaths in the studied period and cities for 2020. Cardiovascular mortality increased in most cities, with greater magnitude in the Northern capitals. However, while there was a reduction in specified cardiovascular deaths in the most cities, the Northern capitals showed an increase of these events. For unspecified cardiovascular deaths, there was a marked increase in all cities, which strongly correlated to the rise in home deaths (r=0.86, p=0.01). CONCLUSION: Excess cardiovascular mortality was greater in the less developed cities, possibly associated with healthcare collapse. Specified cardiovascular deaths decreased in the most developed cities, in parallel with an increase in unspecified cardiovascular and home deaths, presumably as a result of misdiagnosis. Conversely, specified cardiovascular deaths increased in cities with a healthcare collapse.

12.
Popul Health Metr ; 18(Suppl 1): 13, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32993642

RESUMO

BACKGROUND: The aim of this study was to estimate the mortality from all causes as a result of physical inactivity in Brazil and in Brazilian states over 28 years (1990-2017). METHODS: Data from the Global Burden of Disease (GBD) study for Brazil and states were used. The metrics used were the summary exposure value (SEV), the number of deaths, age-standardized mortality rates, and the fraction of population risk attributable to physical inactivity. RESULTS: The Brazilian population presented risk of exposure to physical inactivity of (age-standardized SEV) of 59% (95% U.I. 22-97) in 1990 and 59% in 2017 (95% U.I. 25-99). Physical inactivity contributed a significant number of deaths (1990, 22,537, 95% U.I. 12,157-34,745; 2017, 32,410, 95% U.I. 17,976-49,657) in the analyzed period. These values represented mortality rates standardized by age (per 100,000 inhabitants) of 31 (95% U.I. 17-48) in 1990 and 15 (95% U.I. 8-23) in 2017. From 1990 to 2017, a decrease in standardized death rate from all causes attributable to physical inactivity was observed in Brazil (- 52%, 95% U.I. - 54 to - 49). The Brazilian states with better socioeconomic conditions presented greater reductions in age-standardized mortality (male: rho = 0.80; female: rho 0.84) over the period of 28 years. CONCLUSIONS: These findings support the promotion of physical activity in the Brazilian population for the prevention of early mortality.

13.
Popul Health Metr ; 18(Suppl 1): 24, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32993660

RESUMO

BACKGROUND: The present study sought to analyze smoking prevalence and smoking-attributable mortality estimates produced by the 2017 Global Burden of Disease Study for Brazil, 26 states, and the Federal District. METHODS: Prevalence of current smokers from 1990 to 2017 by sex and age was estimated using spatiotemporal Gaussian process regression. Population-attributable fractions were calculated for different risk-outcome pairs to generate estimates of smoking-attributable mortality. A cohort analysis of smoking prevalence by birth-year cohort was performed to better understand temporal age patterns in smoking. Smoking-attributable mortality rates were described and analyzed by development at state levels, using the Socio-Demographic Index (SDI). Finally, a decomposition analysis was conducted to evaluate the contribution of different factors to the changes in the number of deaths attributable to smoking between 1990 and 2017. RESULTS: Between 1990 and 2017, prevalence of smoking in the population (≥ 20 years old) decreased from 35.3 to 11.3% in Brazil. This downward trend was seen for both sexes and in all states, with a marked reduction in exposure to this risk factor in younger cohorts. Smoking-attributable mortality rates decreased by 57.8% (95% UI - 61.2, - 54.1) between 1990 and 2017. Overall, larger reductions were observed in states with higher SDI (Pearson correlation 0.637; p < 0.01). In Brazil, smoking remains responsible for a considerable amount of deaths, especially due to cardiovascular diseases and neoplasms. CONCLUSIONS: Brazil has adopted a set of regulatory measures and implemented anti-tobacco policies that, along with improvements in socioeconomic conditions, have contributed to the results presented in the present study. Other regulatory measures need to be implemented to boost a reduction in smoking in order to reach the goals established in the scope of the 2030 United Nations Agenda for Sustainable Development.

