Bruna Gonçalves Cordeiro da Silva

Burden of physical inactivity and hospitalization costs due to chronic diseases

OBJECTIVE To evaluate the physical inactivity-related inpatient costs of chronic non-communicable diseases. METHODS This study used data from 2013, from Brazilian Unified Health System, regarding inpatient numbers and costs due to malignant colon and breast neoplasms, cerebrovascular diseases, ischemic heart diseases, hypertension, diabetes, and osteoporosis. In order to calculate the share physical inactivity represents in that, the physical inactivity-related risks, which apply to each disease, were considered, and physical inactivity prevalence during leisure activities was obtained from Pesquisa Nacional por Amostra de Domicílio (Brazil’s National Household Sample Survey). The analysis was stratified by genders and residing country regions of subjects who were 40 years or older. The physical inactivity-related hospitalization cost regarding each cause was multiplied by the respective share it regarded to. RESULTS In 2013, 974,641 patients were admitted due to seven different causes in Brazil, which represented a high cost. South region was found to have the highest patient admission rate in most studied causes. The highest prevalences for physical inactivity were observed in North and Northeast regions. The highest inactivity-related share in men was found for osteoporosis in all regions (≈ 35.0%), whereas diabetes was found to have a higher share regarding inactivity in women (33.0% to 37.0% variation in the regions). Ischemic heart diseases accounted for the highest total costs that could be linked to physical inactivity in all regions and for both genders, being followed by cerebrovascular diseases. Approximately 15.0% of inpatient costs from Brazilian Unified Health System were connected to physical inactivity. CONCLUSIONS Physical inactivity significantly impacts the number of patient admissions due to the evaluated causes and through their resulting costs, with different genders and country regions representing different shares.

Physical activity in early adolescence and pulmonary function gain from 15 to 18 years of age in a birth cohort in Brazil

BACKGROUND The aim of this study was to evaluate the association between physical activity from 11 to 15 years of age and pulmonary function (PF) gain from 15 to 18 years of age among adolescents in a birth cohort in Brazil. METHODS Longitudinal analysis of the individuals participating in the 1993 Pelotas Birth Cohort Study. Physical activity was assessed by self-report at ages 11 and 15, spirometry was performed at ages 15 and 18 (n = 3571). Outcome variables assessed were gains in forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF). Crude and adjusted linear regressions, stratified by sex, and mediation analyses were performed. RESULTS Boys who were active (leisure-time and total physical activity) at ages 11 and 15 had higher gains in FEV1, FVC, and PEF than those who were inactive. Vigorous-intensity physical activity in boys was also associated with FEV1 and FVC gains. Mediation analyses showed that height at age 18 accounted for 5% to 75% of the association between physical activity and PF gains. No significant associations were found among girls. CONCLUSIONS Physical activity in early adolescence is associated with gains in PF by the end of adolescence in boys.

Low birthweight and preterm birth: trends and inequalities in four population-based birth cohorts in Pelotas, Brazil, 1982–2015

Abstract Background Despite positive changes in most maternal risk factors in Brazil, previous studies did not show reductions in preterm birth and low birthweight. We analysed trends and inequalities in these outcomes over a 33-year period in a Brazilian city. Methods Four population-based birth cohort studies were carried out in the city of Pelotas in 1982, 1993, 2004 and 2015, with samples ranging from 4231 to 5914 liveborn children. Low birthweight (LBW) was defined as <2500 g, and preterm birth as less than 37 weeks of gestation. Information was collected on family income, maternal skin colour and other risk factors for low birthweight. Multivariable linear regression was used to estimate the contribution of risk factors to time trends in birthweight. Results Preterm births increased from 5.8% (1982) to 13.8% (2015), and LBW prevalence increased from 9.0% to 10.1%, being higher for boys and for children born to mothers with low income and brown or black skin colour. Mean birthweight remained stable, around 3200 g, but increased from 3058 to 3146 g in the poorest quintile and decreased from 3307 to 3227 g in the richest quintile. After adjustment for risk factors for LBW, mean birthweight was estimated to have declined by 160 g over 1982–2015 (reductions of 103 g in the poorest and 213 g in the richest quintiles). Conclusions Data from four birth cohorts show that preterm births increased markedly. Mean birthweights remained stable over a 33-year period. Increased prevalence of preterm and early term births, associated with high levels of obstetric interventions, has offset the expected improvements due to reduction in risk factors for low birthweight.

