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

Objective: To investigate the joint relationships between cancer mortality, occupational factors, and socioeconomic characteristics among Brazilian civil servants.

Methods: This is a cross-sectional study with data from 116 active workers at the baseline of the Longitudinal Study of Adult Health (ELSA-Brazil) (2008-2010), who died of malignant neoplasms over a 10-year follow-up period. Multiple Correspondence Analysis was used to graphically interpret the association between occupation, work stress, working hours, work regime, and socioeconomic factors with cancer mortality.

Results: The association between variable categories resulted in four groups and allowed us to identify two broad, distinct profiles of workers. The first was characterized as women, aged between 50 and 72 years, working hours of up to 40 hours a week, no exposure to night work, standard work schedule, low job strain, higher education or graduate degree level of education, active work, noncarcinogenic occupations, and death from non-work-related cancer. The second profile was characterized by men, elementary school and high school levels of education, aged between 35 and 49 years, passive work, high job strain, on-call work regime, exposure to night work, carcinogenic occupations, and death from work-related cancer.

Conclusion: Work-related cancer death was associated with worse socioeconomic conditions and occupational circumstances unfavorable to workers' health.

Objective: To analyze the sociodemographic characteristics and temporal trends of deaths due to malignant neoplasms in Brazil, according to whether they occurred at home or in a hospital, from 2002 to 2022.

Methods: This is a descriptive and ecological study analyzing data on cancer deaths from the Brazilian Mortality Information System. The analysis included descriptive measures, mortality rates, and trends based on joinpoint regression of sociodemographic variables, according to the place of death, as well as associations with the occurrence at home or in hospitals.

Results: We analyzed a total of 3,696,553 cancer deaths in Brazil, of which 82.5% occurred in hospitals. The variables positively associated with deaths at home were: men, age between 70 and 79 years and 80 years or older, mixed-race and Indigenous ethnicity, no formal education and one to three years of formal education, and widowed or other marital status. The Northeast and South regions had the highest rates of home mortality, while the Southeast and South regions led in hospital mortality. There was an increasing trend for both deaths occurring at home and those in hospitals nationwide. In the evaluation of home deaths, an increasing trend was observed in nine states and in the Federal District. Regarding hospital deaths, all Brazilian states showed an increasing trend.

Conclusion: The factors that influence the place of death for cancer patients are complex and include support network, access, culture, and the use of healthcare services. Targeted actions for more vulnerable populations and locations are necessary to reverse the growing trend of this condition.

Objective: To analyze the trend of hospitalizations for primary care-sensitive conditions in children in the state of Roraima, Brazil.

Methods: Ecological time series study with secondary data collected from the Hospital Information System, on hospitalizations for primary care-sensitive conditions in children between 2010 and 2023.

Results: The highest hospitalization rates were in 2021 (265.9/10,000 inhabitants/year) and the under 1 age group had the highest rates. There was a reduction in ambulatory care-sensitive conditions in group 1, in the first and second segments (MPC=-1.50; 95%CI -3.79-0.32 p=0.016 and MPC=-1.91; 95%CI -3.44--0.81 and p=0.007), group 2, with a constant drop throughout the series of 0.57% per month (95%CI -0.70--0.43 and p<0.001) and in group 16 (MPC=-0.38; 95%CI -0.55--0.21 and p<0.001). Bacterial pneumonia was the main cause of hospitalization in all age groups. Group 4 showed a uniform increase in rates of 1.56% per month (95%CI 0.27-2.80 and p=0.018). There was a drop in rates in the first segment at all ages: <1 year: -2.90% and p=0.019; 1 to 4 years: -1.75% (p=0.011) and 5 to 9 years: -0.79% (p=0.053), followed by an increase and then a drop again. In the last segment, all the age groups showed an increase in rates.

Conclusions: The scenario in Roraima is worrisome and requires urgent interventions, as there is evidence of weaknesses in primary health care, probably aggravated by the migratory crisis. The strategies sought are still insufficient.

Objective: The objective of this study was to analyze the temporal and spatial trends of accidents involving venomous animals in Brazil during the pre- and COVID-19 pandemic periods.

