ABSTRACT
OBJECTIVE: To analyze the time trend of monthly mortality rates from chronic respiratory diseases in Brazil from 1996 to 2017, with forecasts for 2022, besides analyzing the possibility of achieving the goal of the Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil (Strategic Action Plan to Tackle Chronic Noncommunicable Diseases in Brazil) from 2011 to 2022. METHODS: This is an ecological study that uses data from Sistema de Informações sobre Mortalidade (SIM - Mortality Information System), Sistema de Informações Demográficas e Socioeconômicas (Demographic and Socioeconomic Information System) and Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD Contínua - Continuous National Household Sample Survey). We established the age range between 30 and 69 years old and the evolution of the rates over time was made by autoregressive integrated moving average models in R statistical tool. RESULTS: Premature mortality rates from chronic respiratory diseases are decreasing in Brazil as a whole, mostly in state capitals. There is also a trend to reach the Ministry of Health's goal in most of the country. For capitals that tend not to reach the goal, there is an association between mortality and social indicators, healthcare network and frequency of smoking. CONCLUSION: This study intends to improve planning of the public health system for the control of chronic respiratory diseases.
Subject(s)
Delivery of Health Care , Adult , Age Distribution , Aged , Brazil/epidemiology , Chronic Disease , Humans , Middle Aged , Socioeconomic FactorsABSTRACT
ABSTRACT OBJECTIVE To analyze the time trend of monthly mortality rates from chronic respiratory diseases in Brazil from 1996 to 2017, with forecasts for 2022, besides analyzing the possibility of achieving the goal of the Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil (Strategic Action Plan to Tackle Chronic Noncommunicable Diseases in Brazil) from 2011 to 2022. METHODS This is an ecological study that uses data from Sistema de Informações sobre Mortalidade (SIM - Mortality Information System), Sistema de Informações Demográficas e Socioeconômicas (Demographic and Socioeconomic Information System) and Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD Contínua - Continuous National Household Sample Survey). We established the age range between 30 and 69 years old and the evolution of the rates over time was made by autoregressive integrated moving average models in R statistical tool. RESULTS Premature mortality rates from chronic respiratory diseases are decreasing in Brazil as a whole, mostly in state capitals. There is also a trend to reach the Ministry of Health's goal in most of the country. For capitals that tend not to reach the goal, there is an association between mortality and social indicators, healthcare network and frequency of smoking. CONCLUSION This study intends to improve planning of the public health system for the control of chronic respiratory diseases.
RESUMO OBJETIVO Analisar a tendência temporal das taxas mensais de mortalidade por doenças respiratórias crônicas no Brasil de 1996 até 2017, com projeções para 2022, além de analisar a possibilidade de cumprimento da meta do Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil de 2011 até 2022. MÉTODOS Trata-se de estudo ecológico que utiliza dados do Sistema de Informações sobre Mortalidade, do Sistema de Informações Demográficas e Socioeconômicas e da Pesquisa Nacional por Amostra de Domicílios Contínua. O recorte etário foi estabelecido entre 30 e 69 anos e a evolução das taxas no tempo foi feita por meio de modelos autorregressivos integrados de média móvel em plataforma estatística R. RESULTADOS As taxas de mortalidade precoce por doenças respiratórias crônicas apresentam-se decrescentes no Brasil como um todo e na maior parte das capitais, assim como, há tendência a atingir a meta do Ministério da Saúde na maior parte do país. Para capitais que tendem a não atingir a meta, verifica-se associação entre mortalidade e indicadores sociais, rede assistencial de saúde e frequência do tabagismo. CONCLUSÃO Pretende-se que o estudo possibilite um melhor planejamento do sistema público de saúde para o controle das doenças respiratórias crônicas.
