L L Luz

P2-157 Mortality trends of prostate cancer in elder Brazilians, 1980–2008

Introduction While incidence and mortality rates for most cancers are decreasing in developed countries, they are increasing in the less developed. Prostate cancer is becoming one of the most frequent cancers in men. The aim of this study was to analyse trends of mortality for prostate cancer in elder Brazilians. Methods All deaths with prostate cancer as the underlying cause, occurring during 1980–2008, in the 27 Brazilian States, in men aged 60u2005years or more, were identified in the Mortality Information System, a population-based nationwide registry. Population data was obtained from the Brazilian Institute of Geography and Statistics. Trends were analysed through polynomial regression models, using adjusted and age-specific annual rates of mortality for each State. Results Prostate cancer mortality has been increasing in all Brazilian States, although some showed a certain pattern of stability for the more recent years. There was considerable regional variability in the magnitude of the annual increments, varying from 1.30 to 6.25 deaths per 100u2008000 men/year. Regarding trends by age groups, patterns were similar to those observed for the group as a whole. Conclusion Incidence of prostate cancer has greatly increased over the last decades, following the advent of the prostate-specific antigen test. Consequently, interpreting temporal trends in mortality has become difficult. It remains unclear to what extent the increasing mortality rates are due to detection of the disease or are representing a rise in its incidence. The increase in mortality observed in Brazil requires further monitoring.

P2-265 Mortality in older men of Southeast Brazil: a study of associated causes of death

Introduction The adoption of unhealthy western lifestyles has contributed to changes in mortality patterns in developing countries. The aim of this study was to evaluate associated causes of death in older men in a medium-size Brazilian city. Methods The study was based on a cohort of 2859 older men living in Juiz de Fora, Brazil, followed from 2006 to 2010. All death certificates were retrieved from the Mortality Information System of the city. Underlying and associated causes of death were coded according to the 10th International Classification of Diseases. Results There were 298 deaths and mean age at death was 73.4u2005years. Diseases of the circulatory system (I00–I99) corresponded to 108 (36.2%) deaths and its major associated causes were other circulatory diseases, diseases of the respiratory system (J00–J99) and infectious and parasitic diseases (A00–B99). Neoplasms corresponded to 65 deaths (21.8%) and predominant associated causes were respiratory diseases, mainly pneumonias, and infectious and parasitic diseases. Diseases of the respiratory system corresponded to 44 (14.8%) deaths and infectious and parasitic diseases were the main associated cause. These three groups comprised 72.8% of the underlying causes in the cohort. Conclusion Circulatory and respiratory diseases and neoplasms were major causes of mortality in this cohort and also represent an important public health problem in Brazil. The influence of a westernised life style is probably reflected in this pattern of chronic diseases. Although not as important, infectious and parasitic diseases are still present as associated causes and likely worsening health conditions in this cohort.

P2-156 The Vulnerable Elders Survey (VES-13) as a screening instrument in elders of Brazilian long-stay institutions

Introduction The Comprehensive Geriatric Assessment (CGA) is an evaluation conducted on older people to detect limitations of health in multiple domains. However, CGA is a time-consuming assessment and so the use of abbreviated screening instruments, as the Vulnerable Elders Survey (VES-13) has been proposed. The purpose of this study was to evaluate the performance of the VES-13 in elders who live in Brazilian long-stay institutions. Methods This is a study with elderly residents of long-stay institutions in four Brazilian cities. The assessment of functional, emotional and cognitive domains was performed with CGA and with VES-13. Individuals were scored separately with both instruments and classified accordingly. The proportion of positives identified in each domain with the CGA was compared to that of the VES-13. The characteristics of the targeted group were compared with those not selected using the χ2 test. Results These are preliminary results for 340 elders. Mean age was 75.5u2005years and 304 (89.4%) were considered as vulnerable (score ≥3). VES-13 identified correctly 90.5% of the elders with cognitive impairment, 99.3% of those with dependence in ADL, 99.5% of those in IADL and 86.9% of those who had depression. Compared to those not selected targeted individuals were older (80u2005years or more), male, had cognitive impairment and were dependent in ADL and in IADL (p<0.001). Conclusions VES-13 performed well as a screening instrument in this particular setting, identifying the majority of those elders with functionality problems, cognitive impairment and depression and who would need further evaluation with CGA.

