Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 211
Journal of Central South University(Medical Sciences) ; (12): 106-113, 2023.
Article in English | WPRIM | ID: wpr-971375


OBJECTIVES@#Age-related macular degeneration (AMD) is one of the 3 major eye diseases recognized by WHO to prevent blindness, and which is the main cause of irreversible visual impairment in the elderly. This study aims to analyze the disease epidemiological burden, and provide a theoretical foundation for the prevention and control of AMD in China based on the data in global burden of disease (GBD) 2019.@*METHODS@#The prevalent cases/prevalence, disability-adjusted life year (DALYs)/DALY rate of AMD and socio-demographic index (SDI) for global and China were searched from the GBD 2019 database to analyze the epidemiological trend, age-period-gender trend of AMD in China from 1990 to 2019, and to evaluate the relations between the prevalence and SDI.@*RESULTS@#In 2019, the prevalence of AMD in China was at a high level in the world, and the number of prevalent cases were 1.93 times of that in 1990. The prevalence and DALY rates continued to rise. The age trend of AMD in China was high at the middle of the age stages and low at the two ends, and which was higher in the female than in the male. With the increase of SDI, the prevalence of AMD was increased linearly.@*CONCLUSIONS@#The disease burden of AMD in China is increased significantly and is positively correlated with the social development from 1990 to 2019. It is of great significance to study the relationship between epidemilolgical data of AMD and social development level for diagnosis treatment and policy of AMD.

Humans , Male , Female , Aged , Global Burden of Disease , Quality-Adjusted Life Years , Prevalence , Macular Degeneration/epidemiology , China/epidemiology
Chinese Journal of Preventive Medicine ; (12): 667-673, 2023.
Article in Chinese | WPRIM | ID: wpr-985459


Objective: The direction and intensity of population aging on the burden of non-communicable diseases (NCDs) in China from 1990 to 2019 were analyzed, and the burden of NCDs in 2050 was predicted. Methods: The disease-specific disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) in the Chinese population from 1990 to 2019 were obtained from the Global Burden of Disease Study.The differences in indicators from 1990 to 2019 were attributed to the contribution of age structure, population size, and all other causes. The Bayesian age-time-cohort models were used to predict DALYs from NCDs to 2050. Results: The absolute level of DALYs caused by NCDs increased by 7.460 million from 1990 to 2019, and the age structure contributed 186.0% (95% Uncertainty Intervals (UIs): 178.4%-193.6%), population size contributed 77.0% (95% UIs: 69.5%-80.8%), all other causes contributed -163.0% (95% UIs:-163.1%- -159.3%). DALYs caused by NCDs consist of 2.527 million YLLs and 4.934 million YLDs, in which the contribution of age structure to YLLs and YLDs was 414.6% (95% UIs: 396.2%-432.5%) and 69.1% (95% UIs: 66.7%-71.4%), respectively. From 2019 to 2050, the diseases with increased DALYs due to changes in age structure are cardiovascular diseases, neoplasms, chronic respiratory diseases, neurological disorders, sense organ diseases, diabetes and kidney diseases, musculoskeletal disorders, digestive diseases, mental disorders, and skin and subcutaneous diseases in descending order. Conclusions: From 1990 to 2019, except for skin and subcutaneous diseases, the burden of other NCDs attributable to population aging increased, mainly due to disability. By 2050, the burden of NCDsattributable to population aging will continue to rise.

Humans , Life Expectancy , Quality-Adjusted Life Years , Noncommunicable Diseases/epidemiology , Bayes Theorem , Global Health , China/epidemiology , Aging , Global Burden of Disease
Chinese Medical Journal ; (24): 1598-1605, 2023.
Article in English | WPRIM | ID: wpr-980812


BACKGROUND@#Stroke is the leading cause of death in China, and predicting the stroke burden could provide essential information guiding the setting of medium- and long-term health policies and priorities. The study aimed to project trends associated with stroke burden in China through 2050, not only in terms of incidence and mortality but also for prevalence and disability-adjusted life years (DALYs).@*METHODS@#Data on stroke rates in incidence, prevalence, deaths, and DALYs in China between 1990 and 2019 were obtained from a recent Global Burden of Disease study. Demographic-specific trends in rates over time were estimated using three models: the loglinear model, the Lee-Carter model, and a functional time series model. The mean absolute percentage error and the root mean squared error were used for model selection. Projections up to 2050 were estimated using the best fitting model. United Nations population data were used to project the absolute numbers through 2050.@*RESULTS@#From 2019 to 2050, the crude rates for all measures of the stroke burden are projected to increase continuously among both men and women. We project that compared with those in 2019, the incidence, prevalence, deaths, and DALYs because of stroke in China in 2050 will increase by 55.58%, 119.16%, 72.15%, and 20.04%, respectively; the corresponding increases in number were 2.19, 34.27, 1.58, and 9.21 million. The age-standardized rate is projected to substantially decline for incidence (8.94%), death (40.37%), and DALYs (43.47%), but the age-standardized prevalence rate is predicted to increase by 10.82%. By 2050, the burden of stroke among the population aged ≥65 years will increase significantly: by 104.70% for incidence, by 218.48% for prevalence, by 100.00% for death, and by 58.93% for DALYs.@*CONCLUSIONS@#With the aging population in China increasing over the next three decades, the burden of stroke will be markedly increased. Continuous efforts are needed to improve stroke health care and secondary prevention, especially for older adults.

