Revista brasileira de epidemiologia = Brazilian journal of epidemiology最新文献

Objective: Trends in maternal mortality (MMR) and late maternal mortality ratios (LMMR) were estimated, in periods with and without H1N1 and COVID-19 pandemics, in Rio de Janeiro, Brazil, from 2009 to 2021.

Methods: Ecological study of temporal trends. Data was obtained from the Mortality and Live Birth Information Systems. The annual MMR and LMMR per 100,000 live births (LB) were calculated and the trends were estimated using the joinpoint regression model.

Results: In 2009, the MMR was 103.1, reaching 152.4/100,000 LB in 2021, with an annual reduction of 3.3% (95% confidence interval - 95%CI -5.5; -1.7) until 2019 and an increase of 51.2% (95%CI 23.5; 64.5) in 2020/21. Excluding the years of the COVID-19 pandemic, it was observed that an annual decline of 3.3% and, with the concomitant exclusion of the years of the H1N1 pandemic, stability. The LMMR were 8.3 (2009) and 22.2 (2021) per 100,000 LB, with an annual growth of 28.2% (95%CI 11.8; 47.8) until 2011, remaining stationary from 2011 to 2015, followed by an increase of 11.7% until 2021; with the exclusion of the final biennium, the trend is upward (3.8%) and also with the exclusion of the initial biennium, the trend became downward (7%) until 2014 and upward (8.2%) from then on.

Conclusion: There was a change in trend with the separate or joint incorporation of pandemic biennia: without pandemics, maternal mortality would be stationary, despite actions to prevent maternal deaths, and late maternal mortality, would be descending until 2014 and then ascending, crediting itself in part, to improving death investigation.

Objective: The aim of this study was to estimate the impact of deaths of despair (DoD) on life expectancy at birth and by sex in Brazil in 2019, as well as the contribution of different age groups to this loss.

Methods: We used life tables from the Brazilian Institute of Geography and Statistics and cause-specific mortality data by age and sex from the Mortality Information System. A cause-deleted life table methodology was applied, assuming independence between DoD and other causes of death. The difference in life expectancy with and without DoD was decomposed by age using Arriaga's method. DoD included deaths from suicide, intentional or accidental poisoning, and mental and behavioral disorders due to substance use.

Results: In 2019, there were 23,391 DoD in Brazil (1.73% of all deaths), 89% of which were due to suicide. Removing these deaths would increase life expectancy by 0.43 years for men and 0.12 years for women, with men experiencing a 3.5 times greater impact. The 35-49 age group had the highest relative contribution, especially among men, where DoD accounted for up to 9.7% of the loss in life expectancy. The impact was more concentrated and earlier in men and more diffuse among women.

Conclusion: Although lower in absolute numbers, DoD have a measurable impact on life expectancy, especially among young men. These findings highlight the need for public policies focused on suicide prevention and addressing the social determinants that sustain despair.

Objective: To analyze the relationship between the prevalence of chronic diseases and socioeconomic, demographic and occupational determinants in the Colombian population in 2010, 2013 and 2016. We sought to identify patterns of association between these variables and evaluate how they have evolved over time, with a particular emphasis on the implications for public health, especially in informal work contexts.

Methods: We used longitudinal data from the Colombian Longitudinal Urban Survey, which covers socioeconomic strata 1 to 4. The sample includes both men and women and heads of households and spouses, aged 18 to 65 years. The variables of interest are classified into three categories: health, labor and sociodemographic factors. The main methodology used was Multiple Correspondence Analysis (MCA).

Results: Three different labor groups were identified in the sample: formal, semi-formal and informal. The informal workers group showed a higher prevalence of chronic diseases compared to the other two groups. Labor category was the social determinant of greatest relevance in health variability.

Conclusion: The study's findings indicate that labor informality is associated with an elevated risk of developing chronic diseases in Colombia. These results highlight the necessity for policy interventions that prioritize enhancing working conditions as a strategy to achieve improved public health outcomes.

Objective: To analyze the effect of the COVID-19 pandemic on mortality by cardiovascular disease (CVD) subgroups in Brazil, considering sex and age group.

Methods: Ecological time-series study with secondary data from the Mortality Information System for the period 2000-2022. Age-adjusted mortality rates per 100,000 inhabitants were calculated and joinpoint regression models were used to estimate rate trends.

Results: Mortality from CVD in Brazil between 2000 and 2022 showed a decrease in ischemic heart disease (IHD) and cerebrovascular disease (CBVD), while other CVD showed an unstable behavior, increasing after 2020. The reduction in IHD was more pronounced until 2020, decelerating thereafter. CBVD continued to decline but at a slower pace. Other CVD, after a downward trend, showed a significant increase (+3.8% per year), possibly because of the pandemic. Women had a greater reduction in mortality, especially due to IHD. Intermediate age groups (40-59 years) showed a decrease until 2020 but recorded increases after this period, reinforcing the impact of the pandemic. In 2021, all subgroups showed excess mortality: 8% for CBVD and IHD, and 15% for other CVD. In 2022, this pattern intensified, with values of 16% (CBVD), 18% (IHD) and 23% (other CVD).

Conclusion: The COVID-19 pandemic significantly impacted CVD mortality in Brazil, changing trends according to age group, sex and disease subgroup. The study points to an inflection in mortality rates during the pandemic, highlighting the need for further investigations to understand the mechanisms involved.

Objective: The aim of this study was to investigate the prevalence of bias attributable to composite outcome (BACO) in clinical trials.

