Mortalidade e carga do câncer de laringe atribuíveis aos riscos ocupacionais no Brasil: estudo da Carga Global de Doença, 2019 / Laryngeal cancer mortality and burden attributable to occupational risks in Brazil: 2019 Global Burden of Disease

Resumo Objetivo: descrever a mortalidade e os anos de vida ajustados pela incapacidade disability-adjusted life years - DALYs) para câncer de laringe no Brasil atribuíveis a fatores de risco ocupacionais e comportamentais. Métodos: estudo ecológico com dados do estudo Global Burden of Disease 2019. Foram obtidas taxas de mortalidade e de DALYs para o câncer de laringe atribuíveis aos riscos ocupacionais (ácido sulfúrico e amianto) e comportamentais (tabaco e álcool), de 1990 e 2019. Resultados: no Brasil, em 2019, a taxa de mortalidade por câncer de laringe atribuível aos riscos ocupacionais (ácido sulfúrico e amianto) foi 0,28 (II95%: 0,17;0,43) no sexo masculino e 0,03 (II95%: 0,02;0,04) no feminino, e a de DALYs foi 7,33 (II95%: 4,28;11,44) e 0,64 (II95%: 0,35;0,03), respectivamente. O ácido sulfúrico foi o principal risco ocupacional para a doença. Houve redução das taxas atribuíveis ao tabaco (mortalidade:-45,83%; DALYs:-47,36%) e aos riscos ocupacionais (mortalidade:-23,20%; DALYs:-26,31%), no Brasil, com aumento em alguns estados das regiões Norte e Nordeste. Conclusão: houve redução na mortalidade e na carga do câncer de laringe atribuível aos fatores ocupacionais no período, porém menor em comparação ao tabagismo, reforçando a importância de ações para reduzir o impacto dos riscos ocupacionais, como as medidas regulatórias aplicadas ao tabaco.

Abstract Objective: to describe mortality and disability-adjusted life years (DALYs) due to laryngeal cancer attributable to occupational and behavioral risk factors in Brazil. Methods: this is an ecological study with data from the 2019 Global Burden of Disease. Mortality and DALY rates for laryngeal cancer attributable to occupational (sulfuric acid and asbestos) and behavioral (tobacco and alcohol) risks were obtained from 1990 and 2019. Results: in 2019, the mortality rate from laryngeal cancer attributable to occupational hazards (sulfuric acid and asbestos) totaled 0.28 (95%UI: 0.17; 0.43) and 0.03 (95%UI: 0.02; 0.04), whereas and DALY rates, 7.33 (95%UI: 4.28; 11.44) and 0.64 (95%UI: 0.35; 0.03) in men and women in Brazil, respectively. Sulfuric acid configured the main occupational risk for the disease. The rates attributable to tobacco (mortality: −45.83%; DALYs: −47.36%) and occupational hazards (mortality: −23.20%; DALYs: −26.31%) decreased in Brazil but increased in some Northern and Northeastern states. Conclusion: laryngeal cancer mortality and burden attributable to occupational factors decreased in the period (although less than that for smoking), reinforcing the importance of actions to reduce the impact of occupational risks, such as the regulatory measures applied to tobacco.

Trend of the Burden of Larynx Cancer in Brazil, 1990 to 2019.

INTRODUCTION: Larynx cancer is one of the most common head and neck cancers, whose main risk factors are smoking and alcohol use, and its occurrence and prognosis depend on adequate and timely preventive measures. This study aimed to investigate the burden of larynx cancer in Brazil and its states. METHODS: Using estimates from the Global Burden of Disease Study 2019, this study analyzed the trends of incidence, mortality, and disability-adjusted life years (DALYs) for larynx cancer between 1990 and 2019, besides the mortality-to-incidence ratio and the socio demographic index. RESULTS: Incidence and mortality due to larynx cancer in Brazil, which are approximately eight-fold higher for men, showed a declining trend between 1990 and 2019 (APPC: -0.4% and -1.0%, respectively). The DALYs also showed negative variation between 1990 and 2019 for both sexes in Brazil, mainly due to the decrease in premature deaths, with the greatest reduction in the state of São Paulo. For the states of Brazil in 2019, the higher age-standardized incidence rate (Rio Grande do Sul, 3.83 cases per 100,000 inhabitants) is twice the lowest rate (Piauí, 1.56 cases per 100,000 inhabitants). CONCLUSIONS: A fall in the burden of larynx cancer was observed in Brazil over the past 30 years, which may be attributed to a reduction in smoking and to an improvement in treatment. However, the regional inequalities in the country remain evident, especially for males. This data can guide public policy priorities to control the disease in Brazil.

