Burden of ischemic heart disease mortality attributable to physical inactivity in Brazil

OBJECTIVE: To analyze if the burden of ischemic heart disease mortality trend attributed to physical inactivity in Brazil differs from the global estimates. METHODS: Databases from the Global Burden of Disease Study for Brazil, Brazilian states, and global information were used. We estimated the summary exposure value for physical inactivity, the total number of deaths, and the age-standardized death rates for ischemic heart disease attributed to physical inactivity in the years 1990 and 2015, and the population-attributable fraction. Data were presented according to sex. RESULTS: The Brazilian population was found to have a risk of exposure to physical inactivity varying between 70.4% for men and 75.7% for women in the year of 1990. This risk of exposure was similar in 2015. In men, the mortality rate from ischemic heart disease attributed to physical inactivity decreased in 2015 by approximately 24% around the world and 45% in Brazil. For women, this decrease was in 31% around the world and 45% in Brazil. The states of Southern and Southeastern Brazil presented lower mortality rates due to ischemic heart disease attributed to physical inactivity. If physical inactivity were eliminated in Brazil, mortality from ischemic heart disease would be reduced by 15.8% for men and 15.2% for women. CONCLUSIONS: Over 25 years, the risk of exposure to physical inactivity in Brazil did not change and was high compared to global estimates. The decrease in ischemic heart disease mortality results from the improvement of health services in Brazil and the control of other risk factors. Approximately 15% of deaths from ischemic heart disease in Brazil could be avoided if people met the recommendations for physical activity

Physical inactivity as risk factor for mortality by diabetes mellitus in Brazil in 1990, 2006, and 2016

Background: The aims of this study were to estimate the mortality due to diabetes mellitus attributed to physical inactivity in Brazil, to analyze these estimate in three points in time (1990, 2006 and, 2016), and to analyze these estimates according to the socioeconomic status of Brazilian states. Methods: All deaths and diseases recorded in Brazil during this period were analyzed. Surveys of the general adult population using random sampling procedures evaluating self-reported physical activity in all life domains in Brazil were included. The total number and the age-standardized rates of deaths, and population-attributable fraction (PAF) for diabetes mellitus attributed to physical inactivity in the years 1990, 2006, and 2016 were estimated. Socioeconomic Development Index (SDI) was used as an indicator of socioeconomic status of Brazilian states. Results: In relation to mortality due to diabetes mellitus attributed to physical inactivity, 736 deaths were estimated in 1990, 1337 deaths were estimated in 2006, and 1897 in 2016, which represented, in 1990, an age-standardized mortality rate (per 100,000 inhabitants) of 1.2, 2.1 in 2006, and 1.1 in 2016. Approximately 3.0% (PAF) of deaths due to diabetes mellitus could be avoided if the Brazilian population were physically active. In 2006 and 2016, Brazilian states with worst socioeconomic indicators had higher age-standardized mortality rate by diabetes mellitus due to physical inactivity. Conclusion: These fndings are the frst to estimate the burden of diabetes mellitus due to physical inactivity in Brazil and support the promotion of physical activity in the Brazilian population to prevent and manage diabetes mellitus

List of avoidable causes of deaths due to interventions of the Brazilian Health System

As causas de mortes evitáveis ou reduzíveis são definidas como aquelas preveníveis, total ou parcialmente, por ações efetivas dos serviços de saúde que estejam acessíveis em um determinado local e época. Essas causas devem ser revisadas à luz da evolução do conhecimento e tecnologia para prática da atenção à saúde. Portanto, este estudo está fundamentado em uma revisão da literatura referente à base conceitual e empírica das listas de causas de morte evitáveis, publicadas entre 1975 e 2004, e nas reflexões de um grupo de trabalho organizado pelo Ministério da Saúde do Brasil. O artigo propõe duas listas brasileiras desses eventos – para menores de cinco anos; e para pessoas com cinco ou mais anos de idade –, tendo por referência a tecnologia disponível no Sistema Único de Saúde (SUS). Embora esse debate se encontre em estágio inicial, seu aprofundamento parece promissor para o desenvolvimento metodológico do monitoramento e avaliação de desempenho da atenção à saúde no Brasil. _______________________________________________________________________________________ ABSTRACTThe avoidable or reducible causes of death are defined as those totally or partially preventable by health service effective actions, accessible in a determined place and time. These causes must be reviewed considering the available knowledge and technology for the practice of health care. Thus, this study is based upon a revision of literature that refers to the conceptual and empirical basis of the list of avoidable causes of death published between 1975 and 2004, and on the debate of a working-group organized by the Brazilian Ministry of Health. The paper proposes two Brazilian lists of these events – for individuals aged <5 years and five years and above – based on the available technology in the Brazilian Health System (SUS). Yet, it is on an initial stage. Although in its initial stage, the deepening of this debate seems to be promising for the methodological development of the monitoring and evaluation of health care performance in Brazil