Male , Humans , Female , Aged , Cost of Illness , Quality-Adjusted Life Years , Stroke/epidemiology , Incidence , Prevalence , China/epidemiology
Chinese Journal of Industrial Hygiene and Occupational Diseases ; (12): 417-424, 2023.
Article in Chinese | WPRIM | ID: wpr-986042


Objective: To analyze the disease burden of pneumoconiosis globally and in China from 1990 to 2019 using Global Burden of Disease (GBD) 2019 data, and to provide a theoretical basis for prevention and control of pneumoconiosis. Methods: In September 2022, the data of incidence, prevalence, morality and disability-adjusted life years (DALY) of pneumoconiosis and its subtypes globally and in China from 1990 to 2019 were collected from GBD 2019, including absolute number and age-standardized rate (ASR). Joinpoint linear regression model was used to calculate average annual percent change (AAPC) and analyze the change trends of incidence, prevalence, mortality and DALY of pneumoconiosis and its subtypes. Results: From 1990 to 2019, the incident cases, prevalent cases and DALY value of pneumoconiosis showed upward trends, while the number of death cases showed downward trends. And the ASR of incidence (ASIR), the ASR of prevalence (ASPR), the ASR of mortality (ASMR) and the ASR of DALY (ASDR) showed downward trends globally and in China. China accounted for a large proportion of the global disease burden of penumoconiosis, accounting for more than 67% of the incident cases, more than 80% of the prevalent cases, more than 43% of the deaths cases and more than 60% of the absolute number of DALY in the world every year. Male were the main population of pneumoconiosis disease burden globally and in China, and the age of onset was earlier than that of female. The peak age periods of incidence, prevalence, mortality and DALY of pneumoconiosis globally and in China from 1990 to 2019 have increased. Silicosis was still the type with the highest disease burden of pneumoconiosis globally and in China. The disease burden of coal workers' pneumoconiosis had an overall improvement trend, but asbestosis had an increasing disease burden worldwide. Conclusion: The disease burden of pneumoconiosis is heavy globally and in China, which is necessary to strengthen the supervision and prevention measures according to gender, age and etiological types.

Male , Humans , Female , Quality-Adjusted Life Years , Pneumoconiosis/epidemiology , Cost of Illness , Asbestosis/epidemiology , China/epidemiology , Anthracosis , Incidence
Chinese Journal of Industrial Hygiene and Occupational Diseases ; (12): 271-276, 2023.
Article in Chinese | WPRIM | ID: wpr-986026


Objective: To analyze the burden of disease attributable to high temperature exposure in China and globally from 1990 to 2019, and to study the current burden of disease in relevant populations. Methods: In October 2021, based on data from the global burden of disease 2019 (GBD 2019) study, population attributable fraction (PAF), number of deaths, mortality, disability-adjusted life year (DALY) and DALY rate of Chinese and global populations with different ages and genders in 1990 and 2019 were extracted and analyzed. The rate of change was calculated, the mortality rate was normalized by the age structure of the world standard population, and the causes of disease burden caused by high temperature exposure of Chinese residents were analyzed. Results: In 2019, compared with 1990, the PAF of Chinese and global population decreased by 43.98% and 12.41% respectively, the number of deaths increased by 29.55% and 49.40% respectively, the crude mortality rate increased by 7.81% and 3.30% respectively, the DALY decreased by 48.12% and 14.41% respectively, and the DALY rate decreased by 56.82% and 40.82% respectively. The mortality rate of the ≥70 age group was higher than that of other groups. The disease burden indicators such as PAF, standardized mortality and DALY attributable to high temperature exposure in men were higher than those in women. In 2019, the main cause of DALY affected by high temperature exposure in Chinese population was ischemic heart disease (84400 person-years), and the main cause of death was ischemic heart disease (4900 cases). Conclusion: The burden of diseases attributable to high temperature exposure is still serious in China and the world at large. Targeted interventions should be formulated for men, the elderly and people with occupational exposure, and a sound surveillance system should be established to reduce the burden of diseases caused by high temperature exposure.

Humans , Male , Female , Aged , Quality-Adjusted Life Years , Temperature , Cost of Illness , China/epidemiology , Myocardial Ischemia
Biomedical and Environmental Sciences ; (12): 222-230, 2023.
Article in English | WPRIM | ID: wpr-970311


OBJECTIVE@#This study aimed to estimate spatiotemporal variations of global heat-related cardiovascular disease (CVD) burden from 1990 to 2019.@*METHODS@#Data on the burden of heat-related CVD were derived from the Global Burden of Disease Study 2019. Deaths and disability-adjusted life years (DALYs) were used to quantify heat-induced CVD burden. We calculated the age-standardized mortality rate (ASMR) and DALY rate (ASDR) per 100,000 population to compare this burden across regions. Generalized linear models were applied to evaluate estimated annual percentage changes (EAPC) for temporal trends from 1990 to 2019. The correlation between the socio-demographic index (SDI) and age-standardized rate was measured using the Spearman rank test.@*RESULTS@#Heat-induced CVD caused approximately 90 thousand deaths worldwide in 2019. Global ASMR and ASDR of heat-related CVD in 2019 were 1.17 [95% confidence interval ( CI): 0.13-1.98] and 25.59 (95% CI: 2.07-44.17) per 100,000 population, respectively. The burden was significantly increased in middle and low-SDI regions and slightly decreased in high-SDI regions from 1990 to 2019. ASMR showed an upward trend, with the most considerable increase in low-latitude countries. We observed a negative correlation between SDI and EAPC in ASMR ( r s = -0.57, P < 0.01) and ASDR ( r s = -0.59, P < 0.01) among 204 countries.@*CONCLUSION@#Heat-attributable CVD burden substantially increased in most developing countries and tropical regions.

Humans , Quality-Adjusted Life Years , Cardiovascular Diseases/etiology , Hot Temperature , Temperature , Global Health , Global Burden of Disease
Chinese Medical Journal ; (24): 305-312, 2023.
Article in English | WPRIM | ID: wpr-970044


BACKGROUND@#Epilepsy accounts for a significant portion of the global disease burden. However, little is known about the disease burden of epilepsy in China and its provinces.@*METHODS@#We assessed the burden of epilepsy in China and its provinces, municipalities, and autonomous regions from 1990 to 2019. Burden was measured as incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs), by age, sex, year, and province. We used the Socio-Demographic Index (SDI) to determine the association between the provincial development level and age-standardized DALY rates of epilepsy from 1990 to 2019.@*RESULTS@#In 2019, epilepsy caused 1367.51 thousand (95% uncertainty interval [UI]: 979.92-1837.61 thousand) DALYs, and the age-standardized DALY rate was 99.77 (95% UI: 71.33-133.52)/100,000. The age-standardized incidence and prevalence rates for epilepsy in China were 24.65/100,000 and 219.69/100,000, increased by 45.00% (95% UI: 8.03-98.74%) and 35.72% (95% UI: 0.47-86.19%) compared with that in 1990, respectively. From 1990 to 2019, the proportion of DALY caused by epilepsy in the age group under 25 years steadily decreased. The proportion of DALYs caused by epilepsy in people aged 50 years and over increased from 9.45% and 10.22% in 1990 to 29.01% and 32.72% for male and female individuals in 2019, respectively. The highest age-standardized mortality rates were seen in Tibet (4.26 [95% UI: 1.43-5.66]/100,000), Qinghai (1.80 [95% UI: 1.15-2.36]/100,000), and Yunnan (1.30 [95% UI: 0.88-1.62]/100,000), and the lowest mortality rates were in Guangdong (0.48 [95% UI: 0.39-0.64]/100,000), Zhejiang (0.56 [95% UI: 0.44-0.70]/100,000), and Shanghai (0.57 [95% UI: 0.41-0.73]/100,000). The age-standardized DALY rates across the country and in provinces, municipalities, and autonomous regions generally decreased as their SDI increased.@*CONCLUSIONS@#The disease burden of epilepsy is still heavy in China, especially in the western provinces. The incidence and prevalence of epilepsy increased between 1990 and 2019, and the burden of epilepsy in the elderly increases gradually. This study provides evidence on epilepsy prevention and care of different regions in China.

