Temporal trends in the epidemiology of inflammatory bowel diseases in the public healthcare system in Brazil: A large population-based study.

Background: Population-based data on epidemiology of Inflammatory Bowel Diseases (IBD) in Brazil are scarce. This study aims to define temporal trends of incidence and prevalence rates of Crohn's disease (CD) and ulcerative colitis (UC) in Brazil. Methods: All IBD patients from the public healthcare national system were included from January 2012 to December 2020. Average Annual Percent Change (AAPC) and 95% confidence intervals (CI) were calculated using log-linear regression for incidence and binomial regression for prevalence. Moran's I autocorrelation index was used to analyse clustering of cities by level of prevalence. Findings: A total of 212,026 IBD patients were included. Incidence of IBD rose from 9.4 in 2012 to 9.6 per 100,000 in 2020 (AAPC=0.8%; 95% CI -0.37, 1.99); for UC, incidence increased from 5.7 to 6.9 per 100,000 (AAPC=3.0%; 95% CI 1.51, 4.58) and for CD incidence decreased from 3.7 to 2.7 per 100,000 (AAPC=-3.2%; 95% CI -4.45, -2.02). Prevalence of IBD increased from 30.0 in 2012 to 100.1 per 100,000 in 2020 (AAPC=14.8%; CI 14.78-14.95); for UC, from 15.7 to 56.5 per 100,000 (AAPC=16.0%; CI 15.94, 16.17); for CD from 12.6 to 33.7 per 100,000 (AAPC=12.1% CI 11.95, 12.02). A south-north gradient was observed in 2020 prevalence rates of IBD [I=0.40 (p<0.0001)], CD [I=0.22 (p<0.0001)] and UC [I=0.42 (p<0.0001)]. Interpretation: Incidence of CD is decreasing whereas of UC is increasing, leading to stabilization in the incidence of IBD from 2012 to 2020 in Brazil. Prevalence of IBD has been climbing with 0.1% of Brazilians living with IBD in 2020. Funding: None.

COVID-19 outcomes in patients with inflammatory bowel diseases in Latin America: Results from SECURE-IBD registry.

BACKGROUND AND AIM: One of the most impacted regions by the pandemic globally, Latin America is facing socioeconomic and health-care challenges that can potentially affect disease outcomes. Recent data suggest that inflammatory bowel disease (IBD) patients do not have an increased risk of the development of COVID-19 complications. However, the impact of COVID-19 on IBD patients living in least developed areas remains to be fully elucidated. This study aims to describe the outcomes of IBD patients diagnosed with COVID-19 in countries from Latin America based on data from the SECURE-IBD registry. METHODS: Patients from Latin America enrolled in the SECURE-IBD registry were included. Descriptive analyses were used to summarize clinical and sociodemographic characteristics. The studied outcomes were (i) a composite of need for intensive care unit admission, ventilator use, and/or death (primary outcome) and (ii) a composite of any hospitalization and/or death (secondary outcome). Multivariable regression was used to identify risk factors of severe COVID-19. RESULTS: During the study period, 230 cases (Crohn's disease: n = 115, ulcerative colitis: n = 114, IBD-unclassified [IBD-U]: n = 1) were reported to the SECURE-IBD database from 13 different countries. Primary outcome was observed in 17 (7.4%) patients, and the case fatality rate was 1.7%. In the adjusted multivariable model, the use of systemic corticosteroids (odds ratio [OR] 10.97; 95% confidence interval [CI]: 3.44-34.99) was significantly associated with the primary outcome. Older age (OR 1.03; 95% CI: 1.00-1.05), systemic corticosteroids (OR 9.33; 95% CI: 3.84-22.63), and the concomitant presence of one (OR 2.14; 95% CI: 0.89-5.15) or two (OR 10.67; 95% CI: 1.74-65.72) comorbidities were associated with the outcome of hospitalization or death. CONCLUSION: Inflammatory bowel disease patients with COVID-19 in Latin America appear to have similar outcomes to the overall global data. Risk factors of severe COVID-19 are similar to prior reports.

Where Latin Americans are physically active, and why does it matter? Findings from the IPEN-adult study in Bogota, Colombia; Cuernavaca, Mexico; and Curitiba, Brazil.

Latin America (LA) has a unique structural, political, cultural and social environment. This study aimed to identify the places where Latin American adults are physically active; and to determine the association of using public- and restricted-access places with physical activity (PA). We used data from the International PA Environment Network study in Bogota, Colombia (n=1000, accelerometry=249); Cuernavaca, Mexico (n=677, accelerometry=652); and Curitiba, Brazil (n=697, accelerometry=331) (2010-2011). Walking and moderate-to-vigorous PA for leisure were measured with the International Physical Activity Questionnaire. Overall PA and PA within 10-minute bouts were measured with accelerometers. Participants reported use of public- and restricted-access places for PA. Mixed-effects regression models were used to determine the association of using public- and restricted-access places with PA. The streets were the most frequently-reported place for PA, and walking was the most common PA in the studied places. 'Informal', non-exercise-or-sports places (e.g., shopping malls) ranked high for use for PA in Bogota and Cuernavaca. In Curitiba, use of 'formal' places for sports/exercise (e.g., gyms) was more prevalent. Using public-access places was directly related to walking for leisure in all cities, and to additional PA outcomes in Bogota and Cuernavaca. In Cuernavaca and Curitiba, using restricted-access places was also associated with PA. Our study highlights the importance of public-access places for PA in LA. In some contexts, places for social interaction may be as important for PA as places for exercise/sport. Strategies increasing the availability, accessibility and quality of these places may effectively promote PA in LA.

