ABSTRACT
Resumo O objetivo foi comparar as estimativas das causas externas provenientes do estudo Carga Global de Doenças, entre os anos 1998 e 2008. A estimação do DALY (disability-adjusted life year) e do YLL (years of life lost) foi baseada em metodologia do estudo Carga Global de Doenças. Para o cálculo do YLD (years lived with disability), foram incluídas informações sobre atendimentos em emergências. Para comparabilidade, fez-se necessária a aplicação da mesma metodologia nos dois momentos analisados, tendo sido a mais recente eleita como padrão de referência. Em ambos os anos as causas externas foram responsáveis por cerca de 10% do total do DALY. Entretanto, sua distribuição interna apresentou marcada diferença entre as regiões do Brasil, com queda no Sudeste e aumento no Norte e Nordeste. Houve aumento das causas intencionais e o DALY se tornou mais letal (maior parcela de YLL). Espera-se que tais resultados balizem a formulação de políticas e/ou o aprimoramento das já existentes com vistas ao efetivo enfrentamento das causas externas.
Abstract The objective of this study was to compare estimates of external causes based on the Global Burden of Disease in Brazil Study for the years 1998 and 2008. Methods included estimation of DALYs (disability-adjusted life years) and YLL (years of life lost), based on the methodology proposed in the Global Burden of Disease Study. Calculation of YLD (years lived with disability) required applying the same methodology in both years, with the 2008 methodology as the standard. Although external causes accounted for some 10% of total DALYs in both years, their internal distribution showed marked differences between regions of Brazil, with a decrease in the Southeast and increase in the North and Northeast. There was an increase in intentional causes, and YLLs accounted for the largest share of DALYs. The results can support new policies and/or improve existing ones to address external causes.
Resumen El objetivo fue comparar las estimaciones de las causas externas desde el estudio Carga Global Enfermedades entre los años 1998/2008. La estimación de los DALY (disability-adjusted life year) e YLL (years of life lost) se basó en la metodología del estudio Carga Global de Enfermedades. Para el cálculo de YLD (years lived with disability), era necesario aplicar la misma metodología en ambos períodos, siendo elegido como el último punto de referencia. Pese a que en ambos períodos las causas externas fueron responsables de alrededor del 10% del total de DALY, su distribución interna mostró marcadas diferencias entre las regiones brasileñas con una caída en el Sudeste y un aumento en el Norte y Noreste. Se observó un aumento de causas intencionales y la YLL fue responsable de la mayor proporción de DALY en todos los grupos de causas externas. Se espera que estos resultados balicen la formulación de políticas y/o la mejora de las que ya existen, con el fin de hacer frente eficazmente a las causas externas.
Subject(s)
Adolescent , Adult , Humans , Male , Middle Aged , Young Adult , Cause of Death , Wounds and Injuries/mortality , Age Distribution , Brazil/epidemiology , Life Expectancy , Quality-Adjusted Life Years , Sex FactorsABSTRACT
OBJECTIVE: To present the methodological approach used to estimate injury morbidity (Years Lived with Disability, YLD) in the 2008 Global Burden of Disease study in Brazil (GBD-Br). METHODS: YLD was based on the admission rate for injuries from both public and private sector facilities. Morbidity arising from emergency room (ER) visits was estimated using logistic regression models of the likelihood of hospitalization for different types of injuries, controlling for sex, age and geographic region. Data was obtained from the Mortality Information System, the Hospitalization Information System of the Unified Health System and the 2009 survey for the Surveillance System for Violence and Accidents (VIVA). RESULTS: Injuries accounted for 10.0% of the total burden of disease in Brazil in 2008, corresponding to 19 years of life lost per 100 000 inhabitants. YLD accounted for 10% of total years of life lost. CONCLUSIONS: This approach represents a methodological advance, particularly due to the inclusion of the VIVA survey, which provides a more reliable measurement of the burden of injury in Brazil than other sources.
OBJETIVO: Presentar el enfoque metodológico usado para calcular la morbilidad por lesiones (Años Vividos con Discapacidad, AVD) en el estudio sobre la Carga Mundial de Morbilidad del 2008 en el Brasil. MÉTODOS: El cálculo de los AVD se basó en la tasa de ingresos por lesiones en establecimientos sectoriales tanto públicos como privados. La morbilidad, obtenida a partir de las visitas a los servicios de urgencias, se calculó usando modelos de regresión logística de la probabilidad de hospitalización por diferentes tipos de lesiones, con control del sexo, la edad y la región geográfica. Los datos se obtuvieron del Sistema de Información de Mortalidad, el Sistema de Información de Hospitalización del Sistema de Salud Unificado y la encuesta del Sistema de Vigilancia de Violencias y Accidentes correspondiente al 2009. RESULTADOS: Las lesiones representaron el 10,0% de la carga total de morbilidad del Brasil en el 2008, lo que correspondía a 19 años de vida perdidos por 100 000 habitantes. Los AVD representaron un 10% del total de años de vida perdidos. CONCLUSIONES: Este enfoque representa un adelanto metodológico, en particular como consecuencia de la inclusión de la encuesta del Sistema de Vigilancia de Violencias y Accidentes, que proporciona una medición de la carga de lesiones en el Brasil más fiable que la de otras fuentes.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Cost of Illness , Life Expectancy , Population Surveillance/methods , Wounds and Injuries/epidemiology , Accidents/statistics & numerical data , Age Distribution , Brazil/epidemiology , Epidemiologic Methods , Health Information Systems/statistics & numerical data , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Patient Admission/statistics & numerical data , Sex Distribution , Violence/statistics & numerical dataABSTRACT
A non-controlled longitudinal study was conducted to evaluate the combined vaccine against measles, mumps and rubella (MMR) immunogenicity in 150 children vaccinated in the routine of three health units in the city of Rio de Janeiro, Brazil, 2008-2009, without other vaccines administered during the period from 30 days before to 30 days after vaccination. A previous study conducted in Brazil in 2007, in 1,769 children ranging from 12-15 months of age vaccinated against yellow fever and MMR simultaneously or at intervals of 30 days or more between doses, had shown low seroconversion for mumps regardless of the interval between administration of the two vaccines. The current study showed 89.5% (95% confidence interval: 83.3; 94.0) seroconversion rate for mumps. All children seroconverted for measles and rubella. After revaccination, high antibody titres and seroconversion rates were achieved against mumps. The results of this study and others suggest that two MMR doses confer optimal immunoresponses for all three antigens and the possible need for additional doses should be studied taking into account not only serological, but also epidemiological data, as there is no serological correlate of protection for mumps.