The increasing burden of pancreatic cancer in Brazil from 2000 to 2019: estimates from the Global Burden of Disease Study 2019.

INTRODUCTION: Pancreatic cancer is increasing worldwide. The burden of pancreatic cancer in Brazil and its states was analyzed and compared with that from the USA and China. METHODS: This is a descriptive study of the incidence and mortality estimates from the Global Burden of Disease 2019 study, from 2000 to 2019. The Brazilian states presenting the highest and lowest socio-demographic index (SDI) were selected from each of the five regions. The SDI consists of the per capita income, education, and fertility rate of each population. RESULTS: A significant increase was found in age-standardized incidence and mortality of pancreatic cancer in all three countries, with differences in magnitude and annual increases. In Brazil, this incidence rose from 5.33 [95% Uncertainty Interval (UI): 5.06- 5.51] to 6.16 (95% UI: 5.68- 6.53) per 100,000 inhabitants. China and the Brazilian states with the lowest SDI, such as Pará and Maranhão, showed lower incidence and mortality rates, although presenting the highest annual increases. No difference was found between the sexes. A higher mortality rate was observed for those individuals of 70+ years, which was three to four times higher than those aged 50 to 69 years. CONCLUSIONS: The increasing burden of pancreatic cancer in the studied countries, and the higher estimates for the elderly in a fast-aging country such as Brazil, indicates that more resources and health policies will be necessary. The greatest increase in the states with lower SDI reflects inequalities in the access to diagnosis and registries of this cancer.

Suicide mortality among older adults in Brazil between 2000 and 2019 - estimates from the Global Burden of Disease Study 2019.

INTRODUCTION: Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states. METHODS: This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI). RESULTS: During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states' rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50). CONCLUSIONS: The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.

Trend of the Burden of Larynx Cancer in Brazil, 1990 to 2019

Abstract INTRODUCTION: Larynx cancer is one of the most common head and neck cancers, whose main risk factors are smoking and alcohol use, and its occurrence and prognosis depend on adequate and timely preventive measures. This study aimed to investigate the burden of larynx cancer in Brazil and its states. METHODS: Using estimates from the Global Burden of Disease Study 2019, this study analyzed the trends of incidence, mortality, and disability-adjusted life years (DALYs) for larynx cancer between 1990 and 2019, besides the mortality-to-incidence ratio and the socio demographic index. RESULTS: Incidence and mortality due to larynx cancer in Brazil, which are approximately eight-fold higher for men, showed a declining trend between 1990 and 2019 (APPC: -0.4% and -1.0%, respectively). The DALYs also showed negative variation between 1990 and 2019 for both sexes in Brazil, mainly due to the decrease in premature deaths, with the greatest reduction in the state of São Paulo. For the states of Brazil in 2019, the higher age-standardized incidence rate (Rio Grande do Sul, 3.83 cases per 100,000 inhabitants) is twice the lowest rate (Piauí, 1.56 cases per 100,000 inhabitants). CONCLUSIONS: A fall in the burden of larynx cancer was observed in Brazil over the past 30 years, which may be attributed to a reduction in smoking and to an improvement in treatment. However, the regional inequalities in the country remain evident, especially for males. This data can guide public policy priorities to control the disease in Brazil.