Intensity-specific leisure-time physical activity and the built environment among Brazilian adults: a best-fit model.

BACKGROUND: There is little understanding about which sets of environmental features could simultaneously predict intensity-specific leisure-time physical activity (LTPA) among Brazilians. The objectives were to identify the environmental correlates for intensity-specific LTPA, and to build the best-fit linear models to predict intensity-specific LTPA among adults of Curitiba, Brazil. METHODS: Cross sectional study in Curitiba, Brazil (2009, n = 1461). The International Physical Activity Questionnaire and Abbreviated Neighborhood Environment Assessment Scale were used. Ninety-two perceived environment variables were categorized in 10 domains. LTPA was classified as walking for leisure (LWLK), moderate-intensity leisure-time PA (MLPA), vigorous-intensity leisure-time PA (VLPA), and moderate-to-vigorous intensity leisure-time PA (MVLPA). Best fitting linear predictive models were built. RESULTS: Forty environmental variables were correlated to at least 1 LTPA outcome. The variability explained by the 4 best-fit models ranged from 17% (MLPA) to 46% (MVLPA). All models contained recreation areas and aesthetics variables; none included residential density predictors. At least 1 neighborhood satisfaction variable was present in each of the intensity-specific models, but not for overall MVLPA. CONCLUSIONS: This study demonstrates the simultaneous effect of sets of perceived environmental features on intensity-specific LTPA among Brazilian adults. The differences found compared with high-income countries suggest caution in generalizing results across settings.

Built environment and physical activity for transportation in adults from Curitiba, Brazil.

The goal of this study was to assess the association between features of the built environment and levels of walking and cycling as forms of transportation in the city of Curitiba, Brazil. Data collection was conducted through a telephone survey in 2008. The International Physical Activity Questionnaire was used to identify walking or cycling as forms of transportation. The built environment characteristics were obtained through the Geographic Information System for 1,206 adults. Density indicators were computed, considering a radius of 500 m around each individual's household. For the accessibility measures, the shortest distance to selected built environment features (e.g., bus stop, bike path) was used. The association between characteristics of the environment and the practice of walking or cycling was assessed through logistic regressions. After considering individual characteristics, higher-income areas (OR = 0.56, 95 % CI = 0.41-0.76), higher density of Bus Rapid Transit stations (OR = 1.50, 95 % CI = 1.22-1.84), and the proportion of residential (OR = 1.25, 95 % CI = 1.02-1.53) and commercial (OR = 1.47, 95 % CI = 1.13-1.91) areas were associated with any walking prevalence (≥ 10 min/week). Higher access to bike paths (OR = 0.80, 95 % CI = 0.64-1.00) was inversely associated with walking at recommended levels (≥ 150 min/week). Higher-income areas (OR = 0.26, 95 % CI = 0.08-0.81), greater number of traffic lights (OR = 0.27, 95 % CI = 0.09-0.88), and higher land use mix (OR = 0.52, 95 % CI = 0.31-0.88) were inversely associated with cycling. The neighborhood built environment may affect active commuting among adults living in urban centers in middle-income countries.

Personal, social and environmental correlates of physical activity in adults from Curitiba, Brazil.

BACKGROUND: Leisure-time physical activity is a complex behavior influenced by factors at multiple levels. OBJECTIVE: To examine the associations between intrapersonal, interpersonal, environmental factors and leisure-time walking (LTW) and leisure-time physical activities (LTPA), excluding walking. We also examined the moderating effect of sociodemographic characteristics on these associations. METHODS: A cross-sectional study was conducted with 1461 adults from Curitiba, Brazil (63.7% women). LTW and LTPA were assessed through the International Physical Activity Questionnaire (IPAQ), and a cutoff point of ≥ 150 min/week was used. Associations were examined through multilevel logistic regressions. RESULTS: LTW was positively associated with self-efficacy, enjoyment, social support from family and friends, presence of public places for leisure and neighborhood esthetics. LTPA was associated with self-efficacy, enjoyment, social support from family and friends, safety from crime and neighborhood esthetics. Safety from crime was a predictor of LTPA among older adults only. CONCLUSIONS: Factors at multiple levels were associated with LTW and LTPA. Interventions to promote LTPA would likely benefit from considering personal, social and environmental factors and different levels of influence.