Social inequalities in the prevalence of self-reported chronic non-communicable diseases in Brazil: national health survey 2013

Considering the high socioeconomic inequalities in Brazil related to occurrence of morbidity and premature mortality, the objective of this study was to analyze inequalities in self-reported prevalence of Non-Communicable Diseases (NCD) and in the physical limitations caused by these diseases, among the Brazilian adult population, according to sociodemographic variables. This was a population-based cross-sectional study that analyzed information on 60,202 individuals who formed a representative sample of Brazilian adults interviewed for the National Health Survey 2013. Disparities by schooling levels and possession of private health insurance were assessed by calculating the prevalence (P) and prevalence ratio (PR) of each of the 13 NCDs and any associated limitations, while controlling for other socioeconomic and demographic variables. 45 % of the Brazilian adult population reported having at least one NCD. The prevalence ratio was greater among women (1.24 CI 1.21-1.28), individuals over 55 years of age, individuals with low schooling levels (illiterate and incomplete elementary education) (1.08 CI 1.02-1.14) and people living in the Southeast (1.10 CI 1.04-1.16), South (1.26 CI 1.19-1.34) and Central-West (1.11 CI 1.05-1.18) regions of the country. Diseases such as diabetes (1.42 CI 1.13-1.47), hypertension (1.17 CI 1.06-1.28), stroke (2.52 CI 1.74-3.66), arthritis (1.4 CI 1.11-1.77), spinal problems (1.39 CI .1.25-1.56), and chronic renal failure (1.65 CI 1.10.2.46), were more prevalent among adults with low education. For most NCDs, greater reports of limitations were associated with lower schooling levels and lack of private health insurance. Populations with lower schooling levels and lack of private health insurance present higher prevalence of various NCD and greater degrees of limitation due to these diseases. Results reveal the extent of social inequalities that persist with regard to occurrence and the impact of NCDs in Brazil.15153CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQ307865/2014-

The burden of diabetes and hyperglycemia in Brazil-past and present : findings from the Global Burden of Disease Study 2015

Background: Diabetes, hyperglycemia, and their complications are a growing problem in Brazil. However, no comprehensive picture of this disease burden has yet been presented to date. Methods: We used Global Burden of Disease 2015 data to characterize diabetes prevalence, incidence and risk factors from 1990 to 2015 in Brazil. Additionally, we provide mortality, years of life lost prematurely (YLL), years of life lived with disability (YLD) and disability-adjusted life years (DALYs) lost due to diabetes, as well as similar data for chronic kidney disease (CKD) due to diabetes and, as an overall summary measure, for hyperglycemia, the latter expressed as high fasting plasma glucose (HFPG). Results: From 1990 to 2015 diabetes prevalence rose from around 3.6 to 6.1%, and YLLs, YLDs, and DALYs attributable to diabetes increased steadily. The crude diabetes death rate increased 90% while that of CKD due to diabetes more than doubled. In 2015, HFPG became Brazil’s 4th leading cause of disability, responsible for 65% of CKD, for 7.0% of all disability and for the staggering annual loss of 4,049,510 DALYs. Diabetes DALYs increased by 118.6% during the period, increasing 42% due to growth in Brazil´s population, 72.1% due to population ageing, and 4.6% due to the change in the underlying, age-standardized rate of DALY due to diabetes. Main risk factors for diabetes were high body mass index; a series of dietary factors, most notably low intake of whole grains and of nuts and seeds, and high intake of processed meats; low physical activity and tobacco use, in that order. Conclusions: Our study demonstrates that diabetes, CKD due to diabetes, and hyperglycemia produce a large and increasing burden in Brazil. These findings call for renewed efforts to control the joint epidemics of obesity and diabetes, and to develop strategies to deal with the ever-increasing burden resulting from these diseases

