Ana Maria Nogales Vasconcelos

Transição demográfica: a experiência brasileira

Objective: to describe the process of demographic transition in Brazil and its regions. Methods: descriptive study with demographic Census data from 1950 to 2010, and estimates of demographic dynamics published by Brazilian Institute of Geography and Statistics and Interagency Health Information Network. Results: since 1950, the process of demographic transition in Brazil has been characterized by the drop of mortality, birth and fecundity rates. The age structure started its ageing process. These changes have not simultaneously nor evenly occurred in Brazilian regions. While Southeast, South and Midwest are more advanced in the process of transition, North and Northeast still present mortality and fecundity rates more elevated, and age structures less aged. Conclusion: even though the fecundity levels had declined below reposition level in most parts of Brazil, the demographic balance with low mortality and birth rates has not been achieved yet.

Violências contra mulheres por parceiro íntimo em área urbana economicamente vulnerável, Brasília, DF

OBJETIVO: Estimar a prevalencia de tipos de violencia e de comportamentos de controle praticados por parceiros intimos contra mulheres residentes em area economicamente vulneravel. METODOS: Conduziu-se estudo transversal com 278 mulheres de 15 a 49 anos que tiveram parceiros intimos alguma vez na vida, residentes em uma area metropolitana de Brasilia, DF, em 2007. Utilizou-se processo de amostragem aleatoria sistematica. O instrumento de pesquisa constou de um questionario com 58 perguntas desenvolvido pela Organizacao Mundial de Saude. Foram analisadas as prevalencias de violencia fisica, psicologica e sexual. As variaveis independentes consideradas foram caracteristicas sociodemograficas da mulher, de contexto familiar e comunitario bem como as sociodemograficas do parceiro, de comportamento (frequencia do uso de bebidas ou drogas ilicitas e relacionamento extraconjugal). RESULTADOS: A prevalencia de violencia psicologica foi a mais alta: 80,2% (n=223) das mulheres entrevistadas relataram pelo menos um ato no decorrer da vida e 50% (n=139) nos ultimos 12 meses. A prevalencia de violencia fisica ao longo da vida foi (58,6%) e nos ultimos 12 meses (32%), enquanto a prevalencia de mulheres que sofreram violencia sexual foi de 28,8% e 15,5%, respectivamente. CONCLUSOES: As altas prevalencias das violencias mostram a magnitude da vulnerabilidade e das agressoes praticadas contra mulheres nas relacoes com parceiros intimos.

Identifying and quantifying misclassified and under-reported AIDS deaths in Brazil: a retrospective analysis from 1985 to 2009

Background A retrospective analysis of deaths registered in the Brazilian Mortality System was conducted to quantify the under-reporting of HIV/AIDS deaths and those misclassified to AIDS-related conditions in the 15–49 years old population in Brazil. Methods Death rates for AIDS-related diseases were calculated by age and sex for 1985–2009. Changes in the age-sex-specific death rates over time were used to identify conditions likely to be misclassified AIDS deaths and to quantify the corresponding number of misclassified deaths. Deaths due to ill-defined causes were redistributed across all other natural causes of death. The resulting total number of AIDS deaths was further adjusted for incompleteness of the mortality reporting system. Results Out of the 28 potential causes of death investigated, five increased in the same distinct age pattern as AIDS: pneumonia, Kaposis sarcoma, other immunodeficiencies, other septicaemia and toxoplasmosis. 18 490 deaths due to these five causes were recoded to HIV/AIDS from 1985 to 2009. 38 145 deaths due to ill-defined causes were redistributed to AIDS and 15 485 were added to the number of AIDS deaths to correct for completeness of the mortality system in Brazil. Altogether, 72 120 deaths were recoded to AIDS between 1985 and 2009 and added to the reported 194 445 AIDS related deaths in the country, representing 27% misclassification of AIDS deaths in Brazil. Conclusions This study demonstrated that AIDS mortality is underestimated by the official mortality information system in Brazil. Efforts need to be made to reduce misclassification of causes of death in the future and identify ways in which the confidentiality of information regarding cause of death can be maintained.

Causes of death among people living with HIV/AIDS in Brazil.