Aged , Humans , Male , Female , Middle Aged , Adult , Global Burden of Disease , China/epidemiology , Quality-Adjusted Life Years , Cost of Illness , Epilepsy/epidemiology , Prevalence
Philippine Journal of Ophthalmology ; : 4-9, 2023.
Article in English | WPRIM | ID: wpr-982912


Objective@# This study compared the economic viability of initial medical therapy with topical prostaglandin analogues (PGAs) versus selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG).@*Method@#This was an economic analysis using actual, current treatment costs of PGA therapy versus SLT applied to theoretical, literature-derived clinical efficacy data projected for a period of 19 years. A socioeconomic and demographic survey conducted among POAG patients at the Department of Health Eye Center of the East Avenue Medical Center from March-April 2022 provided the economic context and setting for the analysis. The treatment regimens were compared in terms of total cost, clinical efficacy, cost-effectiveness and cost-utility in the setting of a tertiary government hospital.@*Results@#Thirty-one (31) patients were included in the study. The total annual cost of topical PGAs was Philippine Pesos (Php) 13,532 versus Php 6,195 for SLT. Cost-effectiveness was Php 1,933 for PGAs/mmHg reduction in intraocular pressure (IOP) versus Php 983 for SLT. Cost-utility was Php 59,793/Quality Adjusted Life Years (QALY) gained for PGAs versus Php 27,373/QALY gained for SLT projected for 19 years. With government insurance coverage, cost-utility ratio was Php 47,831/QALY gained for topical PGAs versus 16,327/QALY gained for SLT.@*Conclusion@#In POAG patients, SLT was more cost-effective versus PGAs with a lower cost per mmHg IOP reduction, and lower cost-utility ratio for every QALY gained. SLT can be recommended as initial therapy for POAG especially for patients being treated at tertiary government hospitals.

Economics , Glaucoma , Prostaglandins, Synthetic , Quality-Adjusted Life Years , Philippines
Medicentro (Villa Clara) ; 26(2)jun. 2022.
Article in Spanish | LILACS | ID: biblio-1405631


RESUMEN Introducción: Villa Clara es la provincia más envejecida del país, pues el adulto medio ocupa un alto porciento dentro de su población. Durante esta etapa de la vida, si bien algunos cambios fisiológicos se deben a factores genéticos y biológicos personales, también es importante considerar la influencia del modo de vida, experimentado en la actual calidad de vida del adulto medio, que puede ser mejorada con la actividad física. Objetivos: Diseñar una multimedia como herramienta educativa e instructiva para mejorar la calidad de vida del adulto medio, en la Facultad de Tecnología de la Salud-Enfermería, de la Universidad de Ciencias Médicas de Villa Clara. Métodos: Se realizó un estudio de tipo innovación tecnológica en el período de septiembre de 2018 a septiembre de 2019. El universo de estudio estuvo constituido por 397 profesores, que constituyen el total de docentes a tiempo completo; la muestra fue de 40 profesores. Como criterio de exclusión se consideró a los que no estaban ubicados en el rango de edad correspondiente con el adulto medio. Las variables fueron: edad, peso, talla, sexo, ejercicios físicos, enfermedades crónicas no transmisibles y tipo de alimentación. Se utilizaron métodos teóricos, empíricos y de nivel matemático-estadístico. Resultados: El producto final proporcionó beneficios, pues con él se motivó al adulto medio hacia el desarrollo de habilidades y capacidades que le permitan tomar decisiones correctas para elevar la calidad de vida. Conclusiones: La multimedia educativa constituye una vía novedosa y motivadora para influir en la calidad de vida del adulto medio.

ABSTRACT Introduction: Villa Clara is the oldest province in the country, since middle-aged adults occupy a high percentage of its population. During this stage of life, although some physiological changes are due to individuals' genetic and biological factors, it is also important to consider the influence of lifestyle, experienced in the current quality of life in middle-aged adults, which can be improved with physical activity. Objective: to design a multimedia, at the Faculty of Health Technology and Nursing in the University of Medical Sciences of Villa Clara, as an educational and instructive tool to improve the quality of life in middle-aged adults. Methods: a technological innovation study was carried out from September 2018 to September 2019. The universe of study consisted of 397 teachers, who constituted the total number of full-time teachers; the sample was 40 teachers. Those who were not in the age range corresponding to middle-aged adults were considered as an exclusion criterion. Age, weight, height, gender, physical exercises, non-communicable chronic diseases and type of diet were among the variables studied. Theoretical, empirical and mathematical-statistical methods were used. Results: the final product provided benefits, since middle-aged adults were motivated towards the development of skills and abilities, allowing them to make correct decisions in order to improve their quality of life. Conclusions: educational multimedia is a novel and motivating way to influence the quality of life in middle-aged adults.

Multimedia , Quality-Adjusted Life Years
Cad. Saúde Pública (Online) ; 38(2): e00157921, 2022. graf
Article in English | LILACS | ID: biblio-1360300


Abstract: Mental disorders are the main cause of the young and economically active population worldwide and in Brazil to live with disabilities, being an important public health problem nowadays. The objective was to estimate the burden of mental disorders among professionals working to combat endemic diseases in a state in northeastern Brazil. Medical records of workers linked to the Brazilian Ministry of Health in Ceará State and fighting endemic diseases were surveyed and, from this, a historical cohort was made. The individual quantification of absenteeism by mental disorders (ICD F-chapter referring to mental disorders) was conducted considering a period of about 35 years, from admission (the 1980s) to December 2017. The global burden of disease was measured by the YLD indicator (years lost to disability). Considering that no deaths due to mental disorders were observed, the YLL indicator (years of life lost) was composed. The high mental disorders burden in this group of workers stands out, whose mood disorders, including depression, conferred a YLD equal to 18.6. This represents just over 18 years of work lived with a disability. Our findings reinforce the need to implement surveillance and health promotion actions in workers to promote effective interventions capable of contributing to the reduction of morbidity in workers and economically active people.

