Diabetes burden in Brazil: fraction attributable to overweight, obesity, and excess weight

OBJECTIVE To estimate the burden of type 2 diabetes mellitus and its percentage attributable to overweight and obesity in Brazil. METHODS The burden of diabetes mellitus was described in terms of disability-adjusted life years, which is the sum of two components: years of life lost and years lived with disability. To calculate the fraction of diabetes mellitus attributable to overweight, obesity, and excess weight, we used the prevalence of these risk factors according to sex and age groups (>; 20 years) obtained from the 2008 Pesquisa Dimensões Sociais das Desigualdades (Social Dimensions of Inequality Survey) and the relative risks derived from the international literature. RESULTS Diabetes mellitus accounted for 5.4% of Brazilian disability-adjusted life years in 2008, with the largest fraction attributed to the morbidity component (years lived with disability). Women exhibited higher values for disability-adjusted life years. In Brazil, 49.2%, 58.3%, and 70.6% of diabetes mellitus in women was attributable to overweight, obesity, and excess weight, respectively. Among men, these percentages were 40.5%, 45.4%, and 60.3%, respectively. Differences were observed with respect to Brazilian regions and age groups. CONCLUSIONS A large fraction of diabetes mellitus was attributable to preventable individual risk factors and, in about six years, the contribution of these factors significant increased, particularly among men. Policies aimed at promoting healthy lifestyle habits, such as a balanced diet and physical activity, can have a significant impact on reducing the burden of diabetes mellitus in Brazil.OBJETIVO Estimar a carga do diabetes mellitus tipo 2 e sua fração atribuível ao sobrepeso e obesidade no Brasil. MÉTODOS A carga de diabetes mellitus foi descrita por meio dos anos de vida perdidos ajustados por incapacidade, a partir da soma de dois componentes: anos de vida perdidos por morte prematura e anos de vida perdidos devido à incapacidade. Para o cálculo da fração do diabetes mellitus devida ao sobrepeso, à obesidade e ao excesso de peso, foram utilizadas as prevalências desses fatores de risco por sexo e faixa etária (>; 20 anos), obtidas na Pesquisa Dimensões Sociais das Desigualdades, do ano de 2008, e os riscos relativos obtidos na literatura internacional. RESULTADOS Diabetes mellitus respondeu por 5,4% dos anos de vida perdidos ajustados por incapacidade em 2008, sendo a maior parcela atribuída ao componente de morbidade (anos de vida perdidos devido à incapacidade). As mulheres apresentaram maiores valores de anos de vida ajustados para incapacidade. No Brasil, 49,2%, 58,3% e 70,6% do diabetes mellitus no sexo feminino foram atribuíveis ao sobrepeso, à obesidade e ao excesso de peso, respectivamente. Entre os homens, esses percentuais foram 40,5%, 45,4% e 60,3%, respectivamente. Diferenças foram observadas no que tange às grandes regiões brasileiras e às faixas etárias. CONCLUSÕES Grande parte da carga do diabetes foi atribuível a fatores de risco modificáveis e, em aproximadamente seis anos, a contribuição desses fatores aumentou expressivamente, sobretudo entre os homens. Políticas voltadas à promoção de hábitos saudáveis de vida, como alimentação balanceada e prática de atividade física, podem ter um impacto significativo na redução da carga de diabetes mellitus no Brasil

Burden of disease from COVID-19 and its acute and chronic complications: reflections on measurement (DALYs) and prospects for the Brazilian Unified National Health System

COVID-19 is an acute infectious respiratory distress syndrome (ARDS) caused by the novel coronavirus SARS-CoV-2. The disease is highly communicable and produces mild to severe symptoms, generating a high demand for intensive care and thousands of deaths. In March 2020, COVID-19 was declared a pandemic and has already surpassed five million cases and 300,000 deaths in the world. The natural history of the disease has still not been fully established, hindering the elaboration of effective clinical protocols and preventive measures. Nevertheless, the disease requires a systemic approach, since there is evidence of acute and chronic complications, in addition to the catastrophic effects on the population\u27s mental health. This highlights the need for a methodology that more effectively captures the effect of COVID-19, considering such aspects as severity, duration, and the potential to generate chronic complications that will increase the demands on Brazilian Unified National Health System (SUS). DALYs, or disability-adjusted life years, are thus an extremely useful indictor that adds mortality, an estimate of years of life lost (YLLs), and morbidity, an estimate of years of life lived with disability (YLDs). This article discusses the relevance and difficulties of studying the burden of COVID-19 and its complications in the Brazilian context, highlighting the natural history of the disease and estimating indicators such as YLDs, considering the high burden of disease in planning strategies to deal with the consequences of COVID-19 after the pandemic. The article also discusses the future challenges to deal with the disease in the SUS and the effects on the calculation of DALYs