Browsing by Author "Brant, Luisa Campos Caldeira"

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    Burden of disease attributable to risk factors in Brazil : an analysis of national and subnational estimates from the 2019 Global Burden of Disease study.
    (2022) Malta, Deborah Carvalho; Mendes, Mariana Santos Felisbino; Machado, Ísis Eloah; Veloso, Guilherme Augusto; Gomes, Crizian Saar; Brant, Luisa Campos Caldeira; Ribeiro, Antônio Luiz Pinho; Oliveira, Patrícia Pereira Vasconcelos de; Flor, Luisa Sorio; Gakidou, Emmanuela
    Introduction: Monitoring trends in risk factors (RFs) and the burden of diseases attributable to exposure to RFs is an important measure to identify public health advances and current inadequate efforts. Objective: Analyze the global burden of disease attributable to exposure RFs in Brazil, and its changes from 1990 to 2019, according to the sex and age group. Methods: This study used data from the Global Burden of Disease study. The Summary Exposure Value, which represents weighted prevalence by risk, was used to estimate exposure to RFs. The mortality and DALYs (Disability Adjusted Life Years) measurements were used to estimate the burden of diseases. For comparisons by year and between Brazilian states, age-standardized rates were used. Results: Arterial hypertension was the factor responsible for most deaths in both sexes. For DALYs, the most important RF was the high body mass index (BMI) for women and alcohol consumption for men. Smoking had a substantial reduction in the attributable burden of deaths in the period. An important reduction was identified in the exposure to RFs related to socioeconomic development, such as unsafe water, lack of sanitation, and child malnutrition. Metabolic RFs, such as high BMI, hypertension, and alcohol consumption showed an increase in the attributable burden. Conclusions: Our findings point to an increase in metabolic RFs, which are the main RFs for mortality and DALYs. These results can help to consolidate and strengthen public policies that promote healthy lifestyles, thus reducing disease and death.
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    Cardiovascular mortality during the COVID-19 pandemics in a large Brazilian city : a comprehensive analysis.
    (2022) Brant, Luisa Campos Caldeira; Pinheiro, Pedro Cisalpino; Ribeiro, Antônio Luiz Pinho; Machado, Ísis Eloah; Correa, Paulo Roberto Lopes; Santos, Mayara Rocha dos; Souza, Maria de Fátima Marinho de; Malta, Deborah Carvalho; Passos, Valéria Maria de Azeredo
    Introduction: The impact of COVID-19 pandemics on cardiovascular diseases (CVD) may be caused by health system reorganization and/or collapse, or from changes in the behaviour of individuals. In Brazil, municipalities were empowered to define regulatory measures, potentially resulting in diverse effects on CVD morbimortality. Objective: To analyse the impact of COVID-19 pandemics on CVD outcomes in Belo Horizonte (BH), the sixth greater capital city in Brazil, including: mortality, mortality at home, hospitalizations, intensive care unit utilization, and in-hospital mortality; and the differential effect according to sex, age range, social vulnerability, and pandemic’s phase. Methods: Ecological study analysing data from the Mortality and Hospital Information System of BH residents aged ≥30 years. CVD was defined as in Chapter IX from ICD- 10. Social vulnerability was classified by a composite socioeconomic index as high, medium and low. The observed age-standardized rates for epidemiological weeks 10–48, 2020, were compared to the expected rates (mean of 2015–2019). Risk ratios (RiR) were analysed and 95% confidence intervals were calculated for all estimates. Population projected to 2020 for BH and its census tracts were used to calculate rates. Results: We found no changes in CVD mortality rates (RiR 1.01, 95%CI 0.96–1.06). However, CVD deaths occurred more at homes (RiR 1.32, 95%CI 1.20–1.46) than in hospitals (RiR 0.89, 95%CI 0.79–0.99), as a result of a substantial decline in hospitalization rates, even though proportional in-hospital deaths increased. The rise in home deaths was greater in older adults and in had an increasing gradient in those more socially vulnerable (RiR 1.45); for high (RiR 1.45), medium (RiR 1.32) and low vulnerability (RiR 1.21). Conclusion: The greater occurrence of CVD deaths at home, in parallel with lower hospitalization rates, suggests that CVD care was disrupted during the COVID-19 pandemics, which more adversely affected older and more socially vulnerable individuals, exacerbating health inequities in BH.
