Laboratory-based surveillance of chronic kidney disease in people with private health coverage in Brazil.

BACKGROUND: Although approximately 25% of Brazilians have private health coverage (PHC), studies on the surveillance of chronic kidney disease (CKD) in this population are scarce. The objective of this study was to estimate the prevalence of CKD in individuals under two PHC regimes in Brazil, who total 8,335,724 beneficiaries. METHODS: Outpatient serum creatinine and proteinuria results of individuals from all five regions of Brazil, ≥ 18 years of age, and performed between 10/01/2021 and 10/31/2022, were analyzed through the own laboratory network database. People with serum creatinine measurements were evaluated for the prevalence and staging of CKD, and those with simultaneous measurements of serum creatinine and proteinuria were evaluated for the risk category of the disease. CKD was classified according to current guidelines and was defined as a glomerular filtration rate (GFR) < 60 ml/min/1.73 m² estimated by the 2021 CKD-EPI equation. RESULTS: The number of adults with serum creatinine results was 1,508,766 (age 44.0 [IQR, 33.9-56.8] years, 62.3% female). The estimated prevalence of CKD was 3.8% (2.6%, 0.8%, 0.2% and 0.2% in CKD stages 3a, 3b, 4 and 5, respectively), and it was higher in males than females (4.0% vs. 3.7%, p < 0.001, respectively) and in older age groups (0.2% among 18-29-year-olds, 0.5% among 30-44-year-olds, 2.0% among 45-59-year-olds, 9.4% among 60-74-year-olds, and 32.4% among ≥ 75-year-olds, p < 0.001) Adults with simultaneous results of creatinine and proteinuria were 64,178 (age 57.0 [IQR, 44.8-67.3] years, 58.1% female). After adjusting for age and gender, 70.1% were in the low-risk category of CKD, 20.0% were in the moderate-risk category, 5.8% were in the high-risk category, and 4.1% were in the very high-risk category. CONCLUSION: The estimated prevalence of CKD was 3.8%, and approximately 10% of the participants were in the categories of high or very high-risk of the disease. While almost 20% of beneficiaries with PHC had serum creatinine data, fewer than 1% underwent tests for proteinuria. This study was one of the largest ever conducted in Brazil and the first one to use the 2021 CKD-EPI equation to estimate the prevalence of CKD.

Laboratory-based surveillance of chronic kidney disease in people with private health coverage in Brazil

BACKGROUND Although approximately 25% of Brazilians have private health coverage (PHC), studies on the surveillance of chronic kidney disease (CKD) in this population are scarce. The objective of this study was to estimate the prevalence of CKD in individuals under two PHC regimes in Brazil, who total 8,335,724 beneficiaries. METHODS Outpatient serum creatinine and proteinuria results of individuals from all five regions of Brazil, ≥18 years of age, and performed between 10/01/2021 and 10/31/2022, were analyzed through the own laboratory network database. People with serum creatinine measurements were evaluated for the prevalence and staging of CKD, and those with simultaneous measurements of serum creatinine and proteinuria were evaluated for the risk category of the disease. CKD was classified according to current guidelines and was defined as a glomerular filtration rate (GFR)<60 ml/min/1.73 m² estimated by the 2021 CKD-EPI equation. RESULTS The number of adults with serum creatinine results was 1,508,766 (age 44.0 [IQR, 33.9­56.8] years, 62.3% female). The estimated prevalence of CKD was 3.8% (2.6%, 0.8%, 0.2% and 0.2% in CKD stages 3a, 3b, 4 and 5, respectively), and it was higher in males than females (4.0% vs. 3.7%, p<0.001, respectively) and in older age groups (0.2% among 18-29-year-olds, 0.5% among 30-44-year-olds, 2.0% among 45-59-year-olds, 9.4% among 60-74-yearolds, and 32.4% among ≥75-year-olds, p<0.001) Adults with simultaneous results of creatinine and proteinuria were 64,178 (age 57.0 [IQR, 44.8­67.3] years, 58.1% female). After adjusting for age and gender, 70.1% were in the low-risk category of CKD, 20.0% were in the moderate-risk category, 5.8% were in the high-risk category, and 4.1% were in the very high-risk category. CONCLUSION The estimated prevalence of CKD was 3.8%, and approximately 10% of the participants were in the categories of high or very high-risk of the disease. While almost 20% of beneficiaries with PHC had serum creatinine data, fewer than 1% underwent tests for proteinuria. This study was one of the largest ever conducted in Brazil and the first one to use the 2021 CKD-EPI equation to estimate the prevalence of CKD.