BACKGROUND The monitoring of the underlying causes of death in people living with HIV/AIDS is important so that actions to reduce morbidity and mortality can be taken. OBJECTIVE To describe the temporal trends of underlying causes of death among people living with HIV/AIDS between 2000 and 2007 in Brazil and to identify factors associated with it. METHODS The Mortality Information System data for deaths occurred in Brazil between 2000 and 2007 that contained reference to HIV/AIDS in any of the death certificate fields was analyzed. Temporal trends of the underlying cause of death were studied. Differences in the underlying cause of death according to gender, age, region of residence, level of education, certifying officer, race and year of death were verified. RESULTS Between 2000 and 2007 the percentage of deaths not related to HIV/AIDS among people living with HIV/AIDS increased from 2.5% to 7.0%. People with higher level of formal education, living in the South-East region of Brazil and aged under 13 or over 60 years old were more likely to have their underlying cause of death reported as not related to HIV/AIDS. CONCLUSION The results suggest the importance of implementing actions aimed at improving the quality of life of PLWHA, and which could include behavioral changes, such as smoking and alcoholism cessation, early screening to detect neoplasms and the monitoring of chronic conditions, such as diabetes. That is to say, the need exists to integrate the actions of HIV/AIDS programs with other public health programs.

Melhoria da qualidade das informações sobre tuberculose a partir do relacionamento entre bases de dados

O objetivo deste trabalho foi verificar a melhoria da qualidade das informacoes sobre a tuberculose (TB), apos a vinculacao de registros e a correcao do encerramento por meio do linkage probabilistico do Sistema de Informacoes de Agravos de Notificacao (SINAN) com o Sistema de Informacoes sobre Mortalidade (SIM). Para a vinculacao de registros foi realizado o linkage entre os registros do SINAN do Brasil, anos 2008 e 2009, com o objetivo de excluir as notificacoes nao removidas pelas rotinas do SINAN realizadas por estados e municipios. As bases de dados foram construidas de acordo com o desfecho dos casos. Para o linkage entre SINAN e SIM foi utilizada a base de dados que resultou da vinculacao de registros e os registros do SIM que mencionaram TB como causa basica ou associada, entre 2008 e 2010, no Brasil. A vinculacao de registros diminuiu o percentual de casos novos com encerramento por transferencia, com variacao de 34,8% em 2008 e 35,5% em 2009. Apos o linkage entre SINAN e SIM, o percentual de obito por TB aumentou, com variacao em torno de 15%. Os resultados descrevem uma situacao de alerta no que se refere a qualidade dos dados de desfecho de tratamento de TB no SINAN.The aim of this study was to improve data quality on tuberculosis (TB) after record linkage and outcome correction through probabilistic linkage between the Information System for Notifiable Diseases (SINAN) and the Mortality Information System (SIM). Record linkage was conducted between SINAN records for Brazil in 2008 and 2009 in order to exclude notifications not removed by routine SINAN procedures performed by States and Municipalities. The databases were constructed according to the case outcomes. Linkage between SINAN and SIM used the database resulting from record linkage and SIM data that mentioned TB as the underlying or associated cause from 2008 to 2010 in Brazil. Record linkage decreased the percentage of new cases closed with patient transfer as the outcome, ranging from 34.8% in 2008 to 35.5% in 2009. After linkage between SINAN and SIM, the percentage of TB deaths among new cases increased, varying around 15%. The results highlight the need for attention to data quality for TB treatment outcomes in SINAN.

Intimate partner violence against women in an economically vulnerable urban area, Central-West Brazil