Resumo: Os transtornos mentais são a principal causa de anos vividos com incapacidade entre a população jovem e economicamente ativa no mundo e no Brasil. Os impactos representam um problema importante para a saúde pública hoje. O objetivo do estudo foi de estimar a carga de transtornos mentais entre profissionais que trabalham no combate às doenças endêmicas em um estado do Nordeste brasileiro. Foi realizada uma coorte histórica com base na revisão de prontuários médicos dos profissionais que trabalham no combate às doenças endêmicas e vinculados ao Ministério da Saúde no Ceará. Procedemos à quantificação individual do absenteísmo por transtorno mental (CID, capítulo F, sobre transtornos mentais) ao longo de um período de cerca de 35 anos, desde a admissão (anos 1980) até dezembro de 2017. A carga global de doença foi medida pelo indicador anos vividos com incapacidade, considerando que não foram observados óbitos por transtorno mental, que constitui o indicador de anos de vida perdidos por morte prematura. Destaca-se a alta carga de transtorno mental nesse grupo de trabalhadores, cujos transtornos de humor, inclusive depressão, conferiam 18,6 anos vividos com incapacidade, ou seja, mais de 18 anos de trabalho vividos com incapacidade. Nossos achados reforçam a necessidade de implementar medidas de vigilância e promoção da saúde nos trabalhadores para promover intervenções efetivas capazes de contribuir para a redução da morbidade entre trabalhadores e pessoas economicamente ativas.

Resumen: Los desórdenes mentales son la principal causa de años de vida vividos con discapacidad en la población joven y económicamente activa en el mundo y en Brasil. Sus impactos representan un problema importante para la salud pública hoy en día. El objetivo fue estimar la carga de los desórdenes mentales entre profesionales, que trabajan para combatir enfermedades endémicas en un estado del noreste brasileño. Se llevó a cabo con una cohorte histórica procedente de una investigación con registros médicos de trabajadores que luchaban contra enfermedades endémicas, relacionados con el Ministerio de Salud en Ceará. Se procedió a realizar una cuantificación individual del absentismo mediante desórdenes mentales (capítulo ICD F que se refiere a los desórdenes mentales) durante un período de aproximadamente 35 años, desde la admisión (en los años de 1980) hasta diciembre de 2017. Se midió la carga global de la enfermedad mediante el indicador YLD (años perdidos por la discapacidad). Considerando que no se observaron muertes debido a las desórdenes mentales, que conforman el indicador YLL (años de vida perdidos). Destaca la alta carga de desórdenes mentales en este grupo de trabajadores, cuyos trastornos del comportamiento, incluyendo la depresión, confirió un YLD igual a 18,6. Esto representa algo más de 18 años de trabajo vividos con una discapacidad. Nuestros resultados refuerzan la necesidad de implementar acciones de vigilancia y promoción de la salud en los trabajadores, con el fin de promover intervenciones efectivas capaces de contribuir a la reducción de la morbilidad en trabajadores y gente activa económicamente.

Humans , Disabled Persons , Mental Disorders/epidemiology , Brazil/epidemiology , Public Health , Global Health , Morbidity , Cost of Illness , Quality-Adjusted Life Years
Rev. bras. oftalmol ; 81: e0049, 2022. tab, graf
Article in English | LILACS | ID: biblio-1387974


ABSTRACT Purpose To evaluate the cost-utility of the iStent inject® for the treatment of mild-to-moderate open-angle glaucoma (OAG) within the Brazilian Unified Health System (SUS). Methods A Markov model was developed, in which the effectiveness outcome measure was the incremental cost-effectiveness ratio (ICER: R$ / QALY quality-adjusted life-year). Direct medical costs were obtained from the SUS perspective. The base case comprised of a hypothetical cohort of patients with OAG using topical medication and being managed according to the Clinical Protocol and Therapeutic Guidelines (PCDT) and a real-world setting based on data from Datasus. The model's robustness through sensitivity analyses was tested. Results In the PCDT base case setting, the trabecular micro-bypass implant provided gains of 0.47 QALYs and an ICER of R$7,996.66/QALY compared to treatment with topical medication. In the real-world setting based on data from Datasus, the trabecular micro-bypass implant, provided gains of 0.47 QALYs and an ICER of R$4,485.68/QALY compared to treatment with topical medication. The results were robust to sensitivity analyses. Conclusion Incorporating iStent inject® to SUS provides an improvement in the patient's quality of life with an additional cost that warrants the benefit provided to patients. Results may be considered cost-effective compared to topical medication.

RESUMO Objetivo Avaliar a relação custo-utilidade do iStent inject® para o tratamento do glaucoma de ângulo aberto leve a moderado no Sistema Único de Saúde. Métodos Foi desenvolvido um modelo de Markov, no qual a medida de resultado de efetividade foi a razão custo-efetividade incremental (razão de custo-efetividade incremental: R$/ano de vida ajustado pela qualidade). Os custos médicos diretos foram obtidos por meio da perspectiva do Sistema Único de Saúde. O caso base foi composto de uma coorte hipotética de pacientes com glaucoma de ângulo aberto em uso de medicação tópica tratados de acordo com o Protocolo Clínico e Diretrizes Terapêuticas e um cenário do mundo real baseado em dados do Departamento de Informática do Sistema Único de Saúde. Foi testada a robustez do modelo por meio de análises de sensibilidade. Resultados No cenário base do Protocolo Clínico e Diretrizes Terapêuticas, o implante trabecular micro-bypass proporcionou ganhos de 0,47 ano de vida ajustado pela qualidade e razão de custo-efetividade incremental de R$7.996,66/ano de vida ajustado pela qualidade em relação ao tratamento com medicação tópica. No cenário real baseado em dados do Departamento de Informática do Sistema Único de Saúde, o implante trabecular proporcionou ganhos de 0,47 ano de vida ajustado pela qualidade e razão de custo-efetividade incremental de R$ 4.485,68/ano de vida ajustado pela qualidade em relação ao tratamento com medicação tópica. Os resultados foram robustos para análises de sensibilidade. Conclusão A incorporação do iStent inject® ao Sistema Único de Saúde proporciona melhora na qualidade de vida do paciente com um custo adicional que garante o benefício proporcionado a eles. Os resultados podem ser considerados custo-efetivos em comparação com a medicação tópica.