Mortality of Bolivian immigrants in São Paulo, Brazil: analysis of avoidable causes. / Mortalidade de imigrantes bolivianos em São Paulo, Brasil: análise de causas evitáveis.

The objective was to analyze the mortality of Bolivian immigrants compared to the Brazilian population, living in the city of São Paulo, with an emphasis on the analysis of avoidable deaths. Descriptive study of deaths in the city of São Paulo, between 2007 and 2018, registered in the Mortality Information System. Deaths of people aged 5 to 74 years were analyzed, according to "Brazilian List of Causes of Preventable Deaths", according to groups and sex; Pearson's chi-square test was used to compare nationalities. The temporal trend of avoidable deaths was evaluated by Prais-Winsten regression. There were 1.123 Bolivians deaths and 883.116 among Brazilians, with a predominance of male deaths and the Bolivians died on average 13.6 years younger. The proportion of deaths from preventable causes was similar between Bolivians (71.0%) and Brazilians (72.8%) and the trend did not show significant proportional annual variation for both nationalities. There is a higher frequency, among Bolivians, of external causes (27.6%) and of causes reducible by actions to health promotion, prevention, control, and care for infectious diseases (20.8%) than to Brazilians. Conclusion: Bolivians died younger and showed no reduction in the proportion of potentially avoidable causes, which may indicate unequal access to health services.

Objetivou-se analisar a mortalidade dos imigrantes bolivianos residentes no município de São Paulo comparada à dos brasileiros, com ênfase na análise das mortes evitáveis. Estudo descritivo dos óbitos do município de São Paulo entre 2007 e 2018 registrados no Sistema de Informações sobre Mortalidade. Foram analisados os óbitos de pessoas de 5 a 74 anos, conforme a lista de causas de mortes evitáveis por intervenções do Sistema Único de Saúde, segundo grupos e sexo; o teste de qui-quadrado foi utilizado na comparação das nacionalidades. A tendência temporal foi avaliada pela regressão de Prais-Winsten. Houve 1.123 óbitos de bolivianos e 883.116 de brasileiros, com predomínio de óbitos masculinos, com idade média ao morrer menor (-13,6 anos) para bolivianos. A proporção de óbitos por causas evitáveis foi semelhante entre bolivianos (71,0%) e brasileiros (72,8%) e a tendência não apresentou variação anual proporcional significante para ambas as nacionalidades. Para bolivianos, houve maior frequência de causas externas (27,6%) e de causas reduzíveis por ações de promoção, prevenção, controle e atenção às doenças infecciosas (20,8%). Os bolivianos exibiram mortalidade mais jovem, sem redução na proporção de causas evitáveis, o que pode indicar acesso desigual aos serviços de saúde.

Mortalidade de imigrantes bolivianos em São Paulo, Brasil: análise de causas evitáveis / Mortality of Bolivian immigrants in São Paulo, Brazil: analysis of avoidable causes