SP1-41 Five-year survival of patients with non-Hodgkin's lymphoma submitted to haematopoietic stem cell transplantation in a reference centre in Brazil

Introduction Since the 90s, haematopoietic stem cell transplantation (HSCT) is being used more frequently in the treatment of patients with non-Hodgkins lymphoma (NHL). Methods This study was conducted in a historical cohort of adult patients with NHL undergoing first HSCT in a referral hospital in Rio de Janeiro (1997–2009). The Kaplan–Meier method was used for comparison between strata of covariates and Cox regression for multivariate analysis. Results In the study period 100 patients underwent HSCT. Of these, 61 were male, with a median age of 45. Predominant subtype at transplantation was Diffuse Large B Cell Lymphoma (82%). The median time between diagnosis and transplantation was 17u2005months. At 5u2005years, the probability of overall survival was 50.8% and survival free of evidence of disease was 54.2%. Patients with advanced stage (III/IV) at diagnosis (61.9% vs 31.8%); those with bulky disease (60.6% vs 36.7%) and those without evidence of disease at 12u2005months post transplantation (67.5% vs 5.7%) had higher survival. In multivariate analysis, evidence of disease at 12u2005months after HSCT (HR 5.22), chemo-sensitivity to the last regimen (HR 6.81) and systemic symptoms (HR 2.60) were associated to survival. Conclusions We found that the most well recognised disease characteristics and overall survival in this cohort were similar to those found for patients with NHL undergoing haematopoietic stem cell transplantation in other countries.

SP1-11 Self-reported health as a predictor of mortality in elderly men living in Southeast Brazil

Introduction Self-reported health is a perception based on an individual interpretation of physical aspects, mental status and expectations and is considered a good predictor of mortality among old people in developed countries. The aim of this study was to evaluate the role of self-reported health as a predictor of mortality in elderly men in a developing country. Methods The study population consisted of 2875 elderly men of a medium size city in Southeast Brazil, who were followed for 4u2005years or until the date of their death, whichever occurred first. Individuals alive at the end of follow-up were censored. Multivariate analysis was performed through Cox regression models. Variables presenting statistically significant associations with mortality in bivariate analysis where entered into the models. Results During the follow-up, 298 deaths occurred. Elders with self-reported poor health presented a greater risk of death, compared to those with self-reported good/excellent health in almost all stratus of the analysed variables. In the final model, poor self-reported health (HR 1.54 95% CI 1.21 to 1.96), age (HR 1.07 95% CI 1.06 to 1.09), marital status (HR 1.32 95% CI 1.04 to 1.69), current use of cigarette smoking (HR 1.94 95% CI 1.24 to 2.62), cardiovascular disease (HR 1.62 95% CI 1.06 to 2.47), diabetes (HR 1.53 95% CI 1.14 to 2.04) and recent hospitalisation (HR 1.50 95% CI 1.15 to 1.95) were independently associated to mortality. Conclusion Self-reported health was a good predictor of mortality in this population of elderly men, even when adjusted for other independent variables. It is important that healthcare services incorporate this indicator in the health evaluation of old people.

SP1-36 Mortality rates of prostate cancer and dietary and agricultural variables: an ecological study in Brazil

Introduction Mortality rates of prostate cancer show regional variations in Brazil. The heterogeneous dietary profile and the distribution of agricultural practices could, at least partially, explain the observed patterns. This ecological study aimed to identify associations between selected dietary, agricultural variables and mortality rates for prostate cancer in men aged 60 or more in selected Brazilian States. Methods States selected for study were the main agricultural producers in Brazil. Dietary (characterised as per capita kcal/day consumption of food groups) and agricultural variables were selected in the literature. Agricultural data were obtained from the National Agricultural Census and dietary data from the National Survey by Household Sampling. Multiple linear regression were used to analyse the correlations between mortality rates and the selected variables. Results Age-adjusted mortality rates varied from 112.79 to 174.92 per 100u2008000. The final multivariate model was capable of explaining 99.9% of the variation in mortality rates. Number of agricultural establishments, hectares planted with permanent crops, and hectares planted with temporary crops showed positive associations with mortality rates, as well as vegetable consumption, percentage of population aged 60 or more, and percentage of population having had medical consultation in the last 12u2005months. Negative associations were observed for total calories, consumption of oils and fats and percentage of population with health plan coverage. Conclusions These results suggest that differences in long-term dietary habits and exposures to agricultural hazards could influence patterns of prostate cancer among Brazilian elders. Further epidemiologic studies are needed to clarify these possible associations.