OBJETIVO: Estimar a prevalencia de tipos de violencia e de comportamentos de controle praticados por parceiros intimos contra mulheres residentes em area economicamente vulneravel. METODOS: Conduziu-se estudo transversal com 278 mulheres de 15 a 49 anos que tiveram parceiros intimos alguma vez na vida, residentes em uma area metropolitana de Brasilia, DF, em 2007. Utilizou-se processo de amostragem aleatoria sistematica. O instrumento de pesquisa constou de um questionario com 58 perguntas desenvolvido pela Organizacao Mundial de Saude. Foram analisadas as prevalencias de violencia fisica, psicologica e sexual. As variaveis independentes consideradas foram caracteristicas sociodemograficas da mulher, de contexto familiar e comunitario bem como as sociodemograficas do parceiro, de comportamento (frequencia do uso de bebidas ou drogas ilicitas e relacionamento extraconjugal). RESULTADOS: A prevalencia de violencia psicologica foi a mais alta: 80,2% (n=223) das mulheres entrevistadas relataram pelo menos um ato no decorrer da vida e 50% (n=139) nos ultimos 12 meses. A prevalencia de violencia fisica ao longo da vida foi (58,6%) e nos ultimos 12 meses (32%), enquanto a prevalencia de mulheres que sofreram violencia sexual foi de 28,8% e 15,5%, respectivamente. CONCLUSOES: As altas prevalencias das violencias mostram a magnitude da vulnerabilidade e das agressoes praticadas contra mulheres nas relacoes com parceiros intimos.

Investigation of ill-defined causes of death: assessment of a program's performance in a State from the Northeastern region of Brazil

OBJECTIVE The proportion of ill-defined causes of death (IDCD) was persistently high in some regions of Brazil in 2004. In 2005, the Brazilian government implemented a project in order to decrease this proportion, especially in higher priority states and municipalities. This study aimed to evaluate the performance of this project in Alagoas - a state from the Northeast region of Brazil. METHOD We selected a probabilistic sample of 18 municipalities. For all IDCD identified in 2010, we collected the verbal autopsy (VA) questionnaires used for home investigation, and the Ministry of Health (MoH) form, which contains information about the final disease and cause of death taken from hospital records, autopsies, family health teams, and civil registry office records. The completion rate of the MoH form and VA was calculated using the number of deaths with specific causes assigned among investigated deaths. RESULTS A total of 681 IDCD were recorded in 2010 in the sample, of which 26% had a MoH and/or VA3 forms completed. Although the majority of cases were attended by health professionals during the terminal disease, the completion rate was 45% using the MoH form and 80% when VA was performed. CONCLUSIONS Our findings provide evidence that the training of the epidemiological surveillance teams in the investigation and certification of causes of death could contribute to improve the quality of mortality data.

Cause-specific mortality for 249 causes in Brazil and states during 1990–2015: a systematic analysis for the global burden of disease study 2015

BackgroundReliable data on cause of death (COD) are fundamental for planning and resource allocation priorities. We used GBD 2015 estimates to examine levels and trends for the leading causes of death in Brazil from 1990 to 2015.MethodsWe describe the main analytical approaches focused on both overall and specific causes of death for Brazil and Brazilian states.ResultsThere was an overall improvement in life expectancy at birth from 1990 to 2015, but with important heterogeneity among states. Reduced mortality due to diarrhea, lower respiratory infections, and other infectious diseases contributed the most for increasing life expectancy in most states from the North and Northeast regions. Reduced mortality due to cardiovascular diseases was the highest contributor in the South, Southeast, and Center West regions. However, among men, intentional injuries reduced life expectancy in 17 out of 27 states. Although age-standardized rates due to ischemic heart disease (IHD) and cerebrovascular disease declined over time, these remained the leading CODs in the country and states. In contrast, leading causes of premature mortality changed substantially - e.g., diarrheal diseases moved from 1st to 13th and then the 36th position in 1990, 2005, and 2015, respectively, while violence moved from 7th to 1st and to 2nd. Overall, the total age-standardized years of life lost (YLL) rate was reduced from 1990 to 2015, bringing the burden of premature deaths closer to expected rates given the country’s Socio-demographic Index (SDI). In 1990, IHD, stroke, diarrhea, neonatal preterm birth complications, road injury, and violence had ratios higher than the expected, while in 2015 only violence was higher, overall and in all states, according to the SDI.ConclusionsA widespread reduction of mortality levels occurred in Brazil from 1990 to 2015, particularly among children under 5 years old. Major shifts in mortality rates took place among communicable, maternal, neonatal, and nutritional disorders. The mortality profile has shifted to older ages with increases in non-communicable diseases as well as premature deaths due to violence. Policymakers should address health interventions accordingly.

Trends in non-AIDS-related causes of death among adults with HIV/AIDS, Brazil, 1999 to 2010.