Mortalidade materna no Brasil no período de 2001 a 2012: tendência temporal e diferenças regionais

Objective: To assess time trends in maternal mortality in Brazil and its five geographical regions from 2001 to 2012, as well as to describe its main causes. Methods: This is a time series analysis, from data obtained in the Mortality Information System (SIM) and in the Live Births Information System (SINASC). Maternal mortality ratio (MMR) and causes of maternal death were described according to the categories of the Tenth Revision of the International Classification of Diseases, in the years 2001, 2006, and 2011. To estimate time trends, linear regression was used. Results: The highest MMR in Brazil was observed in 2009 (77.31 per 100,000 live births). A significant decreasing trend was observed in the Northeast and South regions and a significant increasing trend was found in the Midwest. There was an increase in deaths from other obstetric conditions and a decrease in deaths from edema, proteinuria and hypertensive disorders. Conclusion: Although there was a decreasing trend in the MMR in the Northeast and South regions, the high ratio observed in Brazil reveals the need to improve health care in prenatal, childbirth, and puerperium periods.RESUMO: Objetivo: Avaliar a tendencia de mortalidade materna no Brasil e nas cinco regioes brasileiras, de 2001 a 2012, e descrever suas principais causas. Metodos: Trata-se de uma serie temporal, a partir de dados obtidos no Sistema de Informacao sobre Mortalidade e no Sistema de Informacao sobre Nascidos Vivos. A razao de mortalidade materna e as causas de morte materna foram descritas conforme as categorias da 10a revisao da Classificacao Internacional de Doencas, nos anos de 2001, 2006 e 2011. Para estimar a tendencia temporal foi utilizada a regressao linear. Resultados: A razao de mortalidade materna mais elevada no Brasil foi no ano de 2009 (77,31 por 100 mil nascidos vivos). Foi observada tendencia significativa de diminuicao da razao de mortalidade materna para as regioes Nordeste e Sul e de aumento na regiao Centro-Oeste. Houve incremento nas mortes por outras afeccoes obstetricas e uma queda nas mortes por edema, proteinuria e transtornos hipertensivos. Conclusao: Embora tenham sido observadas tendencias de diminuicao da razao de mortalidade materna para o Nordeste e o Sul, as elevadas taxas observadas para o Brasil evidenciam a necessidade de melhoria a assistencia pre-natal, ao parto e ao puerperio.

Maternal mortality in Brazil from 2001 to 2012: Time trends and regional differences

Objective: To assess time trends in maternal mortality in Brazil and its five geographical regions from 2001 to 2012, as well as to describe its main causes. Methods: This is a time series analysis, from data obtained in the Mortality Information System (SIM) and in the Live Births Information System (SINASC). Maternal mortality ratio (MMR) and causes of maternal death were described according to the categories of the Tenth Revision of the International Classification of Diseases, in the years 2001, 2006, and 2011. To estimate time trends, linear regression was used. Results: The highest MMR in Brazil was observed in 2009 (77.31 per 100,000 live births). A significant decreasing trend was observed in the Northeast and South regions and a significant increasing trend was found in the Midwest. There was an increase in deaths from other obstetric conditions and a decrease in deaths from edema, proteinuria and hypertensive disorders. Conclusion: Although there was a decreasing trend in the MMR in the Northeast and South regions, the high ratio observed in Brazil reveals the need to improve health care in prenatal, childbirth, and puerperium periods.RESUMO: Objetivo: Avaliar a tendencia de mortalidade materna no Brasil e nas cinco regioes brasileiras, de 2001 a 2012, e descrever suas principais causas. Metodos: Trata-se de uma serie temporal, a partir de dados obtidos no Sistema de Informacao sobre Mortalidade e no Sistema de Informacao sobre Nascidos Vivos. A razao de mortalidade materna e as causas de morte materna foram descritas conforme as categorias da 10a revisao da Classificacao Internacional de Doencas, nos anos de 2001, 2006 e 2011. Para estimar a tendencia temporal foi utilizada a regressao linear. Resultados: A razao de mortalidade materna mais elevada no Brasil foi no ano de 2009 (77,31 por 100 mil nascidos vivos). Foi observada tendencia significativa de diminuicao da razao de mortalidade materna para as regioes Nordeste e Sul e de aumento na regiao Centro-Oeste. Houve incremento nas mortes por outras afeccoes obstetricas e uma queda nas mortes por edema, proteinuria e transtornos hipertensivos. Conclusao: Embora tenham sido observadas tendencias de diminuicao da razao de mortalidade materna para o Nordeste e o Sul, as elevadas taxas observadas para o Brasil evidenciam a necessidade de melhoria a assistencia pre-natal, ao parto e ao puerperio.

Socioeconomic development of cities and risk factors for non-communicable diseases: a comparative study across Brazilian state capitals

Background Epidemiological transition in lowand middle-income countries has drawn the attention of public health policymakers to noncommunicable diseases (NCDs) and their environmental and individual-level risk factors. We aimed to evaluate the association of socioeconomic indicators of Brazilian state capitals with NCD risk factors. Methods We used cross-sectional data from the 2011 Telephone-based Surveillance of Risk and Protective Factors for Chronic Diseases (VIGITEL) survey. Correlations between various socioeconomic indicators of individual cities (Gross domestic product per capita, illiteracy and Gini index) and the prevalence of NCD risk factors were examined using Kendall’s Tau correlation coefficient. Multilevel models were then employed to assess whether the association between these socioeconomic indicators and NCD risk factors was independent of socioeconomic status at the individual