The increasing burden of pancreatic cancer in Brazil from 2000 to 2019: estimates from the Global Burden of Disease Study 2019

Abstract INTRODUCTION: Pancreatic cancer is increasing worldwide. The burden of pancreatic cancer in Brazil and its states was analyzed and compared with that from the USA and China. METHODS: This is a descriptive study of the incidence and mortality estimates from the Global Burden of Disease 2019 study, from 2000 to 2019. The Brazilian states presenting the highest and lowest socio-demographic index (SDI) were selected from each of the five regions. The SDI consists of the per capita income, education, and fertility rate of each population. RESULTS: A significant increase was found in age-standardized incidence and mortality of pancreatic cancer in all three countries, with differences in magnitude and annual increases. In Brazil, this incidence rose from 5.33 [95% Uncertainty Interval (UI): 5.06- 5.51] to 6.16 (95% UI: 5.68- 6.53) per 100,000 inhabitants. China and the Brazilian states with the lowest SDI, such as Pará and Maranhão, showed lower incidence and mortality rates, although presenting the highest annual increases. No difference was found between the sexes. A higher mortality rate was observed for those individuals of 70+ years, which was three to four times higher than those aged 50 to 69 years. CONCLUSIONS: The increasing burden of pancreatic cancer in the studied countries, and the higher estimates for the elderly in a fast-aging country such as Brazil, indicates that more resources and health policies will be necessary. The greatest increase in the states with lower SDI reflects inequalities in the access to diagnosis and registries of this cancer.

Suicide mortality among older adults in Brazil between 2000 and 2019 - estimates from the Global Burden of Disease Study 2019

Abstract INTRODUCTION: Older adults present a higher risk of suicide, and Brazil is experiencing a fast population aging. To understand the impact of demographic transition, we compared Brazilian suicide mortality rates (MR) among adults (50+ years) with global rates, those from one high-income country, and those from one middle-income country. Looking for regional disparities, the MR was analyzed among older adults (60+ years) by Brazilian states. METHODS: This was an ecological study based on estimates from the Global Burden of Disease Study, from 2000 to 2019. Age-standardized MR and age-specific MR per 100,000 inhabitants were described, with 95% uncertainty intervals (UI). RESULTS: During the period, the annual estimates and the declining trend in mortality were higher in the world than in the studied countries. In 2019, global age-standardized MR was 9.39 (95% UI 8.48-10.29), compared to 5.68 (95% UI 5.40-6.19), 6.01 (95% UI 5.10-7.04), and 6.63 (95% UI 6.43-6.95) in Brazil, Mexico, and England, respectively. In Brazil, despite a significant decline in national rates, stability was observed in 15 states. An increase in aging was only found for men, who presented 3-4 times higher MR than women. The states' rates presented large differences: in 2019, the rates among men aged 60-64 years varied from 7.24 (95% UI 5.31; 9.85) to 26.32 (95% UI 20.21; 34.50). CONCLUSIONS: The smaller decline in suicide mortality among older Brazilian adults, the increasing risk with aging, and the higher mortality among men indicate the need for specific prevention policies. The variation within states suggests differences in the data quality or in socio-cultural and historical aspects, which requires further investigation.

Higher mortality during the COVID-19 pandemic in socially vulnerable areas in Belo Horizonte: implications for vaccine prioritization. / Maior mortalidade durante a pandemia de COVID-19 em áreas socialmente vulneráveis em Belo Horizonte: implicações para a priorização da vacinação.

OBJECTIVE: To assess mortality during the COVID-19 pandemic according to social vulnerability by areas of Belo Horizonte (BH), aiming at strategies for vaccination. METHODS: Ecological study with mortality analysis according to census tracts classified by the Health Vulnerability Index, a composite indicator that includes socioeconomic and sanitation variables. Deaths by natural causes and by COVID-19 were obtained from the "Mortality Information System", between the 10th and 43rd epidemiological weeks (EW) of 2020. Excess mortality was calculated in a time series model, considering observed and expected deaths per EW, between 2015 and 2019, per census tracts. Mortality rates (MR) were calculated and age-standardized using population estimates from the 2010 census, by the Brazilian Institute of Geography and Statistics (IBGE). RESULTS: Excess mortality in BH was 16.1% (n = 1,524): 11, 18.8 and 17.3% in low, intermediate and high vulnerability areas, respectively. The differences between observed and expected age-standardized MR by natural causes were equal to 59/100,000 inhabitants in BH, increasing from 31 to 77 and 95/100,000 inhabitants in the areas of low, intermediate and high vulnerability, respectively. There was an aging gradient in MR by COVID-19, ranging from 4 to 611/100,000 inhabitants among individuals aged 20-39 years and 75+ years. The COVID-19 MR per 100,000 older adults (60+ years) was 292 in BH, increasing from 179 to 354 and 476, in low, intermediate and high vulnerability areas, respectively. CONCLUSION: Inequalities in mortality, particularly among older adults, combined with the limited supply of doses, demonstrate the importance of prioritizing socially vulnerable areas during vaccination against COVID-19.