The aim of this study was to analyze trends in the listing of non-AIDS-related causes of death on the death certificates of adults with HIV/AIDS in Brazil. The study analyzed mortality data for persons 15 to 69 years of age from 1999 to 2010. Standardized mortality odds ratios were used to compare mortality from non-AIDS-related causes in the group with HIV/AIDS listed on the death certificate and in the group without HIV/ AIDS. From 1999 to 2010, there were 6,120,670 deaths among adults in Brazil. Deaths in the HIV group represented 2.2% of the total. Non- AIDS-related causes, and more specifically cardiovascular diseases, diseases of the genitourinary system, and non-AIDS-related malignant neoplasms increased at higher rates in the group with HIV/AIDS listed on the death certificate. The results point to a greater increase in mortality from non-AIDS-related diseases among persons with HIV/AIDS. This finding suggests that long contact with HIV and antiretroviral therapy play an important role in the occurrence of these diseases.

Principais causas da mortalidade na infância no Brasil, em 1990 e 2015: estimativas do estudo de Carga Global de Doença

Objective: To analyze under-5 mortality rates and leading causes in Brazil and states in 1990 and 2015, using the Global Burden of Disease Study (GBD) 2015 estimates. Methods: The main sources of data for all-causes under-5 mortality and live births estimates were the mortality information system, surveys, and censuses. Proportions and rates per 1,000 live births (LB) were calculated for total deaths and leading causes. Results: Estimates of under-5 deaths in Brazil were 191,505 in 1990, and 51,226 in 2015, 90% of which were infant deaths. The rates per 1,000 LB showed a reduction of 67.6% from 1990 to 2015, achieving the proposed target established by the Millennium Development Goals (MDGs). The reduction generally was more than 60% in states, with a faster reduction in the poorest Northeast region. The ratio of the highest and lowest rates in the states decreased from 4.9 in 1990 to 2.3 in 2015, indicating a reduction in socioeconomic regional disparities. Although prematurity showed a 72% reduction, it still remains as the leading cause of death (COD), followed by diarrheal diseases in 1990, and congenital anomalies, birth asphyxia and septicemia neonatal in 2015. Conclusion: Under-5 mortality has decreased over the past 25 years, with reduction of regional disparities. However, pregnancy and childbirth-related causes remain as major causes of death, together with congenital anomalies. Intersectoral and specific public health policies must be continued to improve living conditions and health care in order to achieve further reduction of under-5 mortality rates in Brazil.RESUMO: Objetivo: Analisar as taxas de mortalidade e as principais causas de morte na infância no Brasil e estados, entre 1990 e 2015, utilizando estimativas do estudo Carga Global de Doenca (Global Burden of Disease - GBD) 2015. Metodos: As fontes de dados foram obitos e nascimentos estimados com base nos dados do Sistema de Informacoes sobre Mortalidade (SIM), censos e pesquisas. Foram calculadas proporcoes e taxas por mil nascidos vivos (NV) para o total de obitos e as principais causas de morte na infância. Resultados: O numero estimado de obitos para menores de 5 anos, no Brasil, foi de 191.505, em 1990, e 51.226, em 2015, sendo cerca de 90% mortes infantis. A taxa de mortalidade na infância no Brasil sofreu reducao de 67,6%, entre 1990 e 2015, cumprindo a meta estabelecida nos Objetivos de Desenvolvimento do Milenio (ODM). A reducao total das taxas foi, em geral, acima de 60% nos estados, sendo maior na regiao Nordeste. A disparidade entre as regioes foi reduzida, sendo que a razao entre o estado com a maior e a menor taxa diminuiu de 4,9, em 1990, para 2,3, em 2015. A prematuridade, apesar de queda de 72% nas taxas, figurou como a principal causa de obito em ambos os anos, seguida da doenca diarreica, em 1990, e das anomalias congenitas, da asfixia no parto e da sepse neonatal, em 2015. Conclusao: A queda nas taxas de mortalidade na infância representa um importante ganho no periodo, com reducao de disparidades geograficas. As causas relacionadas ao cuidado em saude na gestacao, no parto e no nascimento figuram como as principais em 2015, em conjunto com as anomalias congenitas. Politicas publicas intersetoriais e de saude especificas devem ser aprimoradas.