Subject(s)
Respiratory Tract Diseases/mortality , Health Programs and Plans , Brazil , Ecological Studies , Noncommunicable Diseases , Chronic Disease IndicatorsABSTRACT
BACKGROUND: Recent reports have suggested that air pollution mixtures represented by nitrogen dioxide (NO2) may have effects on human health, which are independent from those of particulate matter mass. We evaluate the association between NO2 and daily mortality among elderly using one- and multipollutant models. METHODS: This study was a daily time series of non-accidental and cause-specific mortality among the elderly living in São Paulo, Brazil, between 2000 and 2011. Effects of NO2, particulate matter smaller than 10µm (PM10), carbon monoxide (CO) and ozone (O3) were estimated in Poisson generalized additive models. The single lag effect at lags 0 and 1 days and the cumulative effect from 0 to lag 10 days were evaluated in one-, two-, three- and four-pollutant models. The cumulative risk index (CRI) recently proposed to analyze associations with health of multiple correlated pollutants was additionally estimated for each multipollutant model. RESULTS: An association between NO2, PM10, CO and O3 exposures and non-accidental and cause-specific deaths was found in one-pollutant models. NO2 effects remained significant in multipollutant models for non-accidental and circulatory deaths. The estimated CRIs suggested that circulatory deaths were mainly associated with NO2, and respiratory deaths mainly with CO and O3, regardless the lag. For non-accidental deaths, multipollutant models were associated with the highest CRI, with the main pollutants depending on the chosen lag. CONCLUSIONS: The results suggest that air pollution mixtures represented by NO2 have an effect on non-accidental and circulatory mortality, which is independent from PM10, CO and O3. The CRI was always larger than the risks associated with single pollutants.
Subject(s)
Air Pollutants/toxicity , Cardiovascular Diseases/mortality , Environmental Exposure , Nitrogen Dioxide/toxicity , Aged , Aged, 80 and over , Brazil/epidemiology , Carbon Monoxide/analysis , Cardiovascular Diseases/chemically induced , Female , Humans , Male , Middle Aged , Ozone/analysis , Particle Size , Particulate Matter/analysisABSTRACT
This study evaluated the association between air pollution and hospital admissions due to respiratory and cardiovascular diseases in Cubatão, São Paulo State, Brazil. Generalized additive Poisson regression models were used to model daily concentrations of particulate matter (PM10), sulfur dioxide (SO2), and ozone (O3) and daily hospital admissions counts. Explanatory variables were temperature, relative humidity, day of the week, and holidays. For each increment of 10µg/m³ in PM10, we found an excess of 4.25 % (95%CI: 2.82; 71), 5.74% (95%CI: 3.80; 7.71), and 2.29% (95%CI: 0.86; 3.73) in admissions due to respiratory diseases for all ages, respiratory diseases in children under 5 years old, and cardiovascular diseases in adults over 39 years of age, respectively. For SO2, the increase was 3.51% (IC95%: 1.24; 5.83) for cardiovascular diseases in adults more than 39 years. For O3, the increase was 2.85% (IC95%: 0.77; 4.98) for cardiovascular diseases in adults more than 39 years of age and 3.91% (IC95%: 1.37; 6.51) for respiratory diseases in children under 5 years old. Air pollution has serious impacts on health in Cubatão, thus emphasizing the need for air quality control policies.
Subject(s)
Air Pollution/adverse effects , Cardiovascular Diseases/epidemiology , Respiration Disorders/epidemiology , Adult , Age Factors , Air Pollution/analysis , Brazil , Child, Preschool , Hospitalization/statistics & numerical data , Humans , Spatio-Temporal AnalysisABSTRACT
Foi avaliado o impacto da poluição do ar nas internações por doenças respiratórias e cardiovasculares em residentes do Município de Cuba-tão, São Paulo, Brasil. Utilizaram-se modelos de séries temporais, com modelos aditivos generalizados, em regressão de Poisson, testando como variáveis independentes as concentrações diárias de material particulado (PM10); dióxido de enxofre (SO2) e o ozônio (O3). Como variáveis de controle a temperatura, umidade, dias da semana e feriados. Para cada incremento de 10µg/m³ de PM10, encontrou-se um excesso de internações de 4,25% (IC95%: 2,82; 5,71); 5,74% (IC95%: 3,80; 7,71) e 2,29% (IC95%: 0,86; 3,73) para doenças respiratórias totais, doenças respiratórias em menores de 5 anos e doenças cardiovasculares em maiores de 39 anos, respectivamente. O SO2 apresentou relação com as doenças cardiovasculares em maiores de 39 anos de 3,51% (IC95%: 1,24; 5,83) e o O3 com as doenças cardiovasculares em maiores de 39 anos: 2,85% (IC95%: 0,77; 4,98) e doenças respiratórias em menores de 5 anos: 3,91% (IC95%: 1,37; 6,51). Os efeitos da poluição atmosférica na saúde em Cubatão são pronunciados, indicando a necessidade de melhoria das políticas de controle.