Methods: We conducted a population-based ecological study using comprehensive data from the Notifiable Diseases Information System, covering all accidents involving venomous animals in Brazil from January 2013 to December 2022. We did a temporospatial analysis to compare the incidence rates of accidents involving venomous animals per Brazilian municipality in the pre-pandemic period (January 2013 to February 2020) and the pandemic period (March 2020 to December 2022). To analyze the trend, the seasonal-trend model was used based on the classic additive decomposition model. For spatial distribution analysis, the Global Moran's Index was used.

Results: A total of 2,202,842 cases of accidents involving venomous animals were recorded. Brazil showed an increasing trend from 2017 to 2019 (annual percentage change [APC]: 0.98, p<0.001) and a stable trend from 2020 to 2022 (APC: 0.42, p<0.080). The North (APC: 0.19, p<0.330), South (APC: 0.04, p<0.953), and Southeast (APC: 0.26, p<0.312) regions presented a stable trend from 2020 to 2022. Spatial dependence of smoothed rates was observed in both the pre-pandemic (Moran's I: 0.47; p=0.000) and COVID-19 pandemic periods (Moran's I: 0.50; p=0.000).

Conclusion: There was a stable trend in accidents involving venomous animals from 2020 to 2022 in Brazil. The spatial distribution of cases was heterogeneous for both periods studied.

Objective: This study analyzed the prevalence and associated factors of benzodiazepine use among teachers in municipalities of Espírito Santo, Brazil, in 2024.

Methods: A cross-sectional, quantitative study conducted with teachers from the state of Espírito Santo using self-administered questionnaires.

Results: Among the 453 teachers surveyed, the prevalence of benzodiazepine use was 6.8% (n=31), increasing to 21.1% (n=26) among teachers with a previous diagnosis of mental disorders (n=123). Most benzodiazepines were used daily (57.6%; n=19), 42.5% (n=14) had been used for 2-5 years, and 39.4% (n=13) reported use without antidepressant treatment.

Conclusions: Severe anxiety symptoms and clinical insomnia were associated with an increased likelihood of benzodiazepine use, whereas having a partner was associated with reduced use. The prevalence of benzodiazepine use among teachers was higher than in the general population.

Objective: To analyze the factors associated with antiretroviral therapy interruption among people living with the human immunodeficiency virus participating in the A Hora é Agora [The Time is Now] project in the municipalities of Campo Grande, Curitiba, and Florianópolis.

Methods: This is a cross-sectional analytical study using data from the Brazilian Medication Logistics Control System, collected between October 2019 and September 2022. Bivariate analyses were performed to assess associations between sex, age group, race/skin color, and level of education, with the outcomes of treatment interruption and the number of times the treatment was interrupted, using the χ2 test with a 5% significance level.

Results: In Campo Grande, treatment interruption was more frequent among individuals with eight to 11 years of formal education (34.0%). In Curitiba, women (20.4%) showed a higher frequency of treatment interruption, and the age group of 50 years or older had a higher likelihood of treatment interruption (OR: 1.73; 95%CI: 1.12-2.66). In Florianópolis, 31.1% of women experienced treatment interruption, and individuals with up to seven years of formal education had a higher likelihood of treatment interruption (OR: 1.62; 95%CI: 1.15-2.29).

Conclusions: The interruption of antiretroviral therapy was significantly associated with sex, level of education, and age group, with distinct patterns across the analyzed territorial contexts. These findings highlight the need for targeted interventions aimed at vulnerable groups, considering regional differences and local challenges to improve treatment adherence.

Objective: To analyze the differences in the evolution of purchasing food for consumption away from home between urban and rural areas of Brazil, from 2002 to 2018.

Methods: Population data from 245,711 adults (25-59 years old) from the Consumer Expenditure Survey, of the Brazilian Institute of Geography and Statistics, of 2002-2003, 2008-2009, and 2017-2018 were used. The foods were grouped into ten nutritional and marketing categories and the frequency of purchasing food for consumption outside the home was compared according to urban and rural areas of Brazil and geographic regions of the country. Differences between areas were considered when the 95% confidence intervals of the estimates did not overlap.

