Mortalidade cerebrovascular: tendência e sazonalidade nas capitais brasileiras, 2000–2019

OBJETIVO: Avaliar a tendência e a sazonalidade das taxas de mortalidade cerebrovascular na população adulta das capitais brasileiras de 2000 a 2019. MÉTODOS: Estudo ecológico e descritivo de séries temporais de mortalidade por causas cerebrovasculares em adultos (≥ 18 anos) residentes nas capitais do Brasil no período 2000–2019, obtidas do Sistema de Informações sobre Mortalidade. Técnicas de estatística descritiva foram aplicadas na análise exploratória dos dados e no resumo de taxas específicas, padronizadas e razões por características sociodemográficas. A regressão de pontos de junção ( jointpoint regression model) e stimou a t endência d as t axas d e m ortalidade c erebrovascular p or s exo, grupos etários e regiões geográficas. A variabilidade sazonal por regiões geográficas das taxas foi estimada utilizando o modelo aditivo generalizado por meio de splines de suavização cúbica. RESULTADOS: As pessoas maiores de 60 anos representaram 77% dos óbitos cerebrovasculares. Predominaram o sexo feminino (52%), a raça branca (47%), os solteiros (59%) e a baixa escolaridade (57%, ensino fundamental). As capitais Recife (20/1.000 hab.) e Vitória (16/1.000 hab.) apresentaram as maiores taxas brutas de mortalidade. Aplicando as taxas padronizadas Recife (49/10.000 hab.) e Palmas (47/10.000 hab.) prevaleceram. As taxas de mortalidade cerebrovascular no Brasil apresentam uma tendência favorável ao declínio em ambos os sexos e em adultos. A sazonalidade mostrou influenciar na elevação das taxas entre os meses de julho a agosto em quase todas as capitais das regiões, exceto na Norte, que se elevaram nos meses de março, abril e maio. CONCLUSÕES: Os óbitos por causa cerebrovascular prevaleceram em pessoas idosas, solteiras e com baixa escolaridade. A tendência foi favorável ao declínio, sendo o inverno o período de maior risco. As diferenças regionais permitem subsidiar os tomadores de decisões em relação à implementação de políticas públicas para reduzir a mortalidade cerebrovascular.OBJECTIVE: To evaluate the trend and seasonality of cerebrovascular mortality rates in the adult population of Brazilian capitals from 2000 to 2019. METHODS: This is an ecological and descriptive study of a time series of mortality due to cerebrovascular causes in adults (≥ 18 years) living in Brazilian capitals from 2000 to 2019, based on the Brazilian Mortality Information System. Descriptive statistical techniques were applied in the exploratory analysis of data and in the summary of specific, standardized rates and ratios by sociodemographic characteristics. The jointpoint regression model was used to estimate the trend of cerebrovascular mortality rates by gender, age groups, and geographic regions. The seasonal variability of rates by geographic regions was estimated using the generalized additive model by smoothing cubic splines. RESULTS: People aged over 60 years comprised 77% of all cerebrovascular deaths. Women (52%), white individuals (47%), single people (59%), and those with low schooling (57%, elementary school) predominated in our sample. Recife (20/1,000 inhab.) and Vitória (16/1,000 inhab.) showed the highest crude mortality rates. Recife (49/10,000 inhab.) and Palmas (47/10,000 inhab.) prevailed after we applied standardized rates. Cerebrovascular mortality rates in Brazil show a favorable declining trend for adults of all genders. Seasonality influenced rate increase from July to August in almost all region capitals, except in the North, which rose in March, April, and May. CONCLUSIONS: Deaths due to cerebrovascular causes prevailed in older single adults with low schooling. The trend showed a tendency to decline and winter, the greatest risk. Regional differences can support decision-makers in implementing public policies to reduce cerebrovascular mortality

Prevalência de sibilância e fatores associados em crianças menores de 5 anos de Cuiabá, Mato Grosso, Brasil