Humans , Male , Female , Middle Aged , Unified Health System , Stents/economics , Glaucoma, Open-Angle/surgery , Glaucoma, Open-Angle/economics , Cost-Benefit Analysis , Costs and Cost Analysis , Trabeculectomy/economics , Visual Fields/physiology , Markov Chains , Health Care Costs , Quality-Adjusted Life Years , Health Resources/economics , Health Resources/statistics & numerical data , Intraocular Pressure/physiology
Chinese Journal of Epidemiology ; (12): 14-21, 2022.
Article in Chinese | WPRIM | ID: wpr-935344


Objective: To analyze mortality and its trend of chronic respiratory diseases (CRD) in China from 1990 to 2019. Methods: Based on the provincial results of China from the 2019 Global Burden of Disease (GBD) study, the average annual percent change (AAPC) of standardized mortality rates of different CRDs were analyzed by using Joinpoint, and the age-standardized mortality rate of CRD was calculated by using the GBD 2019 world standard population. Based on the comparative risk assessment theory of GBD, the attributable deaths due to 12 CRD risk factors were estimated, including smoking, indoor air pollution, occupational gas exposure, particulates and smog exposure, environmental particulate pollution, low temperature, passive smoking, ozone pollution, occupational exposure to silica, occupational asthma, high body mass index, high temperature and occupational exposure to asbestos. Results: From 1990 to 2019, the number of deaths and standardized mortality of chronic obstructive pulmonary disease (COPD) showed a downward trend (P<0.001). The number of COPD deaths decreased from 1 244 000 (912 000 - 1 395 000) in 1990 to 1 037 000 (889 000 - 1 266 000) in 2019. AAPC=-0.9% (95%CI: -1.5% - -0.3%), P<0.001; The standardized mortality rate decreased from 217.9/100 000 (163.3/100 000 - 242.0/100 000) in 1990 to 65.2/100 000 (55.5/100 000 - 80.1/100 000) in 2019. AAPC= -4.2% (95%CI:-5.2% - -3.2%), P<0.001. The number of deaths from asthma decreased from 40 000 (30 000 - 58 000) in 1990 to 25 000 (20 000 - 31 000) in 2019. AAPC=-2.0% (95%CI: -2.6% - -1.4%), P<0.001; The standardized mortality rate of asthma decreased from 6.4/100 000 (4.7/100 000 - 9.5/100 000) in 1990 to 1.5/100 000 (1.2/100 000 - 1.9/100 000) in 2019. AAPC=-5.1% (95%CI: -5.8% - -4.4%), P<0.001. The number of pneumoconiosis deaths decreased from 11 000 (8 000 - 14 000) in 1990 to 10 000 (8 000 - 14 000) in 2019, AAPC=-0.2%(95%CI:-0.4% - 0.1%), P=0.200; The standardized mortality rate of pneumoconiosis decreased from 1.4/100 000 (1.0/100 000 - 1.7/100 000) in 1990 to 0.5/100 000 (0.4/100 000 - 0.7/100 000) in 2019. AAPC=-3.1% (95%CI: -3.4% - -2.8%), P<0.001. The number of deaths from pulmonary interstitial diseases and pulmonary sarcoidosis increased from 3 000 (3 000 - 6 000) in 1990 to 8 000 (6 000 - 10 000) in 2019, AAPC=3.5% (95%CI: 2.7% - 4.2%), P<0.001; The corresponding standardized mortality rate changed little from 1990 to 2019, and AAPC was not statistically significant.The age-standardized mortality rates of different CRDs were higher in men than those in women. In 1990 and 2019, the mortality rates of COPD, asthma, pneumoconiosis and interstitial pulmonary disease and pulmonary sarcoidosis increased with age. In 2019, the population attributable fractions (PAFs) for smoking, environmental particulate pollution, occupational gas exposure, particulate and smog exposure, low temperature exposure and passive smoking were 71.1% (68.0% - 74.3%), 24.7% (20.1% - 30.0%), 19.3% (13.0% - 25.4%), 15.7% (13.6% - 18.3%) and 8.8% (4.5% - 13.1%) respectively in men, and the PAFs for environmental particulate pollution, smoking, low temperature exposure, occupational gas exposure, particulate and smog exposure, and passive smoking were 24.1% (19.6% - 29.3%), 21.9% (18.7% - 25.2%), 16.4% (14.0% - 19.2%), 15.6% (10.2% - 21.1%) and 14.7% (7.9% - 21.3%) respectively in women. Conclusions: During 1990-2019, the overall death level of CRD decreased significantly in China, but it is still at high level in the world. Active prevention and control measures should be taken to reduce the death level caused by CRD.

Female , Humans , Male , Asthma , China/epidemiology , Global Burden of Disease , Mortality , Pulmonary Disease, Chronic Obstructive , Quality-Adjusted Life Years
Chinese Journal of Preventive Medicine ; (12): 619-625, 2022.
Article in Chinese | WPRIM | ID: wpr-935334


Based on the Global Burden of Disease study 2019, the standardized mortality rate and disability-adjusted life years (DALYs) rate of children under 5 years old were selected as evaluation indicators to compare and analyze the current situation and differences of disease burden of children under 5 years old between China and other regions from 1990 to 2019. The change trend and difference of disease burden of children under 5 years old in China were analyzed by sexes. From 1990 to 2019, the all-cause standardized mortality rate of children under 5 years old in China decreased from 1 153.81/100 000 to 160.39/100 000, and the all-cause standardized DALY rate decreased from 104 426.40/100 000 to 16 479.01/100 000. In 2019, neonatal preterm birth, congenital heart anomalies and lower respiratory infections ranked the top three disease burden of children under 5 years old in China. Except that the disease burden of neonatal preterm birth was lower than that in North America, they were much higher than that in Western Europe and North America in the same period. The burden of unintentional injury diseases, including pulmonary aspiration and foreign body in airway and drowning, was higher than that in Western Europe and North America. The standardized mortality and DALY rate of the top ten diseases and injuries in boys and girls under 5 years old in China showed a downward trend (P<0.05), and most of them were higher in boys than girls (P<0.05). From 1990 to 2019, the disease burden of children under 5 years old in China decreased significantly. However, compared other regions, it is still necessary to strengthen the prevention and control of neonatal premature birth, birth defects and unintentional injuries, and take different sex-specific interventions to improve the overall health of children.

