Mortality from asthma in the state of S. Paulo, Brazil (1970-1992).

Mortality from asthma has shown important variations over time in several countries. In Brazil, a mortality study performed in the 60s, covering the cities of S. Paulo and Ribeirão Preto, and other ten cities showed that S. Paulo presented the lowest death rate from asthma among of them all. It was decided to study the time trends of deaths from asthma and from the whole set of respiratory diseases from 1970 to 1992, in the population aged 15-34 yrs. old in the State of S. Paulo, as well as to compare them with those of other countries. Asthma mortality rates during the 23 years of observation since 1975, showed an oscillatory declining pattern with a peak of deaths in the initial years. The linearization of the curve allows the calculation of Pearson's correlation coefficient that was significantly negative, suggesting a decline in the mortality over this period, mainly in the 5-9 yrs. old and 30-34 yrs. old strata. The segmentation of data between the period of ICD-9, 1970 to 1978, and of ICD-9, 1979 and subsequent years, shows that there is stability within each period, in all age-groups, except for that of 5-9 yr. olds between 1970-1978. Comparing the rates of the population aged 15-34 yrs. old for the State of S. Paulo, Brazil, with trends observed in 14 other countries, an intermediate pattern for the first triennial period (1970-1972) as well as for the subsequent triennial periods, emerges. A prevalence study of asthma, a follow up program meant for using emergency rooms and a surveillance of deaths due to all respiratory diseases and specifically to asthma are strongly recommended.

[Mortality trends due to myocardial ischemia in capital cities of the metropolitan areas of Brazil, 1979-89]. / Tendência da mortalidade por doença isquêmica do coração nas capitais de regiões metropolitanas do Brasil, 1979-89.

PURPOSE: To study the trends of mortality rates from cardiovascular diseases (CVD) and coronary heart disease (CHD) in eight capitals of Brazil. METHODS: Death rates for these cities were studied in men (M) and female (F), standardized using the population of São Paulo, SP, 1980. Rates were calculated for CVD (ICD-9: 390-459) and CHD (ICD-9:410-414). The cities were Belém, Recife, Salvador, Belo Horizonte, Rio de Janeiro, São Paulo, Curitiba and Porto Alegre. Using simple linear regression, we obtained the annual difference in rates with a confidence interval of 95%. RESULTS: For CVD a decline was detected of -2.6% (M) and -2.69% (F) in Belém; in Salvador, -1.53% (M) and -1.70% (F) and in São Paulo, -1.27% (M) and -1% (F) and for F in Belo Horizonte (-0.82%) and in Curitiba (-1.52%). Recife, Porto Alegre and Curitiba (M) showed stability during the period. There was a rise of the rates in Rio de Janeiro +1.37% (M) and +0.84% (F) and for M in Belo Hozironte (1%). The rates for CHD showed a decline in Belém-2.64% (M) and -2.74% (F); São Paulo, -1.4% (M) and -1.06% (F) and for F in Belo Horizonte. A stable trend was detected in Salvador, Curitiba, Porto Alegre and for M in Belo Horizonte. There was a rise in the rates of Recife +3.5% (M) and +4.4% (F) and in Rio de Janeiro +2.34% (M) and +2.53% (F). CONCLUSION: The magnitude of death rates and of the time trends showed in this paper reveal important regional differences. Questions related to the different assignment of diagnosis in the chapter of CVD could explain some of the observed trends. However, the rise of mortality rates in Rio de Janeiro could hardly be explained by classificatory matters. Tobacco, diet and medical care could explain the rise of mortality from CVD and CHD in Rio de Janeiro.

[Smoking and mortality fro ischemic heart disease. Comparative study in capitals of Brazilian metropolitan regions, 1988]. / Tabagismo e mortalidade por doença isquêmica do coração. Estudo comparativo das capitais de regiões metropolitanas do Brasil, 1988.

