Maria de Fátima Marinho de Souza

Cardiovascular disease mortality in the Americas: current trends and disparities

Objective To describe the current situation and trends in mortality due to cardiovascular disease (CVD) in the Americas and explore their association with economic indicators. Design and Setting This time series study analysed mortality data from 21 countries in the region of the Americas from 2000 to the latest available year. Main Outcomes Measures Age-adjusted death rates, annual variation in death rates. Regression analysis was used to estimate the annual variation and the association between age-adjusted rates and country income. Results Currently, CVD comprised 33.7% of all deaths in the Americas. Rates were higher in Guyana (292/100 000), Trinidad and Tobago (289/100 000) and Venezuela (246/100 000), and lower in Canada (108/100 000), Puerto Rico (121/100 000) and Chile (125/100 000). Male rates were higher than female rates in all countries. The trend analysis showed that CVD death rates in the Americas declined −19% overall (−20% among women and −18% among men). Most countries had a significant annual decline, except Guatemala, Guyana, Suriname, Paraguay and Panama. The largest annual declines were observed in Canada (−4.8%), the USA (−3.9%) and Puerto Rico (−3.6%). Minor declines were in Mexico (−0.8%) and Cuba (−1.1%). Compared with high-income countries the difference between the median of death rates in lower middle-income countries was 56.7% higher and between upper middle-income countries was 20.6% higher. Conclusions CVD death rates have been decreasing in most countries in the Americas. Considerable disparities still remain in the current rates and trends.

Tendência de mortalidade do câncer de pulmão, traquéia e brônquios no Brasil, 1980-2003

OBJECTIVE: To describe the mortality trends for lung cancer, cancer of the trachea, and bronchial cancer in relation to gender and age brackets in Brazil. METHODS: Data related to mortality between 1980 and 2003 were collected from the Brazilian Mortality Database. A trend analysis of mortality was carried out, nationwide and in selected states, using the LOWESS technique for rate smoothing and model adjustments. RESULTS: In Brazil, the standardized mortality rate for lung cancer, cancer of the trachea, and bronchial cancer increased from 7.21/100,000 inhabitants in 1980 to 9.36/100,000 inhabitants in 2003. Specific mortality rates decreased in males in the 30-49 and 50-59 age brackets. In the 60-69 age bracket, the rates for males increased from 1980 to 1995 and declined thereafter. There was a trend toward higher mortality rates in males over 70, as well as in females over 30, throughout the period evaluated. CONCLUSIONS: The decrease in the mortality rates in younger males might have resulted from recent national interventions aimed at reducing the prevalence of smoking and reducing exposure in younger cohorts. High mortality rates in older populations remained constant due to prior tobacco use. Increased mortality rates in females are a worldwide trend and are attributable to the recent increase in smoking prevalence in females.

Unintentional injuries at the Emergency Department Injury Surveillance System: Brazil, 2006

In 2006, the Brazilian Ministry of Health established the Injury Surveillance System Network in Sentinel Services (Rede VIVA) to describe data on injuries victims treated at emergency departments (ED), especially minor injuries which do not cause deaths and hospitalization. This study describes the characteristics of unintentional injuries victims treated in these EDs by means of a transversal descriptive study with data coming from EDs located in 35 municipalities with the highest injury rates. The data were collected during 30 consecutive days in an alternated 12-hour shift. There were a total of 41,677 patients with unintentional injuries, mainly among males (64.8%), people aged 20 to 29 years (23.0%) and low level of education (45.8%). Falls were the main cause (40.1% overall), followed by transport related injuries (26.6% overall). The more frequent place of occurrence were public streets (36.3% overall) and residences (33.6% overall). The body parts most affected were upper members (42.7%), lower members (42.0%) and head/face (29.2%). The injury surveillance in sentinel services allows collecting timeless data about minor cases which is essential for planning and implementing preventive measures.

Uso da autópsia verbal na investigação de óbitos com causa mal definida em Minas Gerais, Brasil

Ill-defined causes of death can be related to problems in access to health services or poor quality of medical care and are indicators of data quality in the Mortality Information System (MIS). A sample of municipalities (counties) was selected from the Northeastern Macro-Region of Minas Gerais State, Brazil, with the aim of investigating deaths from ill-defined causes and deaths not reported to the Mortality Information System in 2007, using the verbal autopsy technique. The method allowed identifying 87% of the causes of investigated deaths, of which 17% (n = 37) were due to violent causes. At the end of the study, of the 779 investigated deaths, 9.5% (n = 74) were due to external causes found outside the MIS. The distribution of causes was similar when comparing deaths reported (versus not reported) to the MIS for natural causes, but different when external causes were included. The article concludes that the verbal autopsy method can be a valuable tool for improving the MIS, allowing the identification of causes of death and improving data completeness.