This study evaluated the association between air pollution and hospital admissions due to respiratory and cardiovascular diseases in Cubatão, São Paulo State, Brazil. Generalized additive Poisson regression models were used to model daily concentrations of particulate matter (PM10), sulfur dioxide (SO2), and ozone (O3) and daily hospital admissions counts. Explanatory variables were temperature, relative humidity, day of the week, and holidays. For each increment of 10µg/m³ in PM10, we found an excess of 4.25 % (95%CI: 2.82; 71), 5.74% (95%CI: 3.80; 7.71), and 2.29% (95%CI: 0.86; 3.73) in admissions due to respiratory diseases for all ages, respiratory diseases in children under 5 years old, and cardiovascular diseases in adults over 39 years of age, respectively. For SO2, the increase was 3.51% (IC95%: 1.24; 5.83) for cardiovascular diseases in adults more than 39 years. For O3, the increase was 2.85% (IC95%: 0.77; 4.98) for cardiovascular diseases in adults more than 39 years of age and 3.91% (IC95%: 1.37; 6.51) for respiratory diseases in children under 5 years old. Air pollution has serious impacts on health in Cubatão, thus emphasizing the need for air quality control policies.
Se utilizaron análisis de series temporales con modelos aditivos generalizados en regresión de Poisson, además, para la prueba de las variables independientes se consideraron las concentraciones diarias de material particulado (PM10), dióxido de azufre (SO2) y ozono (O3). Como variables de control se consideraron: la temperatura, humedad, los días de la semana y festivos. Por cada incremento de PM10 10µg/m³, se encontró un exceso de hospitalizaciones de un 4,25% (IC95%: 2,82; 5,71), 5,74% (IC95%: 3,80; 7,71) y 2,29% (IC95%: 0,86; 3,73) para las enfermedades respiratorias en todas las edades, las enfermedades respiratorias en niños menores de 5 años y la enfermedad cardiovascular en adultos mayores de 39 años, respectivamente. El SO2 se relacionó con las enfermedades cardiovasculares en adultos mayores de 39 años en el 3,51% (IC95%: 1,24; 5,83) y O3 con enfermedades cardiovasculares en adultos mayores de 39 años: 2,85% (IC95%: 0,77; 4,98) y enfermedades respiratorias en niños menores de 5 años: 3,91% (IC95%: 1,37; 6,51). Los efectos de la contaminación atmosférica sobre la salud en Cubatão son elevados, lo que indica la necesidad de revisión en las políticas públicas de control.