OBJETIVO: Avaliar a mortalidade por áreas de Belo Horizonte (BH) durante a pandemia de COVID-19 conforme a vulnerabilidade social, visando a uma estratégia de vacinação. MÉTODOS: Estudo ecológico com análise de mortalidade, segundo setores censitários classificados pelo índice de vulnerabilidade da saúde, composto de indicadores de saneamento e socioeconômicos. Óbitos por causas naturais e COVID-19 foram obtidos do Sistema de Informação sobre Mortalidade, entre a 10ª e a 43ª semanas epidemiológicas (SE) de 2020. Calculou-se o excesso de mortalidade por modelo de série temporal, considerando-se as mortes observadas por SE entre 2015 e 2019, por setor censitário. Taxas de mortalidade (TM) foram calculadas e padronizadas por idade com base em estimativas populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). RESULTADOS: Houve 16,1% (n = 1.524) de excesso de mortalidade em BH: 11, 18,8 e 17,3% nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. As diferenças entre TM observadas e esperadas por causas naturais, padronizadas por idade, foi igual a 59/100 mil habitantes em BH, aumentando de 31 para 77 e 95/100 mil, nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. Houve gradiente de aumento com a idade nas TM por COVID-19, variando de 4 a 611/100 mil habitantes entre as idades de 20-39 anos e 75+ anos. A TM por COVID-19 por 100 mil idosos (60+ anos) foi igual a 292, aumentando de 179 para 354 e 476 nos setores de baixa, média e elevada vulnerabilidade, respectivamente. CONCLUSÃO: Desigualdades na mortalidade, mesmo entre idosos, aliadas à baixa oferta de doses, demonstram a importância de priorizar áreas socialmente vulneráveis durante a vacinação contra COVID-19.

Diabetes and hypertension are associated with lowered cognitive performance among middle-aged Brazilian adults: cross-sectional analyses nested in the longitudinal Pró-Saúde study.

BACKGROUND: Cardiovascular risk factors are frequently associated with lowered cognitive performance among elderly people, but rarely among middle-aged adults. OBJECTIVES: To investigate associations between cardiovascular risk factors (age, physical inactivity, smoking, alcohol use, hypertension and diabetes) and lower cognitive performance among middle-aged (45-64 years) Brazilian adults. DESIGN AND SETTING: Cross-sectional study nested within the Pró-Saúde cohort. From 2,876 baseline study participants (1999), we randomly selected 488 participants and gave them validated and standardized cognitive tests (2012). METHODS: We used multiple linear and logistic regression analyses to detect associations of cardiovascular risk factors with crude scores in cognitive tests on memory (word test) and executive function (verbal fluency tests), and with overall cognitive performance scores, respectively. RESULTS: All cognitive test scores presented statistically significant inverse associations with age and direct associations with education. There was no association between lower cognitive performance and smoking or alcohol use. In both 1999 and 2012, after adjusting for sex, age and schooling, being physically active was inversely associated with lower performance regarding late memory. For individuals with diabetes in 1999, there was an association with lower performance regarding executive function, while there was a borderline association for those reporting it only in 2012. Having a diagnosis of hypertension since 1999 was associated with lower performance regarding both memory and executive functions, while reporting hypertension in 2012 was associated with lower performance regarding executive function. CONCLUSIONS: Aging, low schooling and cardiovascular risk factors may represent life course disadvantages associated with cognitive decline even among middle-aged Brazilian adults.