Results: We found an increase in the purchase of food for consumption outside the home in urban areas between 2002-2003 and 2008-2009, followed by a reduction in 2017-2018. In rural areas, the frequency remained stable over the years. Regarding the food groups, there was a reduction in the purchase of soft drinks and alcoholic beverages and an increase in the frequency of meals away from home. The differences between urban and rural areas varied according to the regions of Brazil.

Conclusion: The purchase of food for consumption outside the home between 2002 and 2018 was different in urban and rural areas of the country; nevertheless, the rural area is approaching the urban area. These results highlight the new context of rural life and the need to evaluate eating behaviors in this area.

This study analyzes how the rates of increase in Brazil differ by obesity class. The paper estimates time trends for extreme weight categories from 2006 to 2021 and extrapolates through 2025 using Vigitel. Comparing 2021 to 2006 rates, the prevalence of BMI≥45 increased by 152%, BMI≥40 by 120%, and BMI≥35 by 104%. In contrast, BMI≥30 increased by 66%. Results are adjusted for demographic changes. Severe obesity is increasing far more rapidly than what commonly reported obesity statistics indicate. These groups have higher health burdens and healthcare needs, and the health system needs to be prepared to see such individuals regularly.

Objective: To assess the regular consumption of soft drinks among Brazilian adolescents according to sociodemographic characteristics, eating habits, and lifestyle.

Methods: This is a cross-sectional study using data from 118,497 adolescents from the 2019 National Survey of School Health (PeNSE), a population survey periodically carried out in Brazil. The prevalence of regular soft drinks consumption was estimated and, using Poisson regression analysis, the association of this consumption with variables related to eating habits and lifestyle (physical and sedentary activities, use of cigarette and alcohol) was verified.

Results: The frequency of regular soft drinks consumption was 17.2% (95%CI 16.6-17.8%). Multiple logistic regression analysis showed an association between regular soft drinks consumption and: living in the Southeast and Midwest regions (PR=1.49 and PR=1.50), boys (PR=1.22), eating meals while using a screen on five or more days a week (PR=1.20), eating breakfast less than five days a week (PR=1.14), consuming sweets five or more days a week (PR=2.16), and consuming fast food three or more times a week (PR=2.28). Spending more than three hours a day in sedentary activities (PR=1.18) and cigarette use (PR=1.22) and binge drinking (PR=1.21) were also statistically and significantly associated with regular soft drinks consumption.

Conclusion: Adolescents' regular consumption of soft drinks is associated with the region of residence, sex, and unhealthy eating and lifestyle habits. Interventions to promote the reduction of regular soft drinks consumption among Brazilian adolescents should consider innovative strategies that include comprehensive public policies appropriate to the profile of adolescents.

Objective: To analyze the overall and cancer-specific five-year survival rates for female breast cancer in Greater Cuiabá, Mato Grosso, Brazil.

Methods: A non-concurrent, population-based cohort study using the Population-Based Cancer Registry of Greater Cuiabá (Cuiabá and Varzea Grande), including women diagnosed with breast cancer from 2008 to 2013, followed through 2018 in the regional mortality database. The sample consisted of a total of 1,220 women. Five-year survival analysis was performed using Kaplan-Meier curves and the Cox proportional hazards regression model, computing hazard ratios for variable estimation. Survival curves were compared using the log-rank test (p<0.05). Probabilistic linkage technique by the RecLink III software and survival analysis were conducted using STATA software version 12.0.

Results: There was no statistical difference between the overall (OS) and cancer-specific survival (SS) rates (OS 78.0%, 95%CI 75.6-80.2; SS 81.0%, 95%CI 78.7-83.2). Women with lower educational levels (OS=58.33%; SS=64.89%) and those without a partner (OS 64.81%; SS 70.41%) exhibited poorer survival.

Conclusion: This study demonstrates that educational level and marital status significantly impact both overall and cancer-specific survival rates for female breast cancer. There is a need to propose policies that address the profile of women with lower survival rates.