PURPOSE: An ecological study was performed to test the association between coronary heart disease (CHD) mortality and smoking in Brazil. Lung cancer mortality was used as a surrogate for smoking habit. METHODS: The mortality rate for CHD (ICD-9:410-414) and lung cancer (ICD-9: 162) were determined in the following metropolitan areas: Belém, Recife, Salvador, Belo Horizonte, Rio de Janeiro, São Paulo, Curitiba and Porto Alegre for males and females between 30 and 69 year old. ANOVA test was used to compare both age-adjusted mortality rates. RESULTS: A positive association by ANOVA was determined only for males ages 60-69 and to age-adjusted rates. CONCLUSION: The relationship between smoking and CHD mortality as determined in Brazilian cities, among men, mainly in the older ages, is a proof that tobacco control would contribute to downward trends in CHD mortality rates.

[Trends of peptic ulcer mortality in São Paulo State (Brazil), 1970-1989]. / Tendência da mortalidade por úlcera péptica no Estado de São Paulo (Brasil), 1970-1989.

BACKGROUND: Trends of peptic ulcer mortality rates were studied in São Paulo State (Brazil) among 1970 and 1989. MATERIAL: Deaths from PU, ICD-9 531-534. RESULTS: The PU rates in São Paulo are comparable with those in Europe and rank second place for males and in third place for females. During this period there was a downward trend either for males or females. CONCLUSIONS: For women, the decline was less impressive and the male/female ratio decreased. A cohort effect was suspected for the explanation of female mortality trends.

[Trends of mortality from cerebrovascular disease in the State of São Paulo: 1970 to 1989]. / Tendéncia da mortalidade por doença cerebrovascular no Estado de São Paulo: 1970 a 1989.

AIM: description of proportional mortality and death rates by Stroke in adult population (20 years of age or older) of São Paulo State, Brazil. METHODS: the deaths were obtained from the statistical official bureau; the population data were based in the Federal Census (1970, 1980 and 1991); all trends whose the slope was significantly greater than zero had a calculation of the decline per year. RESULTS: proportional mortality for Stroke decreased for males (M) (-11.40%) and increased for females (F) (+7.58%); Stroke in all cardiovascular diseases showed increase in both sexes, +8.65% (M) and +3.12% (F); Stroke age-adjusted death rates declined 1.19% (M) per year and 1.76% (F) per year between 1970 and 1989; the ages whose decline was more important were those 60-years-old of age or older (M) and 40-years-old or older (F); the male/female sex ratio increased during the observed years (22% in 1970 to 45%) due to the change in the 50-59 age strata (36% in 1970 to 69% in 1989). CONCLUSION: the fall of the Stroke deaths rates could be due to increase in the detection and control of hypertension; other factors such as improve in death certification, decline of Chagasic myocarditis, new image-diagnostic tests and medical care had maybe only a secondary play in the decline of stroke mortality.

[Arterial hypertension and possible risk factors]. / Hipertensão arterial e possíveis fatores de risco.

The results of a cross-sectional (prevalence) study of high blood pressure, carried out in 1987 in Araraquara County in the north of S. Paulo State, Brazil are presented. The group studies numbered 1,199 people, including 533 men and 666 women, of from 15 to 74 years of age. The results show a high prevalence of the disease (32.0% for men and 25.3% for women), with a tendency to increase with age, up to the 40's (men) and the 50's (women). There was also a greater percentage of hypertensives in the mulatto and black groups, in the obese, and among those of lower family income, with a lower level of schooling and with less well remunerated jobs. However, the logistic regression showed very small odds ratios associated with these risk factors, which could be attributed to the way these factors were considered.

[Mortality trends in ischemic heart disease in São Paulo State: 1970-1989]. / Tendência da mortalidade por doença isquêmica do coração no estado de São Paulo: 1970 a 1989.

PURPOSE: Description of proportional mortality and deaths rates by coronary heart disease (CHD) in adult population (20 years of age or older) of São Paulo State, Brazil. METHODS: The deaths were obtained from the statistical official bureau. The population data were based in the Federal Census (1970, 1980 and 1991). All trends whose the slope was significantly greater than zero had a calculation of the decline per year. RESULTS: Proportional mortality for CHD decreased for males(M) (-13.83%) and increased for females(F) (+1.93%). CHD in all cardiovascular diseases showed increase in both sexes: +5.70% M and +13.74% F. CHD adjusted-age death rates declined 1.16% M per year and 1.52% F per year among 1970 and 1989. during 1970-79 a non-significant decline was observed. The ages whose decline was more important were those 60-years-old of age or older. The male/female sex ratio increased during the observed years (67% in 1970 to 77%) due to the change in the 60-69 age (76% in 1970 to 101% in 1989). CONCLUSION: The fall of the CHD deaths rates may be due to decline of heart attacks, to change in risk factors prevalence, mainly smoking, and to medical care.