Child , Child, Preschool , Female , Humans , Infant, Newborn , Male , Accidental Injuries , China/epidemiology , Cost of Illness , Premature Birth/epidemiology , Quality-Adjusted Life Years , Risk Factors
Chinese Journal of Cardiology ; (12): 172-178, 2022.
Article in Chinese | WPRIM | ID: wpr-935123


Objective: To explore the trend of disease burden of degenerative mitral valve disease (DMVD) in the Chinese population from 1990 to 2019. Methods: Based on the 2019 Global Burden of Disease database (GBD 2019), the number of patients, the number of new cases, the number of deaths, the disability-adjusted life years (DALY) as well as the prevalence, incidence and death rate, DALY rate and their age-standardized rates were used to analyze the trend of the burden of DMVD in the Chinese population from 1990 to 2019. Results: In 2019, the number of patients, the number of new cases, and the number of deaths with DMVD in China were 461.2, 27.0 and 0.129 ten thousand, respectively, which increased by 209.0%, 199.1% and 13.2% when compared with 1990. In 2019, the age-standardized prevalence, incidence and death rate were 228.1/100 000, 12.7/100 000 and 0.075/100 000, respectively. Compared with 1990, the change of the age-standardized prevalence, incidence and death rate were 32.6%, 42.8% and -54.1%, respectively. In addition, the 2019 data also showed that the age-standardized prevalence and incidence were higher in females than in males (the age-standardized prevalence was 190.1 (181.5-198.9)/100 000 for males and 262.0 (250.3-273.9)/100 000 for females); the age-standardized incidence was 10.5 (10.0-11.0)/100 000 for males and 14.9 (14.3-15.6)/100 000 for females. The age group with the largest number of DMVD patients was 65 to 69 years old, and the highest incidence was 60 to 64 years old. From 1990 to 2019, DALY caused by DMVD showed an upward trend in China, from 46 439 person-years in 1990 to 69 402 person-years in 2019, with an increase of 49.4%. While the age-standardized DALY rate continued to decline, from 5.5/100 000 in 1990 to 3.8/100 000 in 2019, with a drop of 30.8%. The DALY and the age-standardized DALY rate of females were always higher than that of males in different years. Conclusion: From 1990 to 2019, DALY and the age-standardized prevalence and incidence of DMVD in China shows an increasing trend, and the disease burden caused by DMVD is severe in China.

Aged , Female , Humans , Male , Middle Aged , China/epidemiology , Cost of Illness , Disabled Persons , Incidence , Mitral Valve , Quality-Adjusted Life Years
Article in Spanish | LILACS, CUMED | ID: biblio-1408634


Introducción: El envejecimiento poblacional trae aparejado un incremento de individuos en situación de dependencia funcional, que se entiende como la necesidad de asistencia para realizar las actividades de la vida diaria. Objetivo: Evaluar si existe inequidad en la distribución de la dependencia funcional entre adultos mayores de Argentina y cuáles son los factores que mayormente la explican. Métodos: Con datos de la Encuesta Nacional sobre Calidad de Vida de los Adultos Mayores para el año 2012 se llevaron a cabo los siguientes pasos: i) cómputo del índice de concentración corregido para variables asociadas a la dependencia funcional y explicativas de la inequidad en su distribución mediante la transformación de Erreygers y ii) descomposición de la inequidad en la distribución de dependencias básicas y ampliadas, siguiendo la metodología propuesta por Wagstaff. Resultados: La distribución de todas las dependencias funcionales (tanto básicas como ampliadas) es propobre. El ingreso per cápita, el hecho de presentar algún tipo de deficiencia visual o auditiva y vivir en hogares unipersonales son las variables explicativas que más contribuyen a incrementar la inequidad en la distribución de las dependencias funcionales básicas o ampliadas. Conclusiones: Los resultados que se desprenden de este estudio constituyen un insumo importante a la hora de procurar programas de asistencia a los adultos mayores que permitan evitar consecuencias negativas a futuro sobre su salud (y disminuir los gastos del sistema de salud en su conjunto). Estas acciones deben estar enfocadas específicamente en los adultos mayores de bajo nivel socioeconómico y que viven solos(AU)

Introduction: Population aging brings about an increase in the number of individuals in situations of functional dependence, which is understood as the need for assistance to carry out daily life activities. Objective: To assess whether there is inequity in the distribution of functional dependence among older adults in Argentina and what are the fundamental causative factors. Methods: With data from the 2012 National Survey on Quality of Life of Older Adults, the following steps were carried out: i) calculation of corrected concentration index for variables associated with functional dependence and explanatory of distributed inequity, using Erreygers transformation and ii) decomposition of inequality in the distribution of basic and extended dependences, following the methodology proposed by Wagstaff. Results: The distribution of all functional dependencies (both basic and extended) is poor. Per capita income, the fact of having any type of visual or hearing impairment, and living in one-person households are the explanatory variables that most contribute to increasing inequality regarding the distribution of basic or extended functional dependencies. Conclusions: The results derived from this study are an important input when it comes to ensuring assistance programs for older adults that make it possible to avoid negative consequences on their health in the future; as well as reduce expenses to the health system as a whole). These actions should be focused specifically on older adults of low socioeconomic status and who live alone(AU)

Humans , Male , Female , Aged , Aged, 80 and over , Health of the Elderly , Quality-Adjusted Life Years , Health Status Disparities , Argentina
Biomedical and Environmental Sciences ; (12): 101-109, 2021.
Article in English | WPRIM | ID: wpr-878326


Objective@#To assess the association of socioeconomic status with the burden of cataract blindness in terms of year lived with disability (YLD) rates and to determine whether ultraviolet radiation (UVR) levels modify the effect of socioeconomic status on this health burden.@*Methods@#National and subnational age-standardized YLD rates associated with cataract-related blindness were derived from the Global Burden of Disease (GBD) study 2017. The human development index (HDI) from the Human Development Report was used as a measure of socioeconomic status. Estimated ground-level UVR exposure was obtained from the Ozone Monitoring Instrument (OMI) dataset of the National Aeronautics and Space Administration (NASA).@*Results@#Across 185 countries, socioeconomic status was inversely associated with the burden of cataract blindness. Countries with a very high HDI had an 84% lower age-standardized YLD rate [95% confidence interval ( @*Conclusion@#Long-term high-UVR exposure amplifies the association of poor socioeconomic status with the burden of cataract-related blindness. The findings emphasize the need for strengthening UVR exposure protection interventions in developing countries with high-UVR exposure.