A prevalência de sibilância no Brasil é elevada, com variações entre as regiões do país, bem como com fatores de risco diferenciados. Com o objetivo de analisar a prevalência de sibilância e fatores associados em menores de 5 anos em Cuiabá, Mato Grosso, Brasil, realizou-se estudo transversal, cuja amostra constou de 733 crianças. Foi utilizado o instrumento padronizado, resumido do Estudio Internacional de Sibilancias en Lactantes (EISL). Para análise dos fatores associados à sibilância foi aplicada regressão logística com abordagem hierarquizada. A prevalência de sibilância nos últimos 12 meses foi de 43,2%. Foram associados à sibilância: não amamentação ao seio por 6 meses ou mais (OR ajustada = 1,91; IC95%: 1,18-3,06), diagnóstico de asma familiar (OR ajustada = 2,02; IC95%: 1,06-3,87), doença prévia (OR ajustada = 1,81; IC95%: 1,05-3,14) e sexo masculino (OR ajustada = 1,50; IC95%: 1,07-2,11). Concluiu-se que a prevalência de sibilância em crianças dessa faixa etária em Cuiabá é elevada e está associada a fatores relacionados à provável atopia, doença prévia e sexo masculino

Impact of global warming on Potential Years of Life Lost by cardiopulmonary diseases in Brazilian capital cities

This study aims at assessing the future impact of global warming in the Potencial Years of Life Lost (YLL) for cardiovascular diseases in adults (≥45 years) and respiratory diseases in the elderly (≥60 years). This is an ecological study, which includes all the capitals of Brazil. Future projections used temperature data sourced from the Eta-HadGEM2S Regional Model for the RCP8.5 scenario. YLL fractions attributable to temperature were estimated for global warming scenarios of 1.5°C, 2.0°C, and 4.0°C. The results showed that, in absolute numbers, Rio de Janeiro and São Paulo have presented the largest YLL contribution attributable to global warming among the capital cities. Campo Grande and Cuiabá were the most impacted capitals by a global warming of 1.5ºC compared to the baseline period (1961-2005), both for respiratory diseases in the elderly and for cardiovascular diseases in adults. Results of this research suggest that the impact of exposure to temperature on YLL tends to increase as the level of global warming increases.This study aims at assessing the future impact of global warming in the Potencial Years of Life Lost (YLL) for cardiovascular diseases in adults (≥45 years) and respiratory diseases in the elderly (≥60 years). This is an ecological study, which includes all the capitals of Brazil. Future projections used temperature data sourced from the Eta-HadGEM2S Regional Model for the RCP8.5 scenario. YLL fractions attributable to temperature were estimated for global warming scenarios of 1.5°C, 2.0°C, and 4.0°C. The results showed that, in absolute numbers, Rio de Janeiro and São Paulo have presented the largest YLL contribution attributable to global warming among the capital cities. Campo Grande and Cuiabá were the most impacted capitals by a global warming of 1.5ºC compared to the baseline period (1961-2005), both for respiratory diseases in the elderly and for cardiovascular diseases in adults. Results of this research suggest that the impact of exposure to temperature on YLL tends to increase as the level of global warming increases

Mortality Risk from Respiratory Diseases Due to Non-Optimal Temperature among Brazilian Elderlies.

Over the past decade, Brazil has experienced and continues to be impacted by extreme climate events. This study aims to evaluate the association between daily average temperature and mortality from respiratory disease among Brazilian elderlies. A daily time-series study between 2000 and 2017 in 27 Brazilian cities was conducted. Data outcomes were daily counts of deaths due to respiratory diseases in the elderly aged 60 or more. The exposure variable was the daily mean temperature from Copernicus ERA5-Land reanalysis. The association was estimated from a two-stage time series analysis method. We also calculated deaths attributable to heat and cold. The pooled exposure-response curve presented a J-shaped format. The exposure to extreme heat increased the risk of mortality by 27% (95% CI: 15-39%), while the exposure to extreme cold increased the risk of mortality by 16% (95% CI: 8-24%). The heterogeneity between cities was explained by city-specific mean temperature and temperature range. The fractions of deaths attributable to cold and heat were 4.7% (95% CI: 2.94-6.17%) and 2.8% (95% CI: 1.45-3.95%), respectively. Our results show a significant impact of non-optimal temperature on the respiratory health of elderlies living in Brazil. It may support proactive action implementation in cities that have critical temperature variations

Mortalidade por doenças cardiorrespiratórias em idosos no estado de Mato Grosso, 1986 a 2006