The COVID-19 Pandemic in Brazil: Institute for Health Metrics and Evaluation projections and observed evolution, May-August, 2020. / A pandemia da COVID-19 no Brasil: a série de projeções do Institute for Health Metrics and Evaluation e a evolução observada, maio a agosto de 2020.

OBJECTIVE: To describe the Institute for Health Metrics and Evaluation (IHME) projections for the COVID-19 pandemic in Brazil and the Brazilian states, present their accuracy and discuss their implications. METHODS: The IHME projections from May to August 2020 for Brazil and selected states were compared with the ensuing reported number of cumulative deaths. RESULTS: The pandemic was projected to cause 182,809 deaths by December 1, 2020 in Brazil. An increase in mask use could reduce the projected death toll by ~17,000. The mean error in the cumulative number of deaths at 2, 4 and 6 weeks after the projections were made was 13%, 18% and 22%, respectively. CONCLUSION: Short and medium-term projections provide important and sufficiently accurate data to inform health managers, elected officials, and society at large. After following an arduous course up until August, the pandemic is projected to decline steadily although slowly, with ~400 deaths/day still occurring in early December.

Diabetes and hypertension are associated with lowered cognitive performance among middle-aged Brazilian adults: cross-sectional analyses nested in the longitudinal Pró-Saúde study

ABSTRACT BACKGROUND: Cardiovascular risk factors are frequently associated with lowered cognitive performance among elderly people, but rarely among middle-aged adults. OBJECTIVES: To investigate associations between cardiovascular risk factors (age, physical inactivity, smoking, alcohol use, hypertension and diabetes) and lower cognitive performance among middle-aged (45-64 years) Brazilian adults. DESIGN AND SETTING: Cross-sectional study nested within the Pró-Saúde cohort. From 2,876 baseline study participants (1999), we randomly selected 488 participants and gave them validated and standardized cognitive tests (2012). METHODS: We used multiple linear and logistic regression analyses to detect associations of cardiovascular risk factors with crude scores in cognitive tests on memory (word test) and executive function (verbal fluency tests), and with overall cognitive performance scores, respectively. RESULTS: All cognitive test scores presented statistically significant inverse associations with age and direct associations with education. There was no association between lower cognitive performance and smoking or alcohol use. In both 1999 and 2012, after adjusting for sex, age and schooling, being physically active was inversely associated with lower performance regarding late memory. For individuals with diabetes in 1999, there was an association with lower performance regarding executive function, while there was a borderline association for those reporting it only in 2012. Having a diagnosis of hypertension since 1999 was associated with lower performance regarding both memory and executive functions, while reporting hypertension in 2012 was associated with lower performance regarding executive function. CONCLUSIONS: Aging, low schooling and cardiovascular risk factors may represent life course disadvantages associated with cognitive decline even among middle-aged Brazilian adults.

A pandemia da COVID-19 no Brasil: a série de projeções do Institute for Health Metrics and Evaluation e a evolução observada, maio a agosto de 2020 / La Pandemia de COVID-19 en Brasil: Serie de Proyecciones del Institute for Health Metrics and Evaluation y la Evolución Observada, desde mayo hasta agosto, 2020 / The COVID-19 Pandemic in Brazil: Institute for Health Metrics and Evaluation projections and observed evolution, May-August, 2020

Objetivo: Descrever as projeções do Institute for Health Metrics and Evaluation (IHME) para a COVID-19 no Brasil e seus estados, apresentar sua acurácia e discutir suas implicações. Métodos: As previsões do IHME de maio a agosto de 2020, para o Brasil e alguns estados, foram comparadas ao número de mortes cumulativas observadas. Resultados: A projeção prevê 182.809 mortes causadas pela pandemia até 1º de dezembro de 2020 no Brasil. O aumento no uso de máscara poderia poupar ~17 mil óbitos. O erro médio no número acumulado de óbitos em duas, quatro e seis semanas das projeções foi de 13%, 18% e 22% respectivamente. Conclusão: Projeções de curto e médio prazo dispõem dados importantes e acurácia suficiente para informar os gestores de saúde, autoridades eleitas e sociedade geral. Após trajeto difícil até agosto, a pandemia, conforme as projeções, terá declínio sustentado, embora demorado, causando em média 400 óbitos/dia no início de dezembro.

