Tobacco-related neoplasms: survival analysis and risk of death of population data from Florianópolis, SC

OBJECTIVE To estimate the probability of survival and prognostic factors for tobacco-related neoplasms in a population-based cohort. METHODS This is a cohort with data from the Population-Based Cancer Registry of Florianópolis, southern Brazil, from 2008 to 2012. The Stata 16.0 software was used to estimate the probabilities of survival in five years after diagnosis, by the Kaplan Meier method, and the risk of death, by the Cox regression. RESULTS A total of 2,829 cancer records related to smoking were included, more prevalent among males, over 70 years of age, nine years or more of schooling, white, with a partner and metastatic diagnosis. The most frequent groupings were colon and rectum (28.7%), trachea, bronchi and lungs (18.6%) and stomach (11.8%). At follow-up, 1,450 died. Pancreatic cancer had the worst probability of survival (14.3%), followed by liver cancer (19.4%). CONCLUSION Risk factors for death and survival rates differ across the 13 types of tobacco-related cancers. Early diagnosis and primary prevention are strategies that must be improved to improve survival and decrease the burden related to these types of cancer.OBJETIVO Estimar a probabilidade de sobrevivência e os fatores prognósticos das neoplasias relacionados ao tabagismo em uma coorte de base populacional. MÉTODOS Trata-se de uma coorte com dados do Registro de Câncer de Base Populacional de Florianópolis, região Sul do Brasil, de 2008 a 2012. Utilizou-se o software Stata 16.0 para estimar as probabilidades de sobrevivência em cinco anos após o diagnóstico, pelo método de Kaplan Meier, e os riscos de óbito, pela regressão de Cox. RESULTADOS Foram incluídos 2.829 registros de câncer relacionados ao tabagismo, mais prevalentes entre pessoas do sexo masculino, com mais de 70 anos, nove anos ou mais de escolaridade, cor branca, com companheiro e diagnóstico metastático. Os agrupamentos mais frequentes foram cólon e reto (28,7%), traqueia, brônquios e pulmões (18,6%) e estômago (11,8%). No acompanhamento, 1.450 foram a óbito. O câncer de pâncreas foi o que apresentou pior probabilidade de sobrevivência (14,3%), seguido pelo câncer de fígado (19,4%). CONCLUSÃO Os fatores de risco para o óbito e as taxas de sobrevivência diferem entre os 13 tipos de câncer relacionados ao tabaco. O diagnóstico precoce e a prevenção primária são estratégias que devem ser aprimoradas para melhorar a sobrevivência e diminuir a carga relacionada a esses tipos de câncer

Itinerário dos pacientes com diagnóstico de câncer em Santa Catarina: Relatório de Pesquisa

Este trabalho trata-se de uma pesquisa em parceria entre a Universidade Federal de Santa Catarina - Campus Araranguá e a Rede de Controle do Câncer em Santa Catarina - RECAN/SC, da AMUCC.O objetivo deste relatório é apresentar os resultados referentes ao itinerário terapêutico dos pacientes oncológicos do estado de Santa Catarina. Foram realizadas entrevistas com 78 pessoas indicadas por organizações participantes da Rede de Controle do Câncer em Santa Catarina – RECAN/SC. As entrevistas foram realizadas por meio telefônico ou ambiente virtual e a análise dos dados foi realizada por meio da técnica de Análise de Conteúdo do Tipo Temática, que leva em conta a fala do sujeito no contexto em que vive, buscando compreendê-la no que explicita e nos velamentos e desvelamentos próprios das comunicações das pessoas. Ao todo, foram entrevistados 78 participantes, 87,2% mulheres com média de idade de 51 anos. Dentre os tipos de cânceres incluídos encontram-se: câncer de colo de útero, intestino/reto, mama, próstata e pulmão. As organizações pertencentes a Florianópolis foram as que mais encaminharam participantes. Os resultados das narrativas apresentaram quatro dimensões com maior ênfase: Itinerário terapêutico; Trabalho/Renda; Gênero/corpo/sexualidade; e Pandemia da COVID-19. Assim, evidenciou-se que se trata de um problema coletivo e social, pois constituiu uma experiência que envolve diretamente a pessoa acometida e sua rede de apoio.The purpose of this report is to introduce the results referring to the therapeutic itinerary of oncology patients in the state of Santa Catarina. The interviews were carried out with 78 people indicated by organizations involved in the Cancer Control Network in Santa Catarina - RECAN/SC. The interviews were performed by telephone or virtual setting and data analysis was made through the Thematic Content Analysis technique, which takes into account the subject's speech in the context in which he/she lives, in an attempt to understand it in its explicitness and in the concealments and unveilings of people's own communications. Overall, 78 participants were interviewed, 87.2% women with an average age of 51. The types of cancer included were: cervical, intestinal/rectal, breast, prostate, and lung cancer. The organizations in Florianópolis submitted the majority of participants. The results of the narratives revealed four dimensions with greater emphasis: Therapeutic itinerary; Work/income; Gender/body/sexuality; and the COVID-19 pandemic. Thus, it is evident that this is a collective and social problem, since it constitutes an experience that directly involves the affected person and his/her supporting chain