Resumo Objetivou-se analisar a mortalidade dos imigrantes bolivianos residentes no município de São Paulo comparada à dos brasileiros, com ênfase na análise das mortes evitáveis. Estudo descritivo dos óbitos do município de São Paulo entre 2007 e 2018 registrados no Sistema de Informações sobre Mortalidade. Foram analisados os óbitos de pessoas de 5 a 74 anos, conforme a lista de causas de mortes evitáveis por intervenções do Sistema Único de Saúde, segundo grupos e sexo; o teste de qui-quadrado foi utilizado na comparação das nacionalidades. A tendência temporal foi avaliada pela regressão de Prais-Winsten. Houve 1.123 óbitos de bolivianos e 883.116 de brasileiros, com predomínio de óbitos masculinos, com idade média ao morrer menor (-13,6 anos) para bolivianos. A proporção de óbitos por causas evitáveis foi semelhante entre bolivianos (71,0%) e brasileiros (72,8%) e a tendência não apresentou variação anual proporcional significante para ambas as nacionalidades. Para bolivianos, houve maior frequência de causas externas (27,6%) e de causas reduzíveis por ações de promoção, prevenção, controle e atenção às doenças infecciosas (20,8%). Os bolivianos exibiram mortalidade mais jovem, sem redução na proporção de causas evitáveis, o que pode indicar acesso desigual aos serviços de saúde.

Abstract The objective was to analyze the mortality of Bolivian immigrants compared to the Brazilian population, living in the city of São Paulo, with an emphasis on the analysis of avoidable deaths. Descriptive study of deaths in the city of São Paulo, between 2007 and 2018, registered in the Mortality Information System. Deaths of people aged 5 to 74 years were analyzed, according to "Brazilian List of Causes of Preventable Deaths", according to groups and sex; Pearson's chi-square test was used to compare nationalities. The temporal trend of avoidable deaths was evaluated by Prais-Winsten regression. There were 1.123 Bolivians deaths and 883.116 among Brazilians, with a predominance of male deaths and the Bolivians died on average 13.6 years younger. The proportion of deaths from preventable causes was similar between Bolivians (71.0%) and Brazilians (72.8%) and the trend did not show significant proportional annual variation for both nationalities. There is a higher frequency, among Bolivians, of external causes (27.6%) and of causes reducible by actions to health promotion, prevention, control, and care for infectious diseases (20.8%) than to Brazilians. Conclusion: Bolivians died younger and showed no reduction in the proportion of potentially avoidable causes, which may indicate unequal access to health services.

Mortalidade de imigrantes internacionais no Município de São Paulo, de 2006 a 2015 / Mortality of international immigrants in the city of São Paulo, from 2006 to 2015

Introdução: As mudanças advindas do processo de reestruturação da produção implicam a mobilidade do capital e da população, em diferentes partes do mundo. O processo de migração em busca de melhores condições de vida envolve uma série de eventos que podem ser traumatizantes e podem colocar o migrante em risco. As restrições relacionadas à situação laboral instável e precária, além da dificuldade em obter proteção social, podem influenciar sua saúde. Os custos associados aos cuidados de saúde podem constituir barreiras à utilização dos serviços de saúde. Objetivo: Avaliar a qualidade da informação e o perfil dos óbitos da população de imigrantes no Município de São Paulo, nos anos de 2006 a 2015. Métodos: Foi utilizado o banco de dados do Sistema de Informações sobre Mortalidade - SIM dos anos de 2006 a 2015 e os dados do censo demográfico de 2010. Foi analisada a incompletude das variáveis: sexo, idade, raça/cor, escolaridade, local do óbito, ocupação e médico atestante. A variável naturalidade foi utilizada para separar os óbitos entre imigrantes e brasileiros, além de classificá-los entre ondas migratórias antigas (portugueses, japoneses e italianos) e recentes (argentinos, bolivianos, chilenos, chineses e sul-coreanos). Foram analisados a mortalidade proporcional por sexo, idade e raça/cor e os indicadores de Swaroop & Uemura e Anos Potenciais de Vida Perdidos (APVP). Para mensurar o risco de óbito, foram calculadas as taxas de mortalidade bruta e padronizada por faixa etária, para o ano de 2010. Resultados: Em relação à qualidade do preenchimento da DO, as variáveis sexo, idade, local do óbito e raça/cor foram classificadas como excelentes para imigrantes e brasileiros. A variável médico atestante foi classificada como boa. Escolaridade e ocupação como regulares, com exceção da escolaridade entre os brasileiros, que foi ruim. A única variável que apresentou um crescimento na incompletude foi a médico atestante. Os óbitos de imigrantes somam 6,2% do total de óbitos no período, com maior volume para as ondas mais antigas (62,7%) em comparação com as mais recentes (7,1%). Em todas as nacionalidades estudadas, os óbitos masculinos foram mais frequentes, com destaque para a população chilena (63,6%). Os óbitos de ondas mais antigas apresentaram maior concentração de idosos, principalmente nas faixas etárias mais elevadas. O mesmo não ocorreu com as ondas mais recentes, em que bolivianos tiveram a menor idade média ao morrer (50,3 anos). As três principais causas de morte foram as mesmas, tanto em imigrantes quanto em brasileiros. Para os óbitos masculinos, as causas externas foram a terceira para brasileiros e a quarta para imigrantes, com exceção da população de bolivianos, em que estas foram a primeira causa. Os brasileiros, independente do sexo, apresentaram APVP por óbito maior comparado com os imigrantes; em ambos, a população masculina perdeu mais anos de vida do que a feminina. Conclusão: As ondas mais antigas apresentaram perfil de mortalidade com mais óbitos em idades mais elevadas do que as populações de brasileiros e das ondas mais recentes, com variabilidade entre as nacionalidades que compõem estas últimas, com destaque para a população de bolivianos, que apresentou pior perfil, com óbitos em idades jovens e proporção maior de causas externas do que as demais nacionalidades.