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    Maior mortalidade durante a pandemia de COVID-19 em áreas socialmente vulneráveis em Belo Horizonte : implicações para a priorização da vacinação.
    (2021) Passos, Valéria Maria de Azeredo; Brant, Luisa Campos Caldeira; Pinheiro, Pedro Cisalpino; Correa, Paulo Roberto Lopes; Machado, Ísis Eloah; Santos, Mayara Rocha dos; Ribeiro, Antônio Luiz Pinho; Paixão, Lucia Maria Miana; Pimenta Junior, Fabiano Geraldo; Souza, Maria de Fátima Marinho de; Malta, Deborah Carvalho
    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.
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    The impact of COVID-19 pandemic course in the number and severity of hospitalizations for other natural causes in a large urban center in Brazil.
    (2021) Brant, Luisa Campos Caldeira; Pinheiro, Pedro Cisalpino; Machado, Ísis Eloah; Correa, Paulo Roberto Lopes; Santos, Mayara Rocha dos; Ribeiro, Antônio Luiz Pinho; Tupinambás, Unaí; Santiago, Christine Ferretti; Souza, Maria de Fátima Marinho de; Malta, Deborah Carvalho; Passos, Valéria Maria de Azeredo
    The COVID-19 pandemic may indirectly impact hospitalizations for other natural causes. Belo Horizonte is a city with 2.5 million inhabitants in Brazil, one of the most hardly-hit coun- tries by the pandemic, where local authorities monitored hospitalizations daily to guide regu- latory measures. In an ecological, time-series study, we investigated how the pandemic impacted the number and severity of public hospitalizations by other natural causes in the city, during 2020. We assessed the number and proportion of intensive care unit (ICU) admissions and in-hospital deaths for all-natural causes, COVID-19, non-COVID-19 natural causes, and four disease groups: infectious, respiratory, cardiovascular, and neoplasms. Observed data from epidemiological week (EW) 9 (first diagnosis of COVID-19) to EW 48, 2020, was compared to the mean for the same EW of 2015–2019 and differences were tested by Wilcoxon rank-sum test. The five-week moving averages of the studied variables in 2020 were compared to that of 2015–2019 to describe the influence of regulatory mea- sures on the indicators. During the studied period, there was 54,722 hospitalizations by non- COVID-19 natural causes, representing a 28% decline compared to the previous five years (p<0.001). There was a concurrent significant increase in the proportion of ICU admissions and deaths. The greater reductions were simultaneous to the first social distancing decree or occurred in the peak of COVID-19 hospitalizations, suggesting different drivers. Hospitali- zations by specific causes decreased significantly, with greater increase in ICU admissions and deaths for infectious, cardiovascular, and respiratory diseases than for neoplasms. While the first reduction may have resulted from avoidance of contact with healthcare facili- ties, the second reduction may represent competing causes for hospital beds with COVID- 19 after reopening of activities. Health policies must include protocols to address hospitali- zations by other causes during this or future pandemics, and a plan to face the rebound effect for elective deferred procedures.
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    Trends in mortality due to non- communicable diseases in the Brazilian adult population : national and subnational estimates and projections for 2030.