P2-158 Mortality from haematological malignancies in older Brazilians, 1996–2008

Introduction Incidence and mortality of haematological malignancies have been increasing in Brazil, as a great number of individuals reach the age of 60u2005years. The aim of this study was to analyse patterns of mortality from haematological cancers in older Brazilians. Methods Deaths from haematological malignancies in individuals of 60 or more years in 11 States were identified in the Mortality Information System, a population-based nationwide registry. Population data was obtained from the Brazilian Institute of Geography and Statistics. Polynomial regression was used to analyse trends in age-adjusted and age-specific mortality rates. Results Leukaemia showed the highest rates, varying from 11.96 to 17.58 per 100u2008000. Trends of increment were observed in three States, while a declining trend was observed in one. Mortality rates of Non-Hodgkin lymphoma ranged between 6.64 and 16.35 per 100u2008000 and presented regional variability, with declining trends in South and Southeast States and increments in Central-West States. Mortality rates for myeloma showed steady increasing trends in four States. For Hodgkins disease, declining trends were seen in two States. Trends of increment were observed for leukaemia and Non-Hodgkin lymphoma in the 80 or more age-group. Conclusions The Southeast is the most industrialised Brazilian region with major petroleum exploitation and petroleum-based industries. The South and the Central-West are areas of extensive agriculture. Although the aetiology of these malignancies is still largely undefined, they have some common potential risk factors (solvents, pesticides) which could have contributed to the observed trends. These findings need further analysis to better characterise mortality patterns.

SP1-38 Prevalence of ADL and IADL dependence and associated factors in elders living in long-stay institutions in Brazil

Introduction Health conditions and functionality problems related to ageing affect the ability to live independently, leading to the placement of elders in a long-stay institution. This phenomenon has been increasing in Brazil. This study analyzes functional dependence and its associated factors in this population group. Methods This is a cross-sectional study with elderly residents of long-stay institutions in four Brazilian cities. The studys questionnaire included socio-demographic and health-related variables and the assessment of functioning, cognition and mood with scales widely used in elderly populations. The population profile was characterised and the prevalence of dependence in activities of daily life (ADL) and instrumental activities of daily life (IADL) was estimated. Bivariate and multivariate analyses were performed with Poisson regression. Results These are preliminary results for 340 elders. The mean age was 75.5u2005years, most were men, 0–4u2005years of schooling and <5u2005years of institutionalisation. ADL dependence was 40.0% and IADL 58.5%. Female (PR 2:41, 95% CI 1.84 to 3.17), 80 or more years (PR 3.35; 95% CI 1.37 to 8.17), with very poor/poor health (PR 3.28; 95% CI 1.23 to 8.72) and cognitive impairment (PR 2.66; 95% CI 1.19 to 5.95) had high probability of dependence in ADL. Female (PR 3.55; 95% CI 2.31 to 5.45), 80 or more years (PR 5.47, 95% CI 2.26 to 13.25), illiterate (PR 4.89, 95% CI 2.54 to 9.43) and with cognitive impairment (RP 2.55; 95% CI 1.14 to 5.73) had high probability of dependence in IADL. Conclusions The high prevalence of functional dependence indicates the need for social and healthcare public policies aimed at this specific group in Brazil.

SP1-5 Endocrine, nutritional and metabolic diseases as associated causes of death in older women in Rio de Janeiro, Brazil

Introduction Changes in lifestyle contributed to an increased incidence and mortality from endocrine, nutritional and metabolic diseases in developing countries. The aim of this study was to evaluate the burden of these diseases as a cause of death in older women in a Brazilian city. Methods All deaths of women aged 70u2005years or older, occurring in Rio de Janeiro, between 2003 and 2006, were identified in the Mortality Information System, a population-based nationwide registry. Death certificates with an ICD 10 Chapter IV code (E00-E90) were selected. When the code corresponded to the underlying cause, its subgroup was determined (endocrine, nutritional or metabolic diseases) and the associated causes were ascertained. When these codes corresponded to associated causes, the ICD chapter of the underlying cause was identified. Results There were 55u2008331 deaths, of which 7686 (13.9%) had E00-E90 codes as underlying (50.4%) cause. Endocrine diseases predominated among underlying causes. Diabetes was the leading cause of death (76.4%) and circulatory and respiratory diseases the main associated causes. As for deaths for other underlying causes, 20.7% of the circulatory system, 9.5% of the respiratory system, 6.0% of the neoplasms and 3.3% of the infectious diseases had Diabetes as an associated cause. Conclusion Endocrine diseases, particularly Diabetes, are major causes of mortality in older women in Rio de Janeiro, representing an important public health problem. Urbanisation and socio-cultural influences of the occidental way of life led to changes in dietary patterns and an increased sedentary lifestyle. In order to modify the present patterns, health promotion strategies must be emphasised.