Estudo de sobrevivência de pessoas com diagnóstico de câncer no município de Florianópolis/SC

As Doenças Crônicas Não transmissíveis (DCNT) estão entre as principais causas de mortes no mundo, com grande número de mortes prematuras e muitas vezes, grave limitação nas atividades de trabalho e de lazer, o que provoca impactos econômicos para as famílias, comunidades e a sociedade em geral acentuando as iniquidades e a pobreza. O impacto das DCNTs pode ser revertido por meio de intervenções de promoção de saúde para redução de fatores de risco, além de melhoria da atenção à saúde, detecção precoce e tratamento oportuno. Em relação ao câncer, uma das doenças que compõe as DCNTs, é possível por intermédio de estudos de sobrevida. Estes estudos servem de parâmetro para avaliar resultados de ações na área da atenção oncológica. No Brasil, é possível fazer estudos de sobrevida com dados referentes aos sistemas de informação em saúde, como os Registros de Câncer de Base Populacional, que são fontes sistemáticas de coleta de dados, armazenamento e análise da incidência de câncer na população. Ao relacionar esses dados com outros do Sistema de Informação sobre Mortalidade é possível delinear um estudo de coorte que possibilite a análise de sobrevida e o conhecimento dos fatores associados. Também permite identificar grupos vulneráveis, com maior incidência e menor sobrevida. O projeto pretende estimar o tempo de sobrevida, como o intervalo entre a data do diagnóstico e a do óbito ou final do acompanhamento. Após este passo, serão estimadas as curvas sobrevida pelo método de Kaplan-Meier, e a comparação dessas será feita através do teste log-rank. A estimação do efeito das variáveis independentes em relação a sobrevida será realizada pelo modelo de Cox. O uso de instrumentos adequados de mensuração do processo saúde-doença possibilita à Saúde Pública utilizar racionalmente os recursos disponíveis. Para isto, é fundamental dispor de informações que possibilitem uma análise objetiva das situações de saúde em que se pretende atuar. Os indicadores de saúde cumprem esse papel e suas características determinam quanto são utilizados no nível local. O presente projeto, ao propor a análise de sobrevida nos diversos tipos de neoplasia no nível local e, ao ser um desenvolvido em parceria entre gestores municipais, pesquisadores, profissionais de saúde e acadêmicos, tem o potencial de implementar a vigilância em saúde, e contribuir para a prevenção e o controle das neoplasias de maior incidência e menor sobrevida. Além disso, pode ajudar no planejamento de ações que visam a redução de fatores de risco comuns às doenças não transmissíveis, possibilitando desenvolver ações de promoção de saúde que garantam à população uma melhor qualidade de vida.Chamada Pública FAPESC n10/2015 – FAPESC/MS-DECIT/CNPQ/SES-SC – APOIO À PROGRAMA DE PESQUISA PARA O SUS (PPSUS) – GESTÃO COMPARTILHADA EM SAÚD

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Alcohol use and burden for 195 countries and territories, 1990-2016 : a systematic analysis for the Global Burden of Disease Study 2016

Background Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. Methods Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. Findings Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2.2% (95% uncertainty interval [UI] 1.5-3.0) of age-standardised female deaths and 6.8% (5.8-8.0) of age-standardised male deaths. Among the population aged 15-49 years, alcohol use was the leading risk factor globally in 2016, with 3.8% (95% UI 3.2-4-3) of female deaths and 12.2% (10.8-13-6) of male deaths attributable to alcohol use. For the population aged 15-49 years, female attributable DALYs were 2.3% (95% UI 2.0-2.6) and male attributable DALYs were 8.9% (7.8-9.9). The three leading causes of attributable deaths in this age group were tuberculosis (1.4% [95% UI 1. 0-1. 7] of total deaths), road injuries (1.2% [0.7-1.9]), and self-harm (1.1% [0.6-1.5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27.1% (95% UI 21.2-33.3) of total alcohol-attributable female deaths and 18.9% (15.3-22.6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0.0-0.8) standard drinks per week. Interpretation Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.Peer reviewe

Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an