Factors associated with chronic back pain in adults in Brazil

OBJECTIVE To identify associations of chronic back pain with sociodemographic characteristics, lifestyles, body mass index, self-reported chronic diseases and health assessment, according to sex. METHODS We analyzed data from the 2013 National Health Survey, estimated the prevalence and their respective 95% confidence intervals (95%CI) of chronic back pain, according to selected variables and performed adjustment by age and education. RESULTS 18.5% of the Brazilian population reported chronic back pain, 15.5% (95%CI 14.7–16.4) of them being men and 21.1% (95%CI 20.2–22.0) being women. The characteristics that remained associated and statistically significant (p &lt; 0.05) after adjustment, in men, were: age group, higher in men with 65 years or older (ORa = 6.06); low education level; living in rural area; history of smoking, high salt intake, increase in the time of heavy physical activity at work and at home; being overweight (ORa = 1.18) or obese (ORa = 1.26); diagnostic of hypertension (ORa = 1.42), high cholesterol (ORa = 1.60); and worse health assessment in comparison with very good (good [ORa = 1.48]; regular [ORa = 3.22]; poor [ORa = 5.00], very poor [ORa = 8.60]). Among women, they were: increase with age, higher among women with 55-64 years (ORa = 3.64); low education level; history of smoking, regular candy consumption, high salt intake, heavy physical activity at work and at home and increase in the time of these activities; being overweight (ORa = 1.23) or obese (ORa = 1.32); diagnosis of hypertension (ORa = 1.50), high cholesterol (ORa = 1.84); and worse health assessment than very good (good [ORa = 1.43]; regular [ORa = 3.16]; poor [ORa = 5.44], very poor [ORa = 8.19]). CONCLUSIONS Our findings point out differences by sex and contribute to the knowledge of the panorama of chronic back pain, which, besides affecting individuals, generate negative socioeconomic impacts, by causing work-related disabilities and hindering everyday activities.OBJETIVO Identificar associações de dor crônica na coluna com características sociodemográficas, estilos de vida, índice de massa corporal, doenças crônicas autorreferidas e avaliação do estado de saúde, segundo sexo. MÉTODOS Foram analisados dados da Pesquisa Nacional de Saúde 2013; estimadas as prevalências e seus respectivos intervalos de 95% de confiança (IC95%) da dor crônica na coluna, segundo variáveis selecionadas; e realizado ajuste por idade e escolaridade. RESULTADOS 18,5% da população brasileira referiram dor crônica na coluna, sendo 15,5% (IC95% 14,7–16,4) em homens e 21,1% (IC95% 20,2–22,0) em mulheres. As características que se mantiveram associadas após o ajuste e estatisticamente significativas (p < 0,05) em homens foram: aumento com a faixa etária, sendo maior entre aqueles com 65 anos ou mais (ORa = 6,06); baixa escolaridade; morar em área rural; histórico de tabagismo, consumo elevado de sal, aumento do tempo de prática de atividade física pesada no trabalho e atividade pesada no domicílio; ter sobrepeso (ORa = 1,18) ou obesidade (ORa = 1,26); diagnóstico de hipertensão (ORa= 1,42), colesterol elevado (ORa = 1,60); e pior avaliação do estado de saúde (bom [ORa = 1,48]; regular [ORa = 3,22]; ruim [ORa = 5,00], muito ruim [ORa = 8,60]). Entre mulheres: aumento com a faixa etária, sendo maior entre as mulheres com 55–64 anos (ORa = 3,64); menor escolaridade; histórico de tabagismo, consumo de doces regularmente, consumo elevado de sal, atividade e aumento do tempo de prática de atividade física pesada no trabalho e atividade pesada no domicílio; ter sobrepeso (ORa = 1,23) ou obesidade (ORa = 1,32); diagnóstico de hipertensão (ORa = 1,50), colesterol elevado (ORa = 1,84); e piora da avaliação do estado de saúde (bom [ORa = 1,43]; regular [ORa = 3,16]; ruim [ORa = 5,44], muito ruim [ORa = 8,19]). CONCLUSÕES Os achados apontam diferenças por sexo e contribuem no conhecimento do panorama da dor crônica na coluna, que além de afetar o indivíduo, geram impactos socioeconômicos negativos, por ocasionar incapacidades relacionadas ao trabalho e realização de atividades cotidianas