OBJECTIVE: To describe time trends of mortality due to cardiorespiratory diseases in elderly people. METHODS: Epidemiological descriptive study with an ecological time series approach conducted in the state of Mato Grosso, Central-West Brazil, between 1986 and 2006. Data were obtained from the Brazilian Ministry of Health Mortality Database. Linear regression models were adjusted to analyze trends in mortality rates by age groups (60 to 69; 70 to 79; and 80 or more) and gender. RESULTS: There was an increase in proportion of deaths due to respiratory diseases and a decrease in proportion of deaths due to cardiovascular diseases. As for gender, cardiovascular rates were 15% lower in women than men and respiratory rates were similar in both men and women. High mortality rates for respiratory and cardiovascular diseases were observed with increasing trends among the oldest-old groups. The annual average increase for respiratory and cardiovascular diseases in those aged 80 years and older was 1.99 and 3.43 deaths, respectively. CONCLUSIONS: The state of Mato Grosso shows high mortality rates due to cardiorespiratory disease among elderly people with increasing trends among the oldest-old groups.OBJETIVO: Describir la evolución temporal de la mortalidad por enfermedades cardiorrespiratorias en ancianos. MÉTODOS: Estudio epidemiológico descriptivo con delineamiento ecológico de series temporales realizado en el Estado de Mato Grosso, Centro-Oeste de Brasil, de 1986 a 2006. Se utilizaron datos sobre enfermedades de los aparatos respiratorio y circulatorio obtenidos del Sistema de Información sobre Mortalidad del Ministerio de la Salud. Modelos de regresión lineal simple fueron ajustados para evaluar la tendencia de las tasas específicas de mortalidad por grupos específicos de edad (60 a 69, 70 a 70 y 80 o más años) y sexo. RESULTADOS: Hubo aumento en la proporción de óbitos por enfermedades respiratorias y disminución por enfermedades cardiovasculares. En la comparación de tasas entre los sexos, las mujeres presentaron tasas 15% menores para las causas cardiovasculares y tasas similares al sexo masculino para las causas respiratorias Se observó tasa elevada de mortalidad por enfermedades respiratorias y cardiovasculares, con importante tendencia de incremento entre los grupos más longevos. En ancianos con edad ³80 años o aumento anual promedio en la tasa de mortalidad por enfermedades respiratorias fue de 1,99 óbitos y de 3,43 por enfermedades del aparato circulatorio. CONCLUSIONES: El Estado de Mato Grosso presenta elevada tasa de mortalidad por enfermedades respiratorias y cardiovasculares en ancianos, con importante tendencia de incremento entre los grupos más longevos.OBJETIVO: Descrever a evolução temporal da mortalidade por doenças cardiorrespiratórias em idosos. MÉTODOS: Estudo epidemiológico descritivo com delineamento ecológico de séries temporais realizado no estado do Mato Grosso, de 1986 a 2006. Foram utilizados dados sobre doenças dos aparelhos respiratório e circulatório obtidos do Sistema de Informação sobre Mortalidade do Ministério da Saúde. Modelos de regressão linear simples foram ajustados para avaliar a tendência das taxas específicas de mortalidade por grupos específicos de idade (60 a 69, 70 a 79 e 80 ou mais anos) e sexo. RESULTADOS: Houve aumento na proporção de óbitos por doenças respiratórias e diminuição por doenças cardiovasculares. Na comparação de taxas entre os sexos, as mulheres apresentaram taxas 15% menores para as causas cardiovasculares e taxas similares ao sexo masculino para as causas respiratórias. Foi observada taxa elevada de mortalidade por doenças respiratórias e cardiovasculares, com importante tendência de incremento entre os grupos mais longevos. Em idosos com idade >; 80 anos o aumento anual médio na taxa de mortalidade por doenças respiratórias foi de 1,99 óbitos e de 3,43 por doenças do aparelho circulatório. CONCLUSÕES: O estado de Mato Grosso apresenta elevada taxa de mortalidade por doenças respiratórias e cardiovasculares em idosos, com importante tendência de incremento entre os grupos mais longevos

Impacts of heat stress conditions on mortality from respiratory and cardiovascular diseases in Brazil

This study assesses the risk of exposure to heat stress conditions and their potential impact on mortality from cardiovascular and respiratory diseases in Brazilian capital cities for warming levels of 1.5 °C, 2.0 °C and 4.0 °C in the RCP8.5 scenario. The risk of exposure and the impact of heat stress conditions on mortality were measured by the Wet Bulb Globe Temperature (WBGT) index. The impact on health was estimated by applying exposure-response curves between WBGT and health outcomes in the projections. The potential impact on mortality was measured by attributable fraction of mortality due to heat stress. The results showed an increase in heat stress conditions for Brazil, especially in the Northern and Center-Western regions. The estimated curves showed an association between the WBGT and mortality by cardiovascular and respiratory diseases in Brazil, with an upward impact trend, according to the levels of warming and heterogeneous results among the capitals. Â