[Smoking prevalence in the urban locality of southeastern Brazil]. / Prevalência de tabagismo em localidade urbana da região sudeste do Brasil.

A cross-sectional study for prevalence of arterial hypertension in the population aged 15-74 years of age of the urban area of Araraquara County, 250 km from the city of S. Paulo, S. Paulo, State, Brazil, in 1987, was performed. The questionnaires presented to 1,199 people (533 men and 666 women) at the interview consisted of regarding sociodemographic variables, as well as the use of tobacco (smoking), the ways in which tobacco was used and the habit of inhaling the smoke. The sample was taken by the procedure of clustering, carried out in three stages. The sample was equiprobabilistic. The prevalence of tobacco smoking was very high being of 45.2% for men and 22.8% for women. The ex-smokers accounted for 15.9% of men and 8.0% of women. The men smoked much more than the women. The poorer smoked more than the richer, in both sexes. Among men, the prevalence of smoking was inversely proportional to duration of schooling, but that difference was not noted in women. As there have been other studies regarding the high prevalence of obesity and high blood pressure, it was concluded therefore that the population of Araraquara, an average town of the affluent urban interior of S. Paulo State, has a high frequency of risk factors for chronic non-transmissible diseases.

Geographical patterns of proportionate mortality for the most common causes of death in Brazil.

Mortality due to chronic diseases has been increasing in all regions of Brazil with corresponding decreases in mortality from infectious diseases. The geographical variation in proportionate mortality for chronic diseases for 17 Brazilian state capitals for the year 1985 and their association with socio-economic variables and infectious disease was studied. Calculations were made of correlation coefficients of proportionate mortality for adults of 30 years or above due to ischaemic heart disease, stroke and cancer of the lung, the breast and stomach with 3 socio-economic variables, race, and mortality due to infectious disease. Linear regression analysis included as independent variables the % of illiteracy, % of whites, % of houses with piped water, mean income, age group, sex, and % of deaths caused by infectious disease. The dependent variables were the % of deaths due to each one of the chronic diseases studied by age-sex group. Chronic diseases were an important cause of death in all regions of Brazil. Ischaemic heart diseases, stroke and malignant neoplasms accounted for more than 34% of the mortality in each of the 17 capitals studied. Proportionate cause-specific mortality varied markedly among state capitals. Ranges were 6.3-19.5% for ischaemic heart diseases, 8.3-25.4% for stroke, 2.3-10.4% for infections and 12.2-21.5% for malignant neoplasm. Infectious disease mortality had the highest (p < 0.001) correlation with all the four socio-economic variables studied and ischaemic heart disease showed the second highest correlation (p < 0.05). Higher socio-economic level was related to a lower % of infectious diseases and a higher % of ischaemic heart diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of multiple sclerosis in the city of São Paulo, Brazil, in 1990.

A case register of multiple sclerosis (MS) was set up in the city of São Paulo, Brazil, situated at a latitude of 23-24 degrees south. Cases were notified by neurologists, neuroradiologists and by an association of patients with MS. Prevalence rate was 4.27 x 10(-5) (men: 2.89 x 10(-5); women: 5.59 x 10(-5)), with a preponderance of young adults. We discuss here whether these rates are artifact due to poor health care facilities, to poor notification and deficiencies in diagnosis, or whether these rates are really low.

[Multiple causes of death in diabetics in the municipality of Recife, 1987]. / Causas múltiplas de morte em diabéticos no Município de Recife, 1987.