14.
Popul Health Metr ; 18(Suppl 1): 17, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32993676

RESUMO

BACKGROUND: Hypertension remains the leading risk factor for cardiovascular disease (CVD) worldwide, and its impact in Brazil should be assessed in order to better address the issue. We aimed to describe trends in prevalence and burden of disease attributable to high systolic blood pressure (HSBP) among Brazilians ≥ 25 years old according to sex and federal units (FU) using the Global Burden of Disease (GBD) 2017 estimates. METHODS: We used the comparative risk assessment developed for the GBD study to estimate trends in attributable deaths and disability-adjusted life-years (DALY), by sex, and FU for HSBP from 1990 to 2017. This study included 14 HSBP-outcome pairs. HSBP was defined as ≥ 140 mmHg for prevalence estimates, and a theoretical minimum risk exposure level (TMREL) of 110-115 mmHg was considered for disease burden. We estimated the portion of deaths and DALYs attributed to HSBP. We also explored the drivers of trends in HSBP burden, as well as the correlation between disease burden and sociodemographic development index (SDI). RESULTS: In Brazil, the prevalence of HSBP is 18.9% (95% uncertainty intervals [UI] 18.5-19.3%), with an annual 0.4% increase rate, while age-standardized death rates attributable to HSBP decreased from 189.2 (95%UI 168.5-209.2) deaths to 104.8 (95%UI 94.9-114.4) deaths per 100,000 from 1990 to 2017. In spite of that, the total number of deaths attributable to HSBP increased 53.4% and HSBP raised from 3rd to 1st position, as the leading risk factor for deaths during the period. Regarding total DALYs, HSBP raised from 4th in 1990 to 2nd cause in 2017. The main driver of change of HSBP burden is population aging. Across FUs, the reduction in the age-standardized death rates attributable to HSBP correlated with higher SDI. CONCLUSIONS: While HSBP prevalence shows an increasing trend, age-standardized death and DALY rates are decreasing in Brazil, probably as results of successful public policies for CVD secondary prevention and control, but suboptimal control of its determinants. Reduction was more significant in FUs with higher SDI, suggesting that the effect of health policies was heterogeneous. Moreover, HSBP has become the main risk factor for death in Brazil, mainly due to population aging.

15.
Popul Health Metr ; 18(Suppl 1): 16, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32993685

RESUMO

BACKGROUND: Monitoring and reducing premature mortality due to non-communicable diseases (NCDs) is a global priority of Agenda 2030. This study aimed to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and to project those for 2030 as well as the risk factors (RFs) attributed deaths according to estimates of the Global Burden of Disease Study. METHODS: We analyzed cardiovascular diseases, chronic respiratory diseases, neoplasms, and diabetes, and compared the mortality rates in 1990 and 2017 for all of Brazil and states. The study used the definition of premature mortality (30-69 years) that is used by the World Health Organization. The number of deaths, mortality rates, DALYs, and years of life lost (YLL) were used to compare 1990 and 2017. We analyzed the YLL for NCDs attributable to RFs. RESULTS: There was a reduction of 35.3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCDs in 2017. The DALY rate decreased by 33.6%, and the YLL rate decreased by 36.0%. There were reductions in NCDs rates in all 27 states. The main RFs related to premature deaths by NCDs in 2017 among women were high body mass index (BMI), dietary risks, high systolic blood pressure, and among men, dietary risks, high systolic blood pressure, tobacco, and high BMI. Trends in mortality rates due to NCDs declined during the study period; however, after 2015, the curve reversed, and rates fluctuated and tended to increase. CONCLUSION: Our findings highlighted a decline in premature mortality rates from NCDs nationwide and in all states. There was a greater reduction in deaths from cardiovascular diseases, followed by respiratory diseases, and we observed a minor reduction for those from diabetes and neoplasms. The observed fluctuations in mortality rates over the last 3 years indicate that if no further action is taken, we may not achieve the NCD Sustainable Development Goals. These findings draw attention to the consequences of austerity measures in a socially unequal setting with great regional disparities in which the majority of the population is dependent on state social policies.