Methods: We searched PubMed for randomized clinical trials where the primary outcome was a binary composite that included all-cause mortality among its components from January 1, 2019, to December 31, 2020. For each trial, the BACO index was calculated to assess the correspondence between effects on the composite outcome and mortality. This systematic review was registered in PROSPERO (CRD42021229554).

Results: After screening 1,076 citations and 171 full-text articles, 91 studies were included from 13 different medical areas. The prevalence of significant or suggestive BACO among the 91 included articles was 25.2% (n=23), including 12 with p<0.005 and 11 with p between 0.005 and <0.05. We observed that in 17 (73.9%) of these 23 studies, the BACO index value was between 0 and <1, indicating an underestimation of the effect. The other six studies showed negative values (26.1%), indicating an inversion of the association with mortality. None of the studies showed significant overestimation of the association attributable to the composite outcome.

Conclusion: These findings highlight the need to predefine guidelines for interpreting effects on composite endpoints based on objective criteria such as the BACO index.

Objective: To investigate inequalities of race/skin color and sex in relation to quality of life of people living with the human immunodeficiency virus (HIV) in a Brazilian university hospital between 2017 and 2018.

Methods: This is a cross-sectional study conducted between 2017 and 2018 with 350 people living with HIV, applying the HIV-specific Quality of Life (QoL) scale. The groups were compared using the χ2 test and Student's t-test or Kruskal-Wallis test. To evaluate the factors associated with the nine domains of QoL, Tweedie Regression, an application of the Generalized Linear Model, was performed.

Results: Of the 350 participants, 55.7% self-reported to be white and 44.3%, Black/mixed-race; with a mean age (standard deviation - SD) of 45.2 (±12.6). We verified that 46.3% reported having suffered some type of prejudice, 34.8% due to the disease, 12% due to skin color, and 11.4% due to sexual orientation. The overall mean quality of life was 78.85 (±11.61). The domain with the lowest mean was Confidentiality Concerns (M: 43.45±29.46). Among the factors associated with several domains were sex (woman), level of education, per capita income, having suffered some prejudice, or hospitalizations in the last year.

Conclusion: Differences in level of education, per capita income, and work status by self-reported race/skin color of the participants were evidenced, showing inequalities in the study population. Sex (woman) is the factor associated with most of the QoL domains, among them Life Satisfaction, Confidentiality Concerns, Health Concerns, Financial Concerns, Medication Concerns, Acceptance of HIV, and Sexual Function.

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Objective: The aim of this study was to analyze the spatial and temporal distribution of systemic lupus erythematosus (SLE) cases in Brazil from 2008 to 2022.

Methods: We conducted an ecological study based on data from patients treated in the Unified Health System. SLE cases were identified using International Classification of Diseases-10 codes and analyzed by geographic region, age, and color/race. Spatial distribution was assessed to identify high and low prevalence, while temporal trends were evaluated through annual percentage change (APC).

Results: In 2022, the national prevalence was 52.3/100,000 inhabitants, with marked geographical disparities. Southeast (68.14/100,000) and South (66.37/100,000) regions showed the highest reporting rates. Spatial analysis identified significant clustering, particularly in São Paulo and Paraná, accounting for 95.4% of the high-prevalence municipalities. Temporal analysis of the adult population revealed a consistent increase in SLE prevalence from 2008 to 2022 (APC=15.5%, p<0.001), which was most pronounced in the Northeast and South, while a slower increase was observed in the North. A correlation was observed between the number of rheumatologists and the number of cases/100,000 inhabitants (R=0.567, p=0.002).

Conclusion: This study reveals significant geographic disparities and a rising trend in SLE prevalence across Brazil. The clustering of cases in specific municipalities and the correlation between rheumatologist availability and prevalence underscore the need for targeted healthcare resources. These findings highlight the importance of investigating how healthcare access impacts regional disparities in SLE prevalence and advancing equitable care nationwide.

Objective: To analyze, at national and regional levels, the trend of proxy indicators for the progress toward the elimination of the vertical transmission of syphilis in Brazil.

Methods: This is an ecological study that assessed the annual percent change (APC) of indicators related to gestational and congenital syphilis.

Results: An APC of 11.15% was observed in the detection rate of gestational syphilis (95% confidence interval - 95%CI 2.78-23.19), with stability in congenital syphilis across all regions. There was a reduction of prenatal care coverage among pregnant women with syphilis (APC=-7.34%; 95%CI -10.15; -5.33), and also a decrease in late diagnosis of the infection (APC=-10.77%; 95%CI -14.29; -8.79).

Conclusions: We evidenced challenges in achieving the 2030 elimination targets, highlighting the need for adjustments in current public policies on syphilis prevention and control.

This essay presents the Nova food classification, a conceptual innovation of Brazilian epidemiology, describing its genesis, the scientific evidence derived from its application, and its implications for public health. Created in 2010, Nova classifies foods into four groups based on the degree of processing: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods. Since its development, several epidemiological studies have demonstrated the negative impacts of high consumption of ultra-processed foods on health, such as associations with various non-communicable diseases, including obesity, diabetes, cardiovascular diseases and mental health outcomes. In Brazil, the consumption of these foods has increased significantly in recent decades, with the caloric share of ultra-processed foods rising from 12.6 to 18.4% between 2002-2003 and 2017-2018, with this increase being more pronounced among more vulnerable socioeconomic groups. Nova underpins the recommendations of the Brazilian Dietary Guidelines and has played a crucial role in informing public policies, such as the update of the National basic food basket and the guidelines of the National School Feeding Program, which aim to limit the access to ultra-processed foods. Finally, the essay addresses the political and scientific challenges, including the need for more experimental studies to strengthen the evidence and the potential of fiscal and marketing regulation strategies that take into account the impact of food processing on health.