Subject(s)
Adult , Child, Preschool , Humans , Air Pollution/adverse effects , Cardiovascular Diseases/epidemiology , Respiration Disorders/epidemiology , Age Factors , Air Pollution/analysis , Brazil , Hospitalization/statistics & numerical data , Spatio-Temporal AnalysisABSTRACT
BACKGROUND: Exposure to high levels of particulate matter with an aerodynamic diameter less than 2.5 µm (PM(2.5)) resulting from biomass burning is frequent in the subequatorial Amazon region. OBJECTIVE: To investigate whether or not current exposure to PM(2.5) in the Brazilian Amazon has adverse effects on the daily peak expiratory flow (PEF) of schoolchildren. METHODS: The study design consisted of a panel comprising 309 children aged 6 to 15 years from the same school. PEF was measured daily, except weekends and holidays, from August to December 2006. Each child contributed to the study up to 67 daily measurements. All together there were 19115 PEF measures. Participation rate was 90%. Daily measurements of PM(2.5), temperature, and humidity as well as passive smoking, and subject features were regarded in the statistical analysis. Various exposures of PM(2.5) were considered throughout the analysis, among them 24-hour, 12-hour, 6-hour, and 5-hour means. To account for subject responses to confounders, mixed effects models were applied. The effects were evaluated considering air pollution levels on the current day or at 1- or 2-day lags and the averages of 0-1-day lags, 1-2-day lags and 0-, 1-, and 2-day lags. RESULTS: The 24-hour PM(2.5) means ranged from 6.39 to 99.91 µg/m(3). The adjusted models for the entire group of children revealed adverse effects. For instance, for an increase of 10 µg/m(3) in PM(2.5,) the reduction in the PEF average varied between 0.26 l/min (95% Confidence Interval (CI): -0.49; -0.04) and 0.38 l/min (95% CI: -0.71; -0.04). Restricted to the subgroup of non-asthmatic children, classified as such according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, there was a reduction in the PEF ranging from 0.38 l/min (95% CI: -0.63; -0.13) to 0.53 l/min (95% CI: -0.90; -0.16) for an increase of 10 µg/m(3) in PM(2.5). There was no significant effect in the asthmatic group. When stratified by time of the day children were at school, the concurrent effects of air pollution on PEF were not significant, whereas the 6-hour exposure from 0 am to 5:30 am was significant for both morning and afternoon groups. Finally, the 24-hour mean lagged effect was only significant for the afternoon group of children. For an increase of 10 µg/m(3) in PM(2.5,) there was a reduction in the PEF that ranged from 0.41 l/min (95% CI: -0.76; -0.06) to 0.49 l/min (95% CI: -0.91; -0.07). CONCLUSION: Exposure to current levels of PM(2.5) in the Brazilian Amazon was associated with reductions in the lung function of schoolchildren. The adverse effects were more consistent in non-asthmatic children and with respect to the 6-hour mean from 0 am to 5.30 am.
Subject(s)
Environmental Exposure/adverse effects , Particulate Matter/adverse effects , Peak Expiratory Flow Rate/physiology , Adolescent , Brazil , Child , Humans , Humidity , Models, Statistical , Particle Size , Particulate Matter/analysis , TemperatureABSTRACT
This study aimed at establishing the cross-cultural equivalence of scales used to evaluate physical activity level and measure cardiorespiratory fitness, for further application in elderly subjects. Three scales were identified after systematic review: Veterans Physical Activity Questionnaire (VSAQ), Rating of Perceived Capacity (RPC), and Physical Activity Rating (PA-R). The model proposed by Herdman et al. was applied to analyze equivalence. Test-retest reliability was calculated in a sample of 12 elderly subjects (74.5 +/- 3.5 years) using Lin's concordance coefficient and intraclass correlation coefficient. Good reproducibility was detected in all scales except RPC. Due to the small sample size, hardly any conclusions can de drawn, but the results point to the need for changes in the original scale's structures. The findings also suggest the adequacy of the scale's Portuguese-language version, although further validity studies appear to be necessary.
Subject(s)
Cross-Cultural Comparison , Exercise Tolerance/physiology , Geriatric Assessment/methods , Physical Fitness/physiology , Surveys and Questionnaires/standards , Activities of Daily Living/classification , Aged , Aging/physiology , Cardiovascular Physiological Phenomena , Female , Humans , Leisure Activities/classification , Male , Motor Activity/physiology , Psychometrics/methods , Reproducibility of Results , Respiratory Physiological Phenomena , SemanticsABSTRACT
OBJECTIVE: To propose a correction approach for underreporting and relocation of ill-defined causes of morbidity and mortality in the National Health System Mortality and Hospital Information Systems. METHODS: Modified James-Stein empirical Bayes estimators for events in delimited geographic areas were applied as a correction approach for underreporting in Brazilian municipalities in 2001. RESULTS: There was an increase of 55,671 deaths in the Mortality Information System, an underreporting correction of 5.85%. It was more effective at the age groups under five (8.1%) and 70 years old and more (6.4%); for neonatal (8.7%) and ill-defined (8.0%) causes of death; and in the states of Maranhão (10.6%), Bahia (9.5%) and Alagoas (8.8%). Relocation of ill-defined causes of mortality changed the structure of proportional mortality in the Northern and Northeastern regions, and increased the proportion of deaths due to cardiovascular diseases and reduced those due to external and neonatal causes. Relocation of ill-defined causes of hospital admissions did not affect hospital proportional morbidity. CONCLUSIONS: The results of underreporting correction were consistent with previous studies, in terms of age groups, causes and geographic areas. Relocation of ill-defined causes of death was spatially consistent. The approach studied may be applicable on Brazilian Health Information since it can be implemented in computational algorithms. Some improvements, however, may be considered, like estimation approaches based on time-space event distribution.
