Mortalidade por raça/cor: evidências de desigualdades sociais em Vitória (ES), Brasil Mortality by race/color: evidence of social inequalities in Vitória (ES), Brazil

OBJETIVO: Analisar a mortalidade por causa básica, sexo e raça/cor a partir do sistema de informações sobre mortalidade (SIM), em Vitória (ES), no período de 2003 a 2006. MÉTODOS: Foram calculados e analisados os coeficientes de mortalidade, segundo causa básica e sexo por raça/cor, bem como a idade média e mediana de óbito por causa básica, sexo e raça/cor. Foi calculado o risco relativo (RR) por sexo, idade e causa básica (p<0,05 e IC 95%). RESULTADOS: A completitude da variável raça/cor no SIM variou de 1% em 1996 para 81% em 2006. Foi observado maior RR de óbito entre negros para transtornos mentais e comportamentais (RR=9,29), causas mal definidas (RR=8,71) e causas externas (RR=5,71). Entre mulheres negras, as causas externas apresentaram maior RR (2,38). Foi encontrada uma variação de até 33 anos na idade mediana do óbito entre brancos e negros. Conclusão: Este estudo reitera a existência de desigualdades raciais/étnicas na mortalidade, destacando-se a mortalidade por transtornos mentais e causas externas, além da mortalidade precoce que ocorre na população negra.<br>OBJECTIVE: To analyze mortality by cause and sex among groups of race or color from the mortality information system (MIS) in Vitória (Brazil), in the period from 2003 to 2006. METHODS: We calculated and analyzed the mortality rates according to underlying cause, sex and race/color, and the mean and median age of death by underlying cause, sex and race. We calculated the relative risk (RR) for age, sex and underlying cause (p<0.05 and CI 95%). RESULTS: The completeness of race/color in SIM ranged from 1% in 1996 to 81% in 2006. There was a greater RR of death among blacks for mental and behavioral disorders (RR=9.29), Ill-defined causes (RR=8.71), and external causes (RR=5.71). For black women, we highlight the external causes (RR=2.38). We found a variation of up to 33 years (nervous system) between whites and blacks. CONCLUSION: This study confirms the existence of unequal racial/ethnic mortality, highlighting the mortality from mental disorders and external causes, in addition to early mortality that occurs in the black population

Thiazides in the management of hypertension in older adults - a systematic review

BACKGROUND: Thiazides are commonly prescribed to older people for the management of hypertension. The objective of this study was to identify the evidence on the risks and benefits of their use among adults aged ≥65 years and to develop recommendations to reduce potentially inappropriate use. METHODS: Systematic review (SR) of the literature covering six databases. We applied a staged search approach, where each search was undertaken only if the previous one did not yield high quality results. Searches 1 and 2 identified relevant SRs and meta-analyses published up to December 2015 from all databases. Search 3 identified additional individual interventional studies (IS) and observational studies (OS) not identified by the preceding searches. We included all studies evaluating the effect of thiazides on patient-relevant outcomes in the management of hypertension with a sufficient number of participants aged ≥65 years or a subgroup analysis based on age. Two independent reviewers extracted data and carried out quality appraisal. Recommendations were developed using the GRADE methodology. RESULTS: Searches 1 to 3 were performed. We included 34 articles reporting on 12 IS and 4 OS. Mean ages ranged from 59 to 83.8 years. Four studies had performed a subgroup analysis by age. Information on comorbidity, polypharmacy and frailty of the participants was scarce or not available. The IS compared thiazides to placebo or other antihypertensive drugs and evaluated cardiovascular endpoints or all-cause-mortality as primary outcomes. The OS investigated the association between thiazide use and the risk of gout, fractures and adverse effects. Our results suggest that thiazides are efficacious in preventing cardiovascular events for this population group. Low-dose regimens of thiazides may be safer than high-dose (low quality of evidence), and a history of gout may increase the risk of adverse events (low quality of evidence). Three recommendations were developed. CONCLUSIONS: The use of low dose treatment with thiazides for the management of hypertension in adults aged 65 and older seems justified, unless a history of gout is present. The quality of the evidence is low and studies rarely describe characteristics of the participants such as polypharmacy and frailty. Further good quality studies are needed.The PRIMA-eDS study was supported by a grant from the European Commission within the 7th Framework Programme (Grant No. 305388–2). The work of YVM was also supported by a grant from the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre. Publication of this article was funded by the UK National Institute for Health Research School for Primary Care Research, University of Manchester