Introduction: Changes arising from the process of restructuring production implies the mobility of capital and population, in different parts of the world. The process of migration in search of better living conditions involves a series of events that may be traumatic and may put the migrant at risk.Restrictions related to unstable and precarious employment situation, as well difficulty in obtaining social protection, can influence their health. Costs associated with health care can be barriers to the use of health services. Objective: To evaluate the quality of information and the death profile of the immigrant population in the city of São Paulo, from 2006 to 2015. Methods: We used the Mortality Information System - SIM database from 2006 to 2015 and the 2010 census data. The incompleteness were analyzed for variables: gender, age, race/ skin color, education, place of death, occupation and certifying physician . The naturalness variable was used to classify deaths among immigrants and nationals and to classify them between old (Portuguese, Japanese and Italian) and recent migratory waves (Argentine, Bolivian, Chilean, Chinese and South Korean). Proportional mortality by gender, age and race/ skin color, and Swaroop & Uemura and Potential Years ol Life Lost (PYLL) indicators were analyzed. To measure the risk of death, crude and standardized mortality rates were calculated by age group for 2010. Results: Regarding the quality of DO's completeness , the variables gender, age, place of death and race/skin color were classified as excellent for immigrants and Brazilians. The certifying physician variable was classified as good, education and occupation as regular, except for education among Brazilians, which was poor.The only one variable that showed an incompleteness growth was the certifying physician. Immigrant deaths accounted for 6.2% of total deaths in the period, with higher volume for older waves (62.7%) compared to more recent ones (7.1%). In all nationalities, male deaths were more frequent, especially the Chilean population (63.6%). Deaths from older waves presented higher concentration of the elderly, especially in the older age groups. The same did not happen with the most recent waves, in which Bolivians had the lowest average age at death (50.3 years). The three main causes of death were the same in both immigrants and Brazilians. For male deaths, external causes were third for Brazilians and fourth for immigrants,except for the Bolivian population, that were the first cause-of-death. Brazilians, regardless of gender, had higher PYLL compared to immigrants; in both, the male population lost more years of life than the female. Conclusion: The oldest migratory waves presented a mortality profile with deaths at older ages than the population of Braziliansand the recent waves, with variability between the nationalities that compose it, especially the Bolivian population with the worst profile, with deaths at a young age and a higher proportion external causes than other nationalities.