Objetivo: Describir las proyecciones del Institute for Health Metrics and Evaluation para COVID-19 en Brasil y sus estados, presentar su precisión y discutir sus implicaciones. Métodos Las previsiones del IHME de mayo a agosto de 2020 para Brasil y algunos estados, se compararon con las muertes acumuladas observadas. Resultados La proyección prevé 182.809 muertes por la pandemia hasta el 1º de diciembre de 2020 en Brasil. Un aumento en el uso de mascarillas podría evitar ~17.000 muertes. El error medio en el número acumulado de muertes en 2, 4 y 6 semanas de las proyecciones fue de 13%, 18% y 22%. Conclusión: Las proyecciones de corto y medio plazo proporcionan datos importantes y con suficiente precisión para informar a los administradores de salud, autoridades electas y a la sociedad. Después de un camino difícil hasta agosto, la pandemia, según las proyecciones, tendrá una disminución sostenida, pero lenta, y seguirá causando alrededor de 400 muertes/día a principios de diciembre.

Objective: To describe the Institute for Health Metrics and Evaluation (IHME) projections for the COVID-19 pandemic in Brazil and the Brazilian states, present their accuracy and discuss their implications. Methods: The IHME projections from May to August 2020 for Brazil and selected states were compared with the ensuing reported number of cumulative deaths. Results: The pandemic was projected to cause 182,809 deaths by December 1, 2020 in Brazil. An increase in mask use could reduce the projected death toll by ~17,000. The mean error in the cumulative number of deaths at 2, 4 and 6 weeks after the projections were made was 13%, 18% and 22%, respectively. Conclusion: Short and medium-term projections provide important and sufficiently accurate data to inform health managers, elected officials, and society at large. After following an arduous course up until August, the pandemic is projected to decline steadily although slowly, with ~400 deaths/day still occurring in early December.

Maior mortalidade durante a pandemia de COVID-19 em áreas socialmente vulneráveis em Belo Horizonte: implicações para a priorização da vacinação / Higher mortality during the COVID-19 pandemic in socially vulnerable areas in Belo Horizonte: implications for vaccine prioritization

RESUMO: Objetivo: Avaliar a mortalidade por áreas de Belo Horizonte (BH) durante a pandemia de COVID-19 conforme a vulnerabilidade social, visando a uma estratégia de vacinação. Métodos: Estudo ecológico com análise de mortalidade, segundo setores censitários classificados pelo índice de vulnerabilidade da saúde, composto de indicadores de saneamento e socioeconômicos. Óbitos por causas naturais e COVID-19 foram obtidos do Sistema de Informação sobre Mortalidade, entre a 10ª e a 43ª semanas epidemiológicas (SE) de 2020. Calculou-se o excesso de mortalidade por modelo de série temporal, considerando-se as mortes observadas por SE entre 2015 e 2019, por setor censitário. Taxas de mortalidade (TM) foram calculadas e padronizadas por idade com base em estimativas populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). Resultados: Houve 16,1% (n = 1.524) de excesso de mortalidade em BH: 11, 18,8 e 17,3% nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. As diferenças entre TM observadas e esperadas por causas naturais, padronizadas por idade, foi igual a 59/100 mil habitantes em BH, aumentando de 31 para 77 e 95/100 mil, nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. Houve gradiente de aumento com a idade nas TM por COVID-19, variando de 4 a 611/100 mil habitantes entre as idades de 20-39 anos e 75+ anos. A TM por COVID-19 por 100 mil idosos (60+ anos) foi igual a 292, aumentando de 179 para 354 e 476 nos setores de baixa, média e elevada vulnerabilidade, respectivamente. Conclusão: Desigualdades na mortalidade, mesmo entre idosos, aliadas à baixa oferta de doses, demonstram a importância de priorizar áreas socialmente vulneráveis durante a vacinação contra COVID-19.