Female , Humans , Male , Blindness/etiology , Cataract/etiology , Global Burden of Disease/statistics & numerical data , Quality-Adjusted Life Years , Social Class , Socioeconomic Factors , Ultraviolet Rays/adverse effects
Journal of Zhejiang University. Medical sciences ; (6): 545-552, 2021.
Article in English | WPRIM | ID: wpr-922260


To analyze the global burden of periodontal disease and its relation with socioeconomic development. Data of global disability-adjusted life year (DALY) due to periodontal disease and human development index (HDI) from 1990 to 2019 were obtained from Global Health Data Exchange (GHDx) and human development reports. The trend of the global burden of periodontal disease from 1990 to 2019 was described. The correlation between age-standardized DALY rates and HDI were examined in 2019, and between-country periodontal disease burden inequality from 1990 to 2019 was measured using health-related Gini coefficients and concentration indexes. From 1990 to 2019, the global DALY rate due to periodontal disease increased from 78.63 to 85.48, and the epidemiological burden did not increase significantly. Statistical differences were found across different HDI categories for age-standardized DALY rates of periodontal disease ( 44.315, <0.01) in 2019. Linear regression analysis also revealed a negative correlation between age-standardized DALY rate of periodontal disease and HDI ( = -0.417, <0.01) . Gini coefficients decreased from 0.361 to 0.281 and concentration indexes fell from 0.0339 to -0.0538 between 1990 and 2019. The global burden of periodontal disease did not increase between 1990 and 2019, though the socioeconomic-associated inequality still existed. The burden of periodontal disease was more concentrated in less developed countries, and the socioeconomic-associated inequality has increased since 2000.

Humans , Disability-Adjusted Life Years , Global Health , Periodontal Diseases/epidemiology , Quality-Adjusted Life Years , Socioeconomic Factors
Journal of Peking University(Health Sciences) ; (6): 460-466, 2021.
Article in Chinese | WPRIM | ID: wpr-942202


OBJECTIVE@#To evaluate the potential effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population from economically developed area of China.@*METHODS@#Totally 202 179 adults aged 40 to 74 years without cardiovascular diseases at baseline (January 1, 2010) were enrolled from the Chinese electronic health records research in Yinzhou (CHERRY) study. Three scenarios were considered: the screening strategy based on risk charts recommended by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases in Chinese adults aged 40-74 years (Strategy 1); the screening strategy based on the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) models recommended by the 2019 Guideline on the assessment and management of cardiovascular risk in China in Chinese adults aged 40-74 years (Strategy 2); and the screening strategy based on the China-PAR models in Chinese adults aged 50-74 years (Strategy 3). According to the guidelines, individuals who were classified into medium- or high-risk groups after cardiovascular risk assessment by the corresponding strategies would be introduced to lifestyle intervention, while high-risk population would take medication in addition. Markov model was used to simulate different screening scenarios for 10 years (cycles), using parameters mainly from the CHERRY study, as well as published data, Meta-analyses and systematic reviews for Chinese populations. The life year gained, quality-adjusted life year (QALY) gained, number of cardiovascular disease events/deaths could be prevented and number needed to be screened (NNS) were calculated to compare the effectiveness between the different strategies. One-way sensitivity analysis on uncertainty of cardiovascular disease incidence rate and probabilistic sensitivity analysis on uncertainty of distributions for the hazard ratios were conducted.@*RESULTS@#Compared with non-screening strategy, QALYs gained were 1 433 [95% uncertainty interval (UI): 969-1 831], 1 401 (95%UI: 936-1 807), and 716 (95%UI: 265-1 111) for the Strategies 1, 2, and 3; and the NNS per QALY in the above strategies were 141 (95%UI: 110-209), 144 (95%UI: 112-216), and 198 (95%UI: 127-529), respectively. The Strategies 1 and 2 based on different guidelines showed similar effectiveness, while more benefits were found for screening using China-PAR models in adults aged 40-74 years than those aged 50-74 years. The results were consistent in the sensitivity analyses.@*CONCLUSION@#Screening for cardiovascular diseases in Chinese adults aged above 40 years seems effective in coastal developed areas of China, and the different screening strategies based on risk charts by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases or China-PAR models by the 2019 Guideline on the assessment and management of cardiovascular risk in China may have similar effectiveness.

Adult , Humans , Cardiovascular Diseases/prevention & control , China/epidemiology , Cost-Benefit Analysis , Mass Screening , Primary Prevention , Quality-Adjusted Life Years
Medwave ; 20(11): e8086, dic. 2020.
Article in Spanish | LILACS | ID: biblio-1146057


Antecedentes La osteoartritis destaca por su alta prevalencia y deterioro funcional, siendo la causa más común de incapacidad en mayores de 65 años. El régimen de Garantías Explícitas en Salud chileno otorga cobertura a tratamiento médico a las presentaciones leves y moderadas, excluyendo el manejo quirúrgico en la presentación severa. Objetivos Evaluar el costo-utilidad de incorporar el reemplazo total de rodilla al régimen de Garantías Explícitas en Salud para asegurados del seguro público sobre 65 años en Chile, versus la mantención con manejo farmacológico. Métodos Revisión sistemática explortaria para identificar los parámetros del modelo y evaluaciones económicas basadas en un modelo de Markov de seis estados de salud, desde la perspectiva del pagador público y horizonte lifetime. Se calculó la razón de costo-utilidad incremental que condujo al análisis de incertidumbre determinístico y probabilístico. Resultados Se seleccionaron 22 artículos como fuentes de referencia. Incorporar el procedimiento al alero del régimen, implicaría beneficiarse de 9,8 años de vida ajustados por calidad versus 2,4 en el escenario sin acceso a cirugía. La razón de costo-utilidad incremental es menos $445 689 pesos chilenos por años de vida ajustados por calidad (menos 633,8 dólares americanos por años de vida ajustados por calidad), siendo la incorporación de cirugía de reemplazo al régimen una alternativa dominante, versus el escenario de acceso insuficiente en otros regímenes de cobertura. Cada año de vida ajustado por calidad gracias a la cirugía ahorrará $445 689 pesos chilenos. A una voluntad de pago de $502 596 pesos chilenos por años de vida ajustados por calidad (714,7 dólares americanos por años de vida ajustados por calidad), la alternativa de acceso a reemplazo es costo-útil con 99,9% de certeza. Conclusión El reemplazo total de rodilla en mayores de 65 años es una alternativa dominante. El acceso a cirugía en el régimen de Garantías Explícitas en Salud para el sistema público es costo-útil a un umbral de un producto interno bruto per cápita.