16.
Popul Health Metr ; 18(Suppl 1): 10, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32993691

RESUMO

BACKGROUND: Tuberculosis (TB) continues to be an important cause of fatal and non-fatal burden in Brazil. In this study, we present estimates for TB burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017). METHODS: This descriptive study used GBD 2017 findings to report years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) of TB in Brazil by sex, age group, HIV status, and Brazilian states, from 1990 to 2017. We also present the TB burden attributable to independent risk factors such as smoking, alcohol use, and diabetes. Results are reported in absolute number and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UIs). RESULTS: In 2017, the number of DALYs due to TB (HIV-negative and HIV-positive combined) in Brazil was 284,323 (95% UI: 240,269-349,265). Among HIV-negative individuals, the number of DALYs was 196,366 (95% UI: 189,645-202,394), while 87,957 DALYs (95% UI: 50,624-146,870) were estimated among HIV-positive individuals. Between 1990 and 2017, the absolute number and age-standardized rates of DALYs due to TB at the national level decreased by 47.0% and 68.5%, respectively. In 2017, the sex-age-specific TB burden was highest among males and in children under-1 year and the age groups 45-59 years. The Brazilian states with the highest age-standardized DALY rates in 2017 were Rio de Janeiro, Pernambuco, and Amazonas. Age-standardized DALY rates decreased for all 27 Brazilian states between 1990 and 2017. Alcohol use accounted for 47.5% of national DALYs due to TB among HIV-negative individuals in 2017, smoking for 17.9%, and diabetes for 7.7%. CONCLUSIONS: GBD 2017 results show that, despite the remarkable progress in reducing the DALY rates during the period, TB remains as an important and preventable cause of health lost to due premature death and disability in Brazil. The findings reinforce the importance of strengthening TB control strategies in Brazil through integrated and multisectoral actions that enable the access to prevention, early diagnosis, and timely treatment, with emphasis on high-risk groups and populations most vulnerable to the disease in the country.

17.
Popul Health Metr ; 18(Suppl 1): 18, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32993699

RESUMO

BACKGROUND: The prevalence and burden of disease resulting from obesity have increased worldwide. In Brazil, more than half of the population is now overweight. However, the impact of this growing risk factor on disease burden remains inexact. Using the 2017 Global Burden of Disease (GBD) results, this study sought to estimate mortality and disability-adjusted life years (DALYs) lost to non-communicable diseases caused by high body mass index (BMI) in both sexes and across age categories. This study also aimed to describe the prevalence of overweight and obesity throughout the states of Brazil. METHODS: Age-standardized prevalence of overweight and obesity were estimated between 1990 and 2017. A comparative risk assessment was applied to estimate DALYs and deaths for non-communicable diseases and for all causes linked to high BMI. RESULTS: The prevalence of overweight and obesity increased during the period of analysis. Overall, age-standardized prevalence of obesity in Brazil was higher in females (29.8%) than in males (24.6%) in 2017; however, since 1990, males have presented greater rise in obesity (244.1%) than females (165.7%). Increases in prevalence burden were greatest in states from the North and Northeast regions of Brazil. Overall, burden due to high BMI also increased from 1990 to 2017. In 2017, high BMI was responsible for 12.3% (8.8-16.1%) of all deaths and 8.4% (6.3-10.7%) of total DALYs lost to non-communicable diseases, up from 7.2% (4.1-10.8%), and 4.6% (2.4-6.0%) in 1990, respectively. Change due to risk exposure is the leading contributor to the growth of BMI burden in Brazil. In 2017, high BMI was responsible for 165,954 deaths and 5,095,125 DALYs. Cardiovascular disease and diabetes have proven to be the most prevalent causes of deaths, along with DALYs caused by high BMI, regardless of sex or state. CONCLUSIONS: This study demonstrates increasing age-standardized prevalence of obesity in all Brazilian states. High BMI plays an important role in disease burdens in terms of cardiovascular diseases, diabetes, and all causes of mortality. Assessing levels and trends in exposures to high BMI and the resulting disease burden highlights the current priority for primary prevention and public health action initiatives focused on obesity.