ABSTRACT: Objective: To assess mortality during the COVID-19 pandemic according to social vulnerability by areas of Belo Horizonte (BH), aiming at strategies for vaccination. Methods: Ecological study with mortality analysis according to census tracts classified by the Health Vulnerability Index, a composite indicator that includes socioeconomic and sanitation variables. Deaths by natural causes and by COVID-19 were obtained from the "Mortality Information System", between the 10th and 43rd epidemiological weeks (EW) of 2020. Excess mortality was calculated in a time series model, considering observed and expected deaths per EW, between 2015 and 2019, per census tracts. Mortality rates (MR) were calculated and age-standardized using population estimates from the 2010 census, by the Brazilian Institute of Geography and Statistics (IBGE). Results: Excess mortality in BH was 16.1% (n = 1,524): 11, 18.8 and 17.3% in low, intermediate and high vulnerability areas, respectively. The differences between observed and expected age-standardized MR by natural causes were equal to 59/100,000 inhabitants in BH, increasing from 31 to 77 and 95/100,000 inhabitants in the areas of low, intermediate and high vulnerability, respectively. There was an aging gradient in MR by COVID-19, ranging from 4 to 611/100,000 inhabitants among individuals aged 20-39 years and 75+ years. The COVID-19 MR per 100,000 older adults (60+ years) was 292 in BH, increasing from 179 to 354 and 476, in low, intermediate and high vulnerability areas, respectively. Conclusion: Inequalities in mortality, particularly among older adults, combined with the limited supply of doses, demonstrate the importance of prioritizing socially vulnerable areas during vaccination against COVID-19.

Dementias in Brazil: increasing burden in the 2000-2016 period. Estimates from the Global Burden of Disease Study 2016.

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.

Dementias in Brazil: increasing burden in the 2000-2016 period. Estimates from the Global Burden of Disease Study 2016 / Demências no Brasil: aumento da carga no período de 2000 a 2016. Estimativas do Estudo Carga Global de Doenças 2016

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.

The COVID-19 Pandemic in Brazil: the Series of Projection from the Institute for Health Metrics and Evaluation and the Ensuing Evolution, from May to August, 2020 / La Pandemia de COVID-19 en Brasil: Serie de Proyecciones del Institute for Health Metrics and Evaluation y la Evolución Observada, desde Maio hasta Agosto, 2020 / A pandemia da COVID-19 no Brasil: a série de projeções do Institute for Health Metrics and Evaluation e a evolução observada, maio ­ agosto de 2020

Objective: To describe the Institute for Health Metrics and Evaluation projections for the COVID-19 pandemic in Brazil and its states, present their accuracy and discuss their implications. Methods: We describe projections from May to August, 2020 for Brazil and selected states, comparing them with the ensuing reported number of cumulative deaths. Results: The pandemic is projected to cause 182,809 deaths by December 1, 2020 in Brazil. An increase in mask use could reduce the projected death toll by ~17,000. The average error in projections of the cumulative number of deaths in 2, 4 and 6 weeks was 13%, 18% and 22%. Conclusion: IHME short, and medium term projections provide important and sufficiently accurate information to inform health planners, elected officials, and society. After presenting a very troublesome course to August, the pandemic is projected to decline steadily and slowly, with ~400 deaths/day still occurring in early December.

Objetivo: Descrever as projeções do Institute for Health Metrics and Evaluation (IHME) para a COVID-19 no Brasil e seus estados, apresentar sua acurácia e discutir suas implicações. Métodos: As previsões do IHME de maio a agosto de 2020, para o Brasil e alguns estados, foram comparadas ao número de mortes cumulativas observadas. Resultados: A projeção prevê 182.809 mortes causadas pela pandemia até 1o de dezembro de 2020 no Brasil. O aumento no uso de máscara poderia poupar ~17.000 óbitos. O erro médio no número acumulado de óbitos em duas, quatro e seis semanas das projeções foi de 13%, 18% e 22% respectivamente. Conclusão: Projeções de curto e médio prazo dispõem dados importantes e acurácia suficiente para informar os gestores de saúde, autoridades eleitas e sociedade geral. Após trajeto difícil até agosto, a pandemia, conforme as projeções, terá declínio sustentado, embora demorado, causando em média 400 óbitos/dia no início de dezembro.