Background Osteoarthritis is an important health condition due to its prevalence and functional deterioration, being the most common cause of disability in people over 65 years of age. The Chilean Explicit Health-Guarantees regime provides coverage for medical treatment in mild and moderate presentations, excluding surgical treatment in end-stage knee osteoarthritis. Objectives To evaluate the cost-utility of incorporating total knee replacement to the Explicit Health-Guarantees regime for over-65-years beneficiaries of the public insurance system, versus maintenance with medical treatment. Methods A Scoping review was coducted to identify model parameters and economic evaluation based in a 6 health states Markov Model, from the perspective of the public payer and lifetime horizon. The Incremental Cost-Utility Ratio (ICUR) was calculated, and deterministic and probabilistic uncertainty analysis were performed. Results Twenty-two articles were selected as reference sources. If the regime were to adopt the procedure, the implication would be a benefit of 9.8 Years of Life Adjusted by Quality (QALY) versus 2.4 QALY in the scenario without access to total knee replacement. The ICUR was $ -445 689 CLP/QALY (U$D -633.8/QALY), wherein the inclusion of total knee replacement to the regime becomes a dominant alternative versus the current scenario. Each quality-adjusted life-year gained by the surgery will save CLP 445 689. At a willingness to pay of CLP 502,596/QALY (U$D 714.7/QALY), access to surgery is cost-useful with a 99.9% certainty. Conclusion Total knee replacement in patients older than 65 years is a dominant alternative. Access to this procedure in the Chilean Explicit Health-Guarantees regime in the public system is cost-useful at a threshold of 1 GDP per capita.

Humans , Arthroplasty, Replacement, Knee/economics , Osteoarthritis, Knee/surgery , Chile , Markov Chains , Cost-Benefit Analysis , Quality-Adjusted Life Years , Osteoarthritis, Knee/economics
Arq. neuropsiquiatr ; 78(12): 762-771, Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1142381


ABSTRACT Introduction: Dementia is a globally relevant health problem, which places a great burden on patients and their families. This study aimed to estimate the burden associated with Alzheimer's disease (AD) and other dementias in Brazil. Methods: In this descriptive study, we investigated the estimates obtained by the Global Burden of Disease study. We described the prevalence of AD and other dementias, years lived with disability (YLDs), age-standardized mortality, years of life lost (YLLs), and disability-adjusted life years (DALYs) among individuals aged 60 years or older between 2000 and 2016, with their respective 95% uncertainty intervals (95%UI). Results: During this period, the age-standardized prevalence of AD and other dementias per 100,000 people increased by 7.8%, from 961.7 (95%UI 828.3-1,117.5) to 1,036.9 (95%UI 882.0-1,219.5), with approximately 1.5 million people living with dementia in Brazil. The incidence increased by 4.5%. Similarly, all age-standardized rates had an upward trend (mortality: 3.1%; YLLs: 5.8%; YLDs: 7.9%; and DALYs: 6.3%). Mortality profiles increased with age in both years. Dementias were ranked fourth among the leading causes of death in people aged ≥70 years in 2000, rising to second place in 2016. In 2016, it also represented the second and third leading causes of disability among older women and men, respectively. Conclusion: Population growth and aging have resulted in an increased burden of AD and other dementias in Brazil. Preventive and early diagnostic measures are essential to mitigate the burden associated with these diseases.

RESUMO Introdução: A demência é um problema de saúde globalmente relevante, com grande carga para os pacientes e suas famílias. Este estudo teve como objetivo estimar a carga associada à doença de Alzheimer (DA) e outras demências no Brasil. Métodos: Neste estudo descritivo, foram avaliadas as estimativas obtidas pelo estudo de Carga Global de Doença (Global Burden Disease). Descrevemos a prevalência de DA e outras demências, anos vividos com incapacidade (AVIs), mortalidade padronizada por idade, anos de vida perdidos por morte prematura (AVPs) e anos de vida perdidos ajustados por incapacidade (AVAIs), com respectivos intervalos de incerteza de 95% (95%II), em idosos com 60+ anos, entre 2000 e 2016. Resultados: No período, a prevalência padronizada por idade de DA e de outros tipos de demência aumentou 7,8%, de 961,7 (95%II 828,3-1.117,5) para 1.036,9 (95%II 882,0-1.219,5) por 100.000 pessoas, com aproximadamente 1,5 milhão de pessoas vivendo com demência no Brasil. Houve um aumento de 4,5% na incidência. Todas as taxas padronizadas por idade apresentaram tendência de aumento (mortalidade: 3,1%; AVPs: 5,8%; AVIs: 7,9%; e AVAIs: 6,3%). Os perfis de mortalidade demonstraram aumento com o envelhecimento, em ambos os anos. As demências ocuparam o quarto lugar entre as principais causas de morte em pessoas com 70+ anos em 2000, subindo para a segunda posição em 2016. Em 2016, também representou a segunda e terceira principais causas de incapacidade entre mulheres e homens mais velhos, respectivamente. Conclusões: O crescimento e envelhecimento populacional resultaram em aumento da carga de DA e de outras demências no Brasil. Medidas preventivas e de diagnóstico precoce são essenciais para atenuar a carga associada a essas doenças.

Humans , Male , Female , Middle Aged , Aged , Disabled Persons , Global Burden of Disease , Brazil/epidemiology , Global Health , Incidence , Prevalence , Quality-Adjusted Life Years