In 1987, diabetes mellitus was mentioned in 492 death certificates of the population of the city of Recife, Brazil, 202 of them for males and 290 for females. Diabetes mellitus was the underlying cause of death according to 80 certificates for men and 290 for women, as a result of which premature death occurred in 16.2% of men and 11.1% of women. Multiple cause of death analysis showed that cardiovascular diseases were the most frequent underlying cause of death in individuals over 50 years of age and acute complications of diabetes mellitus in individuals under 50. Cerebrovascular diseases were the most frequent in the cardiovascular group, particularly in females. Arterial hypertension was the most frequent associated cause of death appearing in death certificates mentioning diabetes mellitus (not as the underlying cause of death), also more often in females. The acute complications of diabetes mellitus (keto-acidosis and coma) and peripheral circulatory disorders peculiar to this disease caused 23% and 30% of the deaths, respectively, in cases where diabetes mellitus was the underlying cause. Infectious and parasitic diseases were the most frequent associated causes of death according to those certificates which gave diabetes mellitus as the underlying cause.

[Prevalence of obesity in a locality of the State of São Paulo, Brazil, 1987]. / Prevalência de obesidade em localidade do Estado de São Paulo, Brasil, 1987.

The prevalence of obesity in Araraquara, a county of 150,000 inhabitants situated 250 km from S. Paulo, Brazil was studied. The study population, of 18-74 yrs. of age, resident in the urban area in 1987, was composed of 1,126 inhabitants, 502 males and 624 females, selected through a cluster equiprobabilistic sampling process. The prevalence of overweight (Quetelet 25-29.9 Kg/m2) was 26.9% for males and 27.7% for females. The prevalence of obesity (Quetelet equal or greater than 30.0 kg/m2) was 10.2% for males and 14.7% for females. These percentages are high when compared with those of affluent Anglo-saxon countries. The reasons for this phenomenon are discussed in the light of the fact that the economy of the city is affluent and is dependent on agroindustrial activities. When own cut-off criteria (P85 and P95 for Quetelet for 20-29 yrs of age, for each sex) are calculated, the "lean pattern" for Araraquara County is leaner than that for the a United States population. This raises doubts as to the possibility of applying cut-off criteria of particular regions to regions of different characteristics.

[Mortality of women in reproductive age in the municipality of São Paulo (Brazil), 1986. III--Death by different causes: cardiovascular diseases]. / Mortalidade de mulheres em idade fértil no Município de São Paulo (Brasil), 1986. III--Mortes por diferentes causas: doenças cardiovasculares.

Further to a research project into the accuracy of death given on the causes of death given on the death certificates of women of fertile age (10-49), resident in the City of S. Paulo, SP, Brazil, in 1986, the main causes of death for the population according to age, with remarks on the mortality from cardiovascular diseases (CVD), malignant neoplasms and external causes are presented. The CVD were responsible for 23.6% of all deaths in this age group, strokes occupying the position of greatest importance (51.1% of all CVD deaths) and coronary heart disease coming second (18.2% of all CVD deaths, the greater number of them being due to acute myocardial infarction). Comparing these results with those of a similar research project undertaken in the 60s, in the same place and using the same methodology, a decline of mortality from chronic rheumatic disease of the heart is to be noted, as also a rise in the mortality from stroke and coronary heart disease, but with a global reduction in age-adjusted rates for CVD overall. There was also a great number of references to arterial hypertension both combined with stroke (78.3% of all deaths due to this cause were of hypertensives) and with coronary heart disease (where this proportion was of 63.4%). The importance of the supposedly high prevalence of high blood pressure in the fertile female population and the indiscriminate use of oral contraceptives are discussed.

[Mortality among women in reproductive age in the municipality of São Paulo, Brazil, 1986. II. Deaths by maternal causes]. / Mortalidade de mulheres em idade fértil no município de São Paulo (Brasil), 1986 II--Mortes por causas maternas.