18.
Arq. bras. cardiol ; 115(2): 152-160, ago., 2020. tab, graf
Artigo em Português | LILACS-Express | LILACS, Sec. Est. Saúde SP | ID: biblio-1131301

RESUMO

Resumo Fundamentos O Sistema de Informação sobre Mortalidade (SIM) é de vital importância no monitoramento das tendências das doenças cardiovasculares (DCV), tendo por objetivo apoiar as políticas públicas. Objetivo Comparar séries históricas de mortalidade por DCV tendo como fonte de dados o SIM com e sem correção e o estudo Carga Global de Doenças (GBD) 2017 no Brasil no período de 2000 a 2017. Métodos Análise da mortalidade por DCV no Brasil entre 2000 e 2017 por meio de comparações de três estimativas de mortalidade por DCV: SIM Bruto, SIM Corrigido e GBD 2017. Foram utilizados os números absolutos e as taxas padronizadas por idade para comparação das estimativas para o Brasil e as unidades da federação. Resultados No SIM, o total de óbitos por DCV variou de 261 mil, em 2000, a 359 mil, em 2017, e no GBD 2017, de 292 mil a 388 mil nos mesmos anos, respectivamente. Observou-se alta proporção de códigos garbage definidos pelo GBD 2017 nas causas de morte por DCV, chegando a 42% em 2017. As taxas de óbitos por 100 mil habitantes estimadas pelo GBD variaram de 248,8 (1990) a 178,0 (2017). As taxas do SIM Bruto e do SIM Corrigido também mostraram redução para toda a série analisada, sendo que o SIM Bruto apresentou taxas mais baixas, de 204,9 (1990) e 155,1 (2017) óbitos por 100 mil habitantes. Ao analisar por unidade da federação, as tendências do SIM Bruto se invertem, com aumento das taxas de mortalidade nos estados das regiões Norte e Nordeste. Conclusão O estudo aponta a diminuição das taxas de mortalidade por DCV no período analisado para o Brasil. Ao contrário, na análise por unidade da federação, a variação porcentual do SIM Bruto foi de aumento para os estados do Norte e Nordeste. O uso dos dados não ajustados do SIM pode resultar em erros na interpretação, indicando aumento das taxas decorrente do aumento na captação de óbitos e da melhoria na definição das causas básicas de morte na última década, em especial nas regiões Norte e Nordeste, o que justifica sempre utilizar dados corrigidos na análise de mortalidade. (Arq Bras Cardiol. 2020; 115(2):152-160)


Abstract Background The Brazilian Information System on Mortality (SIM) is of vital importance in monitoring the trends of cardiovascular diseases (CVDs) and is aimed at supporting public policies. Objective To compare historical series of CVD mortality based on data from the SIM, with and without correction, and from the Brazil Global Burden of Disease (GBD) Study 2017, in the 2000-2017 period. Methods Analysis of CVD mortality in Brazil between 2000 and 2017. Three CVD mortality estimates were compared: Crude SIM, Corrected SIM, and GBD 2017. Absolute numbers and age-standardized rates were used to compare the estimates for Brazil, its states and the Federal District. Results In the SIM, the total of deaths ranged from 261,000, in 2000, to 359,000, in 2017. In the GBD 2017, the total of deaths ranged from 292,000 to 388,000, for the same years, respectively. A high proportion of the causes of death from CVD corresponded to garbage codes, classified according to the GBD 2017, reaching 42% in 2017. The rates estimated by GBD ranged from 248.8 (1990) to 178.0 (2017) deaths per 100,000 inhabitants. The rates of the Crude SIM and Corrected SIM also showed a reduction for the whole series analyzed, the Crude SIM showing lower rates: 204.9 (1990) and 155.1 (2017) deaths per 100 thousand inhabitants. When analyzing by the states and Federal District, the Crude SIM trends reversed, with an increase in mortality rates in the Northern and Northeastern states. Conclusion This study shows the decrease in CVD mortality rates in Brazil in the period analyzed. Conversely, when analyzing by the states and Federal District, the Crude SIM showed an increase in those rates for the Northern and Northeastern states. The use of crude data from the SIM can result in interpretation errors, indicating an increase in rates, due to the increase in death data capture and the improvement in the definition of the underlying causes of death in the past decade, especially in the Northern and Northeastern regions, justifying the use of corrected data in mortality analyses. (Arq Bras Cardiol. 2020; 115(2):152-160)