The burden of low back pain in Brazil: estimates from the Global Burden of Disease 2017 Study.

BACKGROUND: The prevalence and burden of musculoskeletal (MSK) conditions are growing around the world, and low back pain (LBP) is the most significant of the five defined MSK disorders in the Global Burden of Disease (GBD) study. LBP has been the leading cause of non-fatal health loss for the last three decades. The objective of this study is to describe the current status and trends of the burden due to LBP in Brazil based on information drawn from the GBD 2017 study. METHODS: We estimated prevalence and years lived with disability (YLDs) for LBP by Brazilian federative units, sex, age group, and age-standardized between 1990 and 2017 and conducted a decomposition analysis of changes in age- and sex-specific YLD rates attributable to total population growth and population ageing for the purpose of understanding the drivers of changes in LBP YLDs rates in Brazil. Furthermore, we analyzed the changes in disability-adjusted life years (DALYs) rankings for this disease over the period. RESULTS: The results show high prevalence and burden of LBP in Brazil. LBP prevalence increased 26.83% (95% UI 23.08 to 30.41) from 1990 to 2017. This MSK condition represents the most important cause of YLDs in Brazil, where the increase in burden is mainly related to increase in population size and ageing. The LBP age-standardized YLDs rate are similar among Brazilian federative units. LBP ranks in the top three causes of DALYs in Brazil, even though it does not contribute to mortality. CONCLUSIONS: Findings from this study show LBP to be the most important cause of YLDs and the 3rd leading cause of DALYs in Brazil. The Brazilian population is ageing, and the country has been experiencing a rapid epidemiological transition, which generates an increasing number of people who need chronic care. In this scenario, more attention should be paid to the burden of non-fatal health conditions.

The burden of diabetes and hyperglycemia in Brazil: a global burden of disease study 2017.

BACKGROUND: The Global Burden of Diseases (GBD) 2017 database permits an up-to-date evaluation of the frequency and burden of diabetes at the state level in Brazil and by type of diabetes. The objective of this report is to describe, using these updated GBD data, the current and projected future burden of diabetes and hyperglycemia in Brazil, as well as its variation over time and space. METHODS: We derived all estimates using the GBD 2016 and 2017 databases to characterize disease burden related to diabetes and hyperglycemia in Brazil, from 1990 to 2040, using standard GBD methodologies. RESULTS: The overall estimated prevalence of diabetes in Brazil in 2017 was 4.4% (95%UI 4.0-4.9%), with 4.0% of those with diabetes being identified as having type 1 disease. While the crude prevalence of type 1 disease has remained relatively stable from 1990, type 2 prevalence has increased 30% for males and 26% for females. In 2017, approximately 3.3% of all disability-adjusted life years lost were due to diabetes and 5.9% to hyperglycemia. Diabetes prevalence and mortality were highest in the Northeast region and growing fastest in the North, Northeast, and Center-West regions. Over this period, despite a slight decrease in age-standardized incidence of type 2 diabetes, crude overall burden due to hyperglycemia has increased 19%, with population aging being a main cause for this rise. Cardiovascular diseases, responsible for 38.3% of this burden in 1990, caused only 25.9% of it in 2017, with premature mortality attributed directly to diabetes causing 31.6% of the 2017 burden. Future projections suggest that the diabetes mortality burden will increase 144% by 2040, more than twice the expected increase in crude disease burden overall (54%). By 2040, diabetes is projected to be Brazil's third leading cause of death and hyperglycemia its third leading risk factor, in terms of deaths. CONCLUSIONS: The disease burden in Brazil attributable to diabetes and hyperglycemia, already large, is predicted by GBD estimates to more than double to 2040. Strong actions by the Ministry of Health are necessary to counterbalance the major deleterious effects of population aging.