Leading causes of child mortality in Brazil, in 1990 and 2015 : estimates from the Global Burden of Disease study

Objetivo: analisar as taxas de mortalidade e as principais causas de morte na infância no Brasil e estados, entre 1990 e 2015, utilizando estimativas do estudo Carga Global de Doença (Global Burden of Disease - GBD) 2015. Métodos: as fontes de dados foram óbitos e nascimentos estimados com base nos dados do Sistema de Informações sobre Mortalidade (SIM), censos e pesquisas. Foram calculadas proporções e taxas por mil nascidos vivos (NV) para o total de óbitos e as principais causas de morte na infância. Resultados: o número estimado de óbitos para menores de 5 anos, no Brasil, foi de 191.505, em 1990, e 51.226, em 2015, sendo cerca de 90% mortes infantis. A taxa de mortalidade na infância no Brasil sofreu redução de 67,6%, entre 1990 e 2015, cumprindo a meta estabelecida nos Objetivos de Desenvolvimento do Milênio (ODM). A redução total das taxas foi, em geral, acima de 60% nos estados, sendo maior na região Nordeste. A disparidade entre as regiões foi reduzida, sendo que a razão entre o estado com a maior e a menor taxa diminuiu de 4,9, em 1990, para 2,3, em 2015. A prematuridade, apesar de queda de 72% nas taxas, figurou como a principal causa de óbito em ambos os anos, seguida da doença diarreica, em 1990, e das anomalias congênitas, da asfixia no parto e da sepse neonatal, em 2015. Conclusão: a queda nas taxas de mortalidade na infância representa um importante ganho no período, com redução de disparidades geográficas. As causas relacionadas ao cuidado em saúde na gestação, no parto e no nascimento figuram como as principais em 2015, em conjunto com as anomalias congênitas. Políticas públicas intersetoriais e de saúde específicas devem ser aprimoradas.Objective: to analyze under-5 mortality rates and leading causes in Brazil and states in 1990 and 2015, using the Global Burden of Disease Study (GBD) 2015 estimates. Methods: the main sources of data for all-causes under-5 mortality and live births estimates were the mortality information system, surveys, and censuses. Proportions and rates per 1,000 live births (LB) were calculated for total deaths and leading causes. Results: estimates of under-5 deaths in Brazil were 191,505 in 1990, and 51,226 in 2015, 90% of which were infant deaths. The rates per 1,000 LB showed a reduction of 67.6% from 1990 to 2015, achieving the proposed target established by the Millennium Development Goals (MDGs). The reduction generally was more than 60% in states, with a faster reduction in the poorest Northeast region. The ratio of the highest and lowest rates in the states decreased from 4.9 in 1990 to 2.3 in 2015, indicating a reduction in socioeconomic regional disparities. Although prematurity showed a 72% reduction, it still remains as the leading cause of death (COD), followed by diarrheal diseases in 1990, and congenital anomalies, birth asphyxia and septicemia neonatal in 2015. Conclusion: under-5 mortality has decreased over the past 25 years, with reduction of regional disparities. However, pregnancy and childbirth-related causes remain as major causes of death, together with congenital anomalies. Intersectoral and specific public health policies must be continued to improve living conditions and health care in order to achieve further reduction of under-5 mortality rates in Brazil