Vector-borne diseases in Brazil: climate change and future warming scenarios

Climate change affects human health either directly or indirectly, and related impacts are complex, non-linear, and depend on several variables. The various climate change impacts on health include a change in the spatial distribution of vector-borne diseases. In this regard, this study presents and discusses changes in the spatial distribution of climate suitability for visceral leishmaniasis, yellow fever and malaria in Brazil, in different global warming scenarios. Maximum entropy (MaxEnt) was used to construct climate suitability models in warming scenarios. Models were based in climate variables generated by the Eta-HadGEM2 ES regional model, in the baseline period 1965-2005 and RCP8.5 scenario, representing global warming levels of 1,5ºC (2011-2040), 2,0ºC (2041-2070) and 4,0ºC (2071-2099). The three diseases studied are largely influenced by climate and showed different distribution patterns within the country. In global warming scenarios, visceral leishmaniasis found more favorable climate conditions in the Southeastern and Southern regions of Brazil, while climate in the Northern and Center-West regions gradually became more favorable to yellow fever. In malaria scenarios, an increase in favorable climate conditions to its high incidence was observed in the Atlantic Forest, where currently extra-Amazonian cases occur. The scenarios presented herein represent different possible consequences for the health sector in terms of adopting (or not) different measures to mitigate climate change in Brazil, such as reducing the emission of greenhouse gases.  Climate change affects human health either directly or indirectly, and related impacts are complex, non-linear, and depend on several variables. The various climate change impacts on health include a change in the spatial distribution of vector-borne diseases. In this regard, this study presents and discusses changes in the spatial distribution of climate suitability for visceral leishmaniasis, yellow fever and malaria in Brazil, in different global warming scenarios. Maximum entropy (MaxEnt) was used to construct climate suitability models in warming scenarios. Models were based in climate variables generated by the Eta-HadGEM2 ES regional model, in the baseline period 1965-2005 and RCP8.5 scenario, representing global warming levels of 1,5ºC (2011-2040), 2,0ºC (2041-2070) and 4,0ºC (2071-2099). The three diseases studied are largely influenced by climate and showed different distribution patterns within the country. In global warming scenarios, visceral leishmaniasis found more favorable climate conditions in the Southeastern and Southern regions of Brazil, while climate in the Northern and Center-West regions gradually became more favorable to yellow fever. In malaria scenarios, an increase in favorable climate conditions to its high incidence was observed in the Atlantic Forest, where currently extra-Amazonian cases occur. The scenarios presented herein represent different possible consequences for the health sector in terms of adopting (or not) different measures to mitigate climate change in Brazil, such as reducing the emission of greenhouse gases. Â

Adverse effects of air pollution in children and adolescents due to fires in the Amazon: a mixed models approach in panel studies