Bicycling and walking for transportation in three Brazilian cities.

BACKGROUND: Physical inactivity plays a role in the acquisition of heart disease, type 2 diabetes, and breast and colon cancer. The impact of such noncommunicable diseases on low- and middle-income countries is a major global health concern, but most studies in this area have focused on high-income countries. A better understanding of the factors that may influence physical activity in low- and middle-income countries is needed. PURPOSE: This study describes the prevalence of cycling and walking for transportation and their association with personal and environmental factors in adults from three state capitals in Brazil. METHODS: In 2007-2009, a random-digit-dialing telephone survey was conducted with residents (aged ≥18 years) of Curitiba, Vitoria, and Recife, sampled through a clustered multistage sampling process. Walking and cycling for transportation, perception of the environment related to physical activity, and demographic and health characteristics were collected. Poisson regression was used to examine associations between cycling and walking for transportation with covariates stratified by cities. All analyses were conducted in 2011. RESULTS: The prevalence of bicycling for transportation was 13.4%; higher in Recife (16.0%; 95% CI=13.7, 18.4) compared to Curitiba (9.6%; 95% CI=7.8, 11.4) and Vitoria (8.8%; 95% CI=7.34, 10.1); and 26.6% for walking regularly as a mode of transportation. The adjusted analysis showed that cycling is positively associated with being male (prevalence OR [pOR]=3.4; 95% CI=2.6, 18.4) and younger (pOR=2.9; 95% CI=1.8, 4.9) and inversely associated with having a college degree (pOR=0.3; 95% CI=0.2, 0.4). Walking for transportation is inversely associated with having a college degree (pOR=0.6; 95% CI=0.5, 0.8). No strong evidence of association was found of environmental indicators with walking or bicycling. CONCLUSIONS: The prevalence of active commuting was low and varied by city. Personal factors were more consistently associated with bicycling than with walking, whereas perceived environmental features were not related to active commuting.

Walking for leisure among adults from three Brazilian cities and its association with perceived environment attributes and personal factors.

BACKGROUND: Walking is a popular form of physical activity and a convenient option to prevent chronic diseases. However, most of the evidence on this topic derives from high-income countries and little is known about walking patterns and its association with environmental features in low and middle income countries. OBJECTIVES: To describe walking for leisure and to identify its association with perceived environment and personal factors among residents of three state capitals from different regions of Brazil METHODS: Cross sectional phone surveys were conducted in Recife, Curitiba and Vitória (n = 6,166) in 2007, 2008 and 2009 respectively. Physical activity was measured using the leisure-time sections of the long version of the International Physical Activity Questionnaire (IPAQ). Perceived environment characteristics were assessed using a modified version of the Neighborhood Environment Walkability Scale (NEWS). Multivariable analysis tested the associations between walking for leisure and perceived environment characteristics across the cities using logistic regression. RESULTS: The proportions of respondents meeting physical activity recommendations through walking for leisure were 9.6%, 16.0% and 8.8% in Curitiba, Recife and Vitoria, respectively. Engaging in 150 min/wk or more of walking for leisure was significantly associated with younger age, higher education, better self-rated health and with lack of sidewalks on nearby streets. We did not find positive associations between walking for leisure and traffic conditions and safety related to cycling/walking during the day or night. CONCLUSION: Most environmental features were not associated with walking for leisure. Personal factors were stronger predictors of walking for leisure as compared with perceived environment factors.

The built environment and recreational physical activity among adults in Curitiba, Brazil.

OBJECTIVE: To examine the relationship between objective measures of the built environment (BE) and recreational physical activity (PA) in adults from Curitiba, Brazil. METHOD: A phone survey was carried among a random sample of 1206 people. Walking during leisure time (WLT) and moderate and vigorous recreational PA (MVPA) was measured using IPAQ. Characteristics of the BE were determined in an area of 500 m surrounding respondent's homes. Multivariate logistic regression analysis was used to estimate the associations between recreational PA and BE. RESULTS: After adjusting for confounders, WLT was associated with area income level US$971.45-3341.64 vs. US$167.05-461.06 (25.7% vs. 11.1% POR=2.5; 95% CI=1.5-4.4), having ≥ 2 gyms vs. none (26.1% vs. 12.7%, POR=1.9; 95% CI=1.2-3.0) and distance to recreation centers, 1769.1-2835.5 km vs. 2835.6-10,212.3 km (22.1% vs. 11.0%, POR=2.3; 95% CI=(1.0-2.5). MVPA was associated with neighborhood income US$971.45-3341.64 vs. US$167.05-461.06 (47.6% vs. 22.0% POR=3.0; 95% CI=1.5-5.9) and having ≥ 2 gyms vs. none (41.7% vs. 26.0%, POR=1.5; 95% CI=1.11-2.1). CONCLUSION: The presence of some recreational facilities for PA was associated with recommended levels of PA during leisure time in Curitiba, Brazil.