Fiscal austerity measures hamper noncommunicable disease control goals in Brazil

Tendo em vista a Emenda Constitucional 95 e a crise econômica, são discutidos os possíveis efeitos que as medidas de austeridade podem ter no cumprimento das metas estabelecidas para o controle das doenças crônicas não transmissíveis (DCNT) no Brasil. As tendências de DCNT e os fatores de risco foram analisadas, de acordo com os dados de levantamentos epidemiológicos e os de mortalidade do estudo Global Burden of Disease. Os resultados indicam uma tendência de estabilidade nas taxas de mortalidade por DCNT em 2015 e 2016. Os brasileiros com baixa escolaridade, em geral, apresentam maior prevalência de fatores de risco e menor de fatores de proteção. Entre 2015 e 2017, tendências anteriormente favoráveis foram revertidas para indicadores como consumo de frutas e vegetais, atividade física, estabilização das taxas de uso de tabaco e aumento do consumo de álcool. Conclui-se que, se tais tendências forem mantidas, o Brasil poderá não cumprir as metas previamente acordadas em conjunto com a Organização Mundial de Saúde e as Nações Unidas para reduzir as DCNT e seus fatores de risco.Given the Constitutional Amendment 95 and the economic crisis, we discussed the possible effects of austerity measures on the achievement of the goals established for the control of chronic noncommunicable diseases (NCDs) in the country. The trends of NCDs and risk factors were analyzed, according to data from epidemiological surveys and mortality data from the Global Burden of Disease study. The resultsindicate a trend of stability in mortality rates by NCD in 2015 and 2016. Brazilians with low schooling, in general, have a higher prevalence of risk factors and a lower prevalence of protective factors. In the 2015-2017 period, previously favorable trends reversed for indicators such as fruit and vegetable consumption and physical activity, tobacco trends stabilized, and alcohol intake increased. In conclusion, should these trends be maintained, it is unlikely that Brazil will achieve the goals previously agreed upon with the World Health Organization and the United Nations to curb NCDs and their risk factors

Variations and particularities in cardiovascular disease mortality in Brazil and Brazilian states in 1990 and 2015 : estimates from the Global Burden of Disease

Objetivo: Analisar as variações e os diferenciais da mortalidade por doenças cardiovasculares (DCV) no Brasil e em seus estados, em 1990 e 2015. Métodos: Foram utilizados os dados de mortalidade compilados pelo Global Burden of Disease (GBD) 2015, obtidos da base de dados do Sistema de Informação sobre Mortalidade do Ministério da Saúde. Foram realizadas a correção do sub-registro de óbitos e a reclassificação dos códigos garbage por meio de algoritmos específicos. As causas cardiovasculares foram subdivididas em 10 causas específicas. As taxas de mortalidade — dos anos 1990 e 2015 — foram padronizadas pela idade, de acordo com o sexo e o estado brasileiro. Resultados: A taxa de mortalidade por DCV padronizada por idade caiu de 429,5 (1990) para 256,0 (2015) a cada 100 mil habitantes (40,4%). A redução proporcional foi semelhante em ambos os sexos, mas as taxas em homens são substancialmente mais altas do que nas mulheres. A redução da taxa padronizada por idade foi mais acentuada para a doença cardíaca reumática (44,5%), cardiopatia isquêmica (43,9%) e doença cerebrovascular (46,0%). A queda na mortalidade diferiu marcadamente entre os estados, sendo mais acentuada nos estados das regiões Sudeste e Sul do país e no Distrito Federal, e atenuada nos estados do Norte e Nordeste. Conclusão: A mortalidade por DCV padronizada por idade reduziu no Brasil nas últimas décadas, porém de forma heterogênea entre os estados e para diferentes causas específicas. Considerando a magnitude da carga de doença e o envelhecimento da população brasileira, as políticas de enfrentamento das DCV devem ser priorizadas.Objective: To analyze variations and particularities in mortality due to cardiovascular disease (CVD) in Brazil and in Brazilian states, in 1990 and 2015. Methods: We used data compiled from the Global Burden of Disease (GBD) 2015, obtained from the database of the Mortality Information System (SIM) of the Brazilian Ministry of Health. Correction of the sub-registry of deaths and reclassification of the garbage codes were performed using specific algorithms. The cardiovascular causes were subdivided into 10 specific causes. Age-standardized CVD mortality rates — in 1990 and 2015 — were analyzed according to sex and Brazilian state. Results: Age-standardized CVD mortality rate decreased from 429.5 (1990) to 256.0 (2015) per 100,000 inhabitants (40.4%). The proportional decrease was similar in both sexes, but death rates in males were substantially higher. The reduction of age-standardized mortality rate was more significant for rheumatic heart disease (44.5%), ischemic cardiopathy (43.9%), and cerebrovascular disease (46.0%). The decline in mortality was markedly different across states, being more pronounced in those of the southeastern and southern regions and the Federal District, and more modest in most states in the north and northeast regions. Conclusion: Agestandardized CVD mortality has declined in Brazil in recent decades, but in a heterogeneous way across states and for different specific causes. Considering the burden magnitude and the Brazilian population aging, policies to prevent and manage CVD should continue to be prioritized