Subject(s)
Cause of Death , Death Certificates , Hospital Information Systems/standards , Hospital Mortality , Adolescent , Adult , Aged , Bayes Theorem , Brazil , Child , Child, Preschool , Hospital Information Systems/statistics & numerical data , Humans , Infant , Infant, Newborn , International Classification of Diseases , Middle AgedABSTRACT
OBJETIVO: Propor técnicas de correção de sub-registro e redistribuição de causas mal definidas para o Sistema de Informações sobre Mortalidade e o Sistema de Informações Hospitalares do SUS. MÉTODOS: Para a correção de sub-registro foram utilizados os estimadores bayesianos empíricos de James-Stein modificados para eventos em áreas geográficas delimitadas, aplicadas nos municípios brasileiros, no ano de 2001. RESULTADOS: Em relação aos dados de mortalidade, obteve-se um acréscimo de 55.671 óbitos, resultando num percentual de correção de sub-registro de 5,9 por cento, mais efetivo nas faixas etárias de menores de cinco anos (8,1 por cento) e de 70 anos e mais (6,4 por cento); nas causas perinatais (8,7 por cento) e causas mal definidas (8,0 por cento); e nos Estados do Maranhão (10,6 por cento), Bahia (9,5 por cento) e Alagoas (8,8 por cento). A redistribuição das causas mal definidas de óbito modificou a estrutura da mortalidade proporcional das regiões Norte e Nordeste, com aumento da proporção de óbitos por doenças do aparelho circulatório e redução para as causas externas e perinatais. A redistribuição das causas mal definidas de internação não alterou a morbidade hospitalar proporcional. CONCLUSÕES: Os resultados da correção de sub-registro apresentaram consistência em relação aos achados da literatura, quanto as faixas etárias, causas e regiões do País mais acometidas. Em relação à redistribuição das causas mal-definidas de morte, observou-se coerência espacial na reordenação da mortalidade proporcional. Considera-se este método aplicável aos Sistemas de Informação em Saúde nacionais, já que pode ser implementado em rotinas computacionais. Entretanto, alguns aprimoramentos podem ser considerados, como a distribuição espaço-temporal dos eventos na aplicação dos estimadores.
OBJECTIVE: To propose a correction approach for underreporting and relocation of ill-defined causes of morbidity and mortality in the National Health System Mortality and Hospital Information Systems. METHODS: Modified James-Stein empirical Bayes estimators for events in delimited geographic areas were applied as a correction approach for underreporting in Brazilian municipalities in 2001. RESULTS: There was an increase of 55,671 deaths in the Mortality Information System, an underreporting correction of 5.85 percent. It was more effective at the age groups under five (8.1 percent) and 70 years old and more (6.4 percent); for neonatal (8.7 percent) and ill-defined (8.0 percent) causes of death; and in the states of Maranhão (10.6 percent), Bahia (9.5 percent) and Alagoas (8.8 percent). Relocation of ill-defined causes of mortality changed the structure of proportional mortality in the Northern and Northeastern regions, and increased the proportion of deaths due to cardiovascular diseases and reduced those due to external and neonatal causes. Relocation of ill-defined causes of hospital admissions did not affect hospital proportional morbidity. CONCLUSIONS: The results of underreporting correction were consistent with previous studies, in terms of age groups, causes and geographic areas. Relocation of ill-defined causes of death was spatially consistent. The approach studied may be applicable on Brazilian Health Information since it can be implemented in computational algorithms. Some improvements, however, may be considered, like estimation approaches based on time-space event distribution.