19.
Arq Bras Cardiol ; 115(2): 152-160, 2020 08 28.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32696855

RESUMO

BACKGROUND: The Brazilian Information System on Mortality (SIM) is of vital importance in monitoring the trends of cardiovascular diseases (CVDs) and is aimed at supporting public policies. OBJECTIVE: To compare historical series of CVD mortality based on data from the SIM, with and without correction, and from the Brazil Global Burden of Disease (GBD) Study 2017, in the 2000-2017 period. METHODS: Analysis of CVD mortality in Brazil between 2000 and 2017. Three CVD mortality estimates were compared: Crude SIM, Corrected SIM, and GBD 2017. Absolute numbers and age-standardized rates were used to compare the estimates for Brazil, its states and the Federal District. RESULTS: In the SIM, the total of deaths ranged from 261,000, in 2000, to 359,000, in 2017. In the GBD 2017, the total of deaths ranged from 292,000 to 388,000, for the same years, respectively. A high proportion of the causes of death from CVD corresponded to garbage codes, classified according to the GBD 2017, reaching 42% in 2017. The rates estimated by GBD ranged from 248.8 (1990) to 178.0 (2017) deaths per 100,000 inhabitants. The rates of the Crude SIM and Corrected SIM also showed a reduction for the whole series analyzed, the Crude SIM showing lower rates: 204.9 (1990) and 155.1 (2017) deaths per 100 thousand inhabitants. When analyzing by the states and Federal District, the Crude SIM trends reversed, with an increase in mortality rates in the Northern and Northeastern states. CONCLUSION: This study shows the decrease in CVD mortality rates in Brazil in the period analyzed. Conversely, when analyzing by the states and Federal District, the Crude SIM showed an increase in those rates for the Northern and Northeastern states. The use of crude data from the SIM can result in interpretation errors, indicating an increase in rates, due to the increase in death data capture and the improvement in the definition of the underlying causes of death in the past decade, especially in the Northern and Northeastern regions, justifying the use of corrected data in mortality analyses. (Arq Bras Cardiol. 2020; 115(2):152-160).

20.
Rev Bras Epidemiol ; 23 Suppl 1: e200010.SUPL.1, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32638989

RESUMO

OBJECTIVE: To analyze the spatial distribution of female mortality due to motorcycle accidents in Brazilian municipalities between 2005 and 2015, as well as the variation in rates in the same period. METHODS: Female mortality rates for the years 2005, 2010 and 2015 were estimated considering a three-year moving average around the base year, standardized by the direct method. Rates were standardized using the same pattern (Brazilian females in 2010) for each year. Then, the empirical Bayes estimator was used to reduce the effect of the random fluctuation. The percentage variation of the standardized rates was also analyzed for different population sizes (less than ten thousand, less than 50 thousand, more than 100 thousand and more than one million inhabitants). RESULTS: Bayesian rates showed a clear increase in female mortality due to motorcycle accidents, especially in the North, Northeast and Midwest regions. In the municipalities of the South and Southeast regions, mainly in the period between 2010 and 2015, there was an apparent decrease in mortality. The percentage variation showed a reduction in the indicator analyzed in the period between 2010 and 2015 for the largest municipalities in the South and Southeast regions. For almost all regions and population sizes, the period between 2010 and 2015 showed a deceleration in the growth of rates. CONCLUSION: The analysis clearly shows concentrations of municipalities with higher mortality, while also showing that the phenomenon has spread to a greater number of municipalities. The studied period allows the identification of different dynamics in female mortality, in a period of significant variation in mortality due to motorcycle accidents.


Assuntos
Acidentes de Trânsito/mortalidade , Motocicletas , Teorema de Bayes , Brasil/epidemiologia , Cidades/epidemiologia , Feminino , Humanos , Densidade Demográfica
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