Esta tese investiga os efeitos agudos da poluição atmosférica no pico de fluxo expiratório (PFE) de escolares com idades entre 6 e 15 anos, residentes em municípios da Amazônia Brasileira. O primeiro artigo avaliou os efeitos do material particulado fino (PM2,5) no PFE de 309 escolares do município de Alta Floresta, Mato Grosso (MT), durante a estação seca de 2006. Modelos de efeitos mistos foram estimados para toda a amostra e estratificados por turno escolar e presença de sintomas de asma. O segundo artigo expõe as estratégias utilizadas para a determinação da função de variância do erro aleatório dos modelos de efeitos mistos. O terceiro artigo analisa os dados do estudo de painel com 234 escolares, realizado na estação seca de 2008 em Tangará da Serra, MT. Avaliou-se os efeitos lineares e com defasagem distribuída (PDLM) do material particulado inalável (PM10), do PM2,5 e do Black Carbon (BC) no PFE de todos os escolares e estratificados por grupos de idade. Nos três artigos, os modelos de efeitos mistos foram ajustados por tendência temporal, temperatura, umidade e características individuais. Os modelos também consideraram o ajuste da autocorrelação residual e da função de variância do erro aleatório. Quanto às exposições, foram avaliados os efeitos das exposições de 5hs, 6hs, 12hs e 24hs, no dia corrente, com defasagens de 1 a 5 dias e das médias móveis de 2 e 3 dias. No que se refere aos resultados de Alta Floresta, os modelos para todas as crianças indicaram reduções no PFE variando de 0,26 l/min (IC95%: 0,49; 0,04) a 0,38 l/min (IC95%: 0,71; 0,04), para cada aumento de 10g/m3 no PM2,5. Não foram observados efeitos significativos da poluição no grupo das crianças asmáticas. A exposição de 24hs apresentou efeito significativo no grupo de alunos da tarde e no grupo dos não asmáticos. A exposição de 0hs a 5:30hs foi significativa tanto para os alunos da manhã quanto para a tarde. Em Tangará da Serra, os resultados mostraram reduções significativas do PFE para aumentos de 10 unidades do poluente, principalmente para as defasagens de 3, 4 e 5 dias. Para o PM10, as reduções variaram de 0,15 (IC95%: 0,29; 0,01) a 0,25 l/min (IC95%: 0,40 ; 0,10). Para o PM2,5, as reduções estiveram entre 0,46 l/min (IC95%: 0,86 to 0,06 ) e 0,54 l/min (IC95%: 0,95; 0,14). E no BC, a redução foi de aproximadamente 0,014 l/min. Em relação ao PDLM, efeitos mais importantes foram observados nos modelos baseados na exposição do dia corrente até 5 dias passados. O efeito global foi significativo apenas para o PM10, com redução do PFE de 0,31 l/min (IC95%: 0,56; 0,05). Esta abordagem também indicou efeitos defasados significativos para todos os poluentes. Por fim, o estudo apontou as crianças de 6 a 8 anos como grupo mais sensível aos efeitos da poluição. Os achados da tese sugerem que a poluição atmosférica decorrente da queima de biomassa está associada a redução do PFE de crianças e adolescentes com idades entre 6 e 15 anos, residentes na Amazônia Brasileira.This thesis investigates the acute effects of air pollution on peak expiratory flow (PEF) of schoolchildren between the ages of 6 and 15, living in Brazilian Amazon municipalities. The first article evaluated the effects of fine particulate matter (PM2.5) on PEF of 309 schoolchildren in the municipality of Alta Floresta, Mato Grosso (MT), during the dry season in 2006. Mixed effect models were estimated for the whole sample and stratified by the time of the day children attended school, and also by the presence of asthma symptoms. The second article describes the strategies used to determine the random error variance function of mixed effect models. The third one analyzes the data of the panel study with a sample of 234 schoolchildren carried out in Tangará da Serra, MT, during the dry season in 2008. Linear effects and the ones with distributed lag (PDLM) of inhalable particulate matter (PM10), PM2.5 and Black Carbon (BC) were assessed for the whole sample and stratified by age. In all three articles, the mixed effect models were adjusted by time trend, temperature, humidity and personal characteristics. The models also considered the adjustment of the residual autocorrelation and of the random error variance function. Regarding the exposures, its effects were evaluated in 5hs, 6hs, 12hs and 24hs, on the current day, with lags of 1 to 5 days and moving averages of 2 and 3 days. According to results in Alta Floresta, the models for all the children indicated reductions in the PEF varying from 0.26 l/min (CI95%: 0.49; 0.04) to 0.38 l/min (CI95%: 0.71; 0.04), for each increase of 10g/m3 on PM2.5. Significant effects of pollution were not observed in the group of asthmatic children. The 24-hour exposure presented significant effects in the group of students who attended school in the afternoon and in the group of non-asthmatic ones. The exposure from midnight to 5:30 A.M. was significant both to students who attended school in the morning and the ones who studied in the afternoon. In Tangará da Serra, the results showed significant reductions on the PEF for increases of 10 units of pollutants, mainly for lagged exposures of 3, 4 and 5 days. For PM10, the reductions varied from 0.15 (CI95%: 0.29; 0.01) to 0.25 l/min (CI95%: 0.40; 0.10). For PM2.5, the reductions ranged from 0.46 l/min (CI95%: 0.86 to 0.06) to 0.54 l/min (CI95%:0.95; 0.14). And for BC, the reduction was about 0.014 l/min. In relation to PDLM, more important effects were noticed in models based on the exposure of the current day until 5 past days. The global effect was significant only for PM10, with PEF reduction of 0.31 l/min (CI95%: 0.56; 0.05). This approach also indicated significant lagged effects for all pollutants. In the end, this study observed that the children between 6 and 8 years old were the most vulnerable to pollution effects. These findings in the thesis suggest that air pollution due to biomass burning is associated to PEF reduction in children and teenagers between the ages of 6 and 15, living in the Brazilian Amazon