In continuation to the research project on the accuracy of the certification of the underlying causes of death in women of child-bearing age (10-49), resident in the Municipality of S. Paulo, Brazil, in 1986, "original" death certificates were compared with "revised" death certificates (including additional information). The maternal mortality rate rose from 44.5 per 100,000 live births (l.b.) to 99.6 per 100,000 l.b., a high rate when compared with that of other places. When these data were compared with those of previous, similar investigations in the same city, the maternal mortality rate rose in the period 1962/4 through 1972/4 and fell in 1986. The main causes of death were: hypertension complicating pregnancy, other conditions of the mother which complicated pregnancy and puerperal complications. The need to extend the 42-day period related to the concept of maternal death, as well as the relationship between the non-maternal conditions (cancer, violence) and the gravidic-puerperal cycle are discussed.

[Adolescent mortality in Brazil, 1977, 1980 and 1985. Magnitude and tendencies]. / Mortalidade de adolescentes no Brasil, 1977, 1980 e 1985. Magnitude e tendências.

Mortality among adolescents (10-19 yrs. of age), resident in 9 states of Brazil in 1977, 1980 and 1985, was analysed according to age (10-14 and 15-19 yrs. of age), sex (male, female) and underlying cause of death. The mortality was greater among males aged 15-19. External causes were responsible for the great mortality in all strata, mainly in the metropolitan regions of the urban southeast, rising throughout the period in these regions. The chronic diseases (cancer and cardiovascular diseases) were also frequent as the underlying cause of death in adolescents; though in much lesser proportion than the non-natural causes.

[Prevalence of arterial hypertension in Araraquara, Brazil]. / Prevalência da hipertensão arterial em Araraquara.

PURPOSE: To study the prevalence of high blood pressure (HBP) in Araraquara, São Paulo, Brazil. PATIENTS AND METHODS: Cross sectional study: cluster equiprobabilistic sampling of 1.8% of the urban population aged 15-74 years, old (1.199 adults: 533 men and 66 women). For each subject, an interview was performed, with the fulfilling of a questionnaire; measures of blood pressure (BP, systolic and 2nd diastolic) as well as height and weight were taken. Criteria of definition for HBP were those of WHO (greater than or equal to 160/95). RESULTS: Systolic BP (mean +/- standard error) for men 137.6 +/- 0.8 mmHg, and for women 130.9 +/- 1.0 mmHg. Second diastolic BP for men 88.5 +/- 0.5 mmHg and for women 84.0 +/- 0.6 mmHg. Prevalence of definite HBP: 32.0% of men and 25.3% women (28.3% both sexes). Prevalence of borderline HBP; 18.7% of men and 12.0% of women (14.8% for both sexes). The greater part of hypertensives (68.3%) was of mild cases (less than 105 mmHg the second diastolic BP). CONCLUSION: It is the highest prevalence of HBP in Brazil described till now, and, therefore, an important public health problem.

[Treatment of hypertension and the decline of mortality caused by cerebrovascular accidents]. / Tratamento da hipertensão e declínio da mortalidade por acidentes vasculares cerebrais.

A possible cause-effect relationship between the decline of mortality from cerebrovascular accidents (CVA) and a better control of arterial hypertension is discussed. The international literature on the subject is critically reviewed in the light of the possible statistical artifacts for enumeration of CVAs, the incidence and fatality of the disease, the prevalence of other risk factors such as hypercholesterolemia, smoking, and the consumption of sodium, potassium and alcohol, and obesity, as well as the contribution of health care.

[Mortality of women in reproductive age in the municipality of São Paulo (Brazil), 1986. I. Methodology and general results]. / Mortalidade de mulheres em idade fértil no município de São Paulo (Brasil), 1986. I--Metodologia e resultados gerais.

The purpose of this study was to evaluate the accuracy of the death certificates of a sample of a quarter of all deaths in women of reproductive age (10-49 years) resident in the Municipality of S. Paulo, SP, Brazil, in 1986. For each death, further data were gathered by means of household interviews and from medical records and autopsy information where available. Nine hundred and fifty-three deaths were analysed, for whom there were good quality death certificates except with regard to maternal deaths an terminal respiratory diseases, the former being greatly under-reported. The official maternal mortality rate was 44.5 per 100,000 live births but the true rate was 99.6 per 100,000 live births. The three main causes of death were cardiovascular diseases, neoplasms and external causes. A great proportion of smokers was found among the deceased women (40.4%). Eleven percent of the deceased consumed large amounts of alcoholic beverages regularly.