    (2020) Malta, Deborah Carvalho; Duncan, Bruce Bartholow; Schmidt, Maria Inês; Teixeira, Renato; Ribeiro, Antônio Luiz Pinho; Mendes, Mariana Santos Felisbino; Machado, Ísis Eloah; Velásquez Meléndez, Jorge Gustavo; Brant, Luisa Campos Caldeira; Silva, Diego Augusto Santos; Passos, Valéria Maria de Azeredo; Nascimento, Bruno Ramos; Cousin, Ewerton; Glenn, Scott; Naghavi, Mohsen
    Background: Monitoring and reducing premature mortality due to non-communicable diseases (NCDs) is a global priority of Agenda 2030. This study aimed to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and to project those for 2030 as well as the risk factors (RFs) attributed deaths according to estimates of the Global Burden of Disease Study. Methods: We analyzed cardiovascular diseases, chronic respiratory diseases, neoplasms, and diabetes, and compared the mortality rates in 1990 and 2017 for all of Brazil and states. The study used the definition of premature mortality (30–69 years) that is used by the World Health Organization. The number of deaths, mortality rates, DALYs, and years of life lost (YLL) were used to compare 1990 and 2017. We analyzed the YLL for NCDs attributable to RFs. Results: There was a reduction of 35.3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCDs in 2017. The DALY rate decreased by 33.6%, and the YLL rate decreased by 36.0%. There were reductions in NCDs rates in all 27 states. The main RFs related to premature deaths by NCDs in 2017 among women were high body mass index (BMI), dietary risks, high systolic blood pressure, and among men, dietary risks, high systolic blood pressure, tobacco, and high BMI. Trends in mortality rates due to NCDs declined during the study period; however, after 2015, the curve reversed, and rates fluctuated and tended to increase. Conclusion: Our findings highlighted a decline in premature mortality rates from NCDs nationwide and in all states. There was a greater reduction in deaths from cardiovascular diseases, followed by respiratory diseases, and we observed a minor reduction for those from diabetes and neoplasms. The observed fluctuations in mortality rates over the last 3 years indicate that if no further action is taken, we may not achieve the NCD Sustainable Development Goals. These findings draw attention to the consequences of austerity measures in a socially unequal setting with great regional disparities in which the majority of the population is dependent on state social policies.
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    Trends in prevalence and mortality burden attributable to smoking, Brazil and federated units, 1990 and 2017.
    (2020) Malta, Deborah Carvalho; Flor, Luisa Sorio; Machado, Ísis Eloah; Mendes, Mariana Santos Felisbino; Brant, Luisa Campos Caldeira; Ribeiro, Antônio Luiz Pinho; Teixeira, Renato Azeredo; Macário, Eduardo Marques; Reitsma, Marissa Bettay; Glenn, Scott; Naghavi, Mohsen; Gakidou, Emmanuela
    Background: The present study sought to analyze smoking prevalence and smoking-attributable mortality estimates produced by the 2017 Global Burden of Disease Study for Brazil, 26 states, and the Federal District. Methods: Prevalence of current smokers from 1990 to 2017 by sex and age was estimated using spatiotemporal Gaussian process regression. Population-attributable fractions were calculated for different risk-outcome pairs to generate estimates of smoking-attributable mortality. A cohort analysis of smoking prevalence by birth-year cohort was performed to better understand temporal age patterns in smoking. Smoking-attributable mortality rates were described and analyzed by development at state levels, using the Socio-Demographic Index (SDI). Finally, a decomposition analysis was conducted to evaluate the contribution of different factors to the changes in the number of deaths attributable to smoking between 1990 and 2017. Results: Between 1990 and 2017, prevalence of smoking in the population (≥ 20 years old) decreased from 35.3 to 11.3% in Brazil. This downward trend was seen for both sexes and in all states, with a marked reduction in exposure to this risk factor in younger cohorts. Smoking-attributable mortality rates decreased by 57.8% (95% UI − 61.2, − 54.1) between 1990 and 2017. Overall, larger reductions were observed in states with higher SDI (Pearson correlation 0.637; p < 0.01). In Brazil, smoking remains responsible for a considerable amount of deaths, especially due to cardiovascular diseases and neoplasms. Conclusions: Brazil has adopted a set of regulatory measures and implemented anti-tobacco policies that, along with improvements in socioeconomic conditions, have contributed to the results presented in the present study. Other regulatory measures need to be implemented to boost a reduction in smoking in order to reach the goals established in the scope of the 2030 United Nations Agenda for Sustainable Development.