Análise descritiva e de tendência de acidentes de transporte terrestre para políticas sociais no Brasil

Este artigo analisou a mortalidade por acidentes de transporte terrestre no Brasil em 2003 e sua tendencia de 1980 a 2003. Utilizaram-se os obitos por acidente de transporte terrestre captados pelo Sistema de Informacoes sobre Mortalidade (SIM). Para a analise de tendencia, adotaram-se taxas padronizadas, tendo, como referencia, a populacao brasileira no ano 2000. Houve 33.182 obitos em 2003 – 19 obitos por 100 mil habitantes. Atropelamentos e acidentes com motocicleta cresceram no periodo estudado, com declinio dos primeiros a partir de 1998 e crescimento dos ultimos, principalmente, a partir de 1995. Houve diferencial no risco de mortalidade segundo raca/cor e condicao social – escolaridade. Individuos pretos associaram-se a pior condicao social e mortes por atropelamento, enquanto brancos, a melhor condicao social e mortes como ocupantes de veiculo. Os resultados reforcam a importância da vigilância de acidentes de transporte no apoio a politicas de promocao da saude e prevencao desses eventos...

Use of verbal autopsy in a national health information system: Effects of the investigation of ill-defined causes of death on proportional mortality due to injury in small municipalities in Brazil

BackgroundThe Mortality Information System (MIS) in Brazil records mortality data in hospitals and civil registries with the responsibility of compiling underlying cause of death. Despite continuous improvements in the MIS, some areas still maintain a high proportion of deaths assigned to ill-defined causes. Deaths coded to this category have most likely been considered as miscoded deaths from communicable and noncommunicable diseases. However, some local studies have provided evidence of underreporting of injury in Brazil. The aim of this study was to investigate ill-defined causes of death using the verbal autopsy (VA) method to estimate injury-specific mortality fraction in small municipalities in northeastern Minas Gerais, Brazil.MethodsA sample size of reported death certificates with ill-defined conditions in a random sample of 10 municipalities was obtained, and then trained interviewers questioned family members using a standardized VA questionnaire to elicit information on symptoms experienced by the deceased before death. All attempts were made to collect existing information about the disease or death using health facilities records. Probable causes of death were assigned by a physician after review of the completed questionnaires following rules of the 10th revision of the International Classification of Diseases (ICD-10).ResultsOf 202 eligible ill-defined deaths, 151 were investigated using the VA methodology, and 12.6% had injury as the underlying cause of death. The proportional mortality fraction from injury among all causes of death increases from 4.4% to 8.2% after investigation. Different specific injury category causes were observed between recorded injury causes and those detected by VA. Drowning was the top specific injury cause detected after investigation.ConclusionsThis study provides evidence that the use of VA in the investigation of registered ill-defined conditions in an existing MIS can furnish information on the relevance of injury as a priority health problem in small municipalities of Minas Gerais. Local research with VA should be brought to the attention of regional health policymakers to improve the quality of data for their planning.

Burden of influenza-associated deaths in the Americas, 2002–2008

Influenza disease is a vaccine‐preventable cause of morbidity and mortality. The Pan American Health Organization (PAHO) region has invested in influenza vaccines, but few estimates of influenza burden exist to justify these investments. We estimated influenza‐associated deaths for 35 PAHO countries during 2002–2008.

Homicídios na região das Américas: magnitude, distribuição e tendências, 1999-2009

The scope of this study was to describe the magnitude and distribution of deaths by homicide in the Americas and to analyze the prevailing trends. Deaths by homicide (X85 to Y09 and Y35) were analyzed in 32 countries of the Americas Region from 1999 to 2009, recorded in the Mortality Information System/Pan American Health Organization. A negative binomial model was used to study the trends. There were around 121,297 homicides (89% men and 11% women) in the Americas, annually, predominantly in the 15 to 24 and 25 to 39 year age brackets. In 2009 the homicide age-adjusted mortality rate was 15.5/100,000 in the region. Countries with lower rates/100,000 were Canada (1.8), Argentina (4.4), Cuba (4.8), Chile (5.2), and the United States (5.8), whereas the highest rates/100,000 were in El Salvador (62.9), Guatemala (51.2), Colombia (42.5), Venezuela (33.2), and Puerto Rico (25.8). From 1999-2009, the homicide trend in the region was stable. They increased in nine countries: Venezuela (p<0.001), Panama (p<0.001), El Salvador (p<0.001), Puerto Rico (p<0.001); decreased in four countries, particularly in Colombia (p<0.001); and were stable in Brazil, the United States, Ecuador and Chile. The increase in Mexico occurred in recent years. Despite all efforts, various countries have high homicide rates and they are on the increase.

Trends in mortality from respiratory disease in Latin America since 1998 and the impact of the 2009 influenza pandemic

OBJECTIVE To determine trends in mortality from respiratory disease in several areas of Latin America between 1998 and 2009. METHODS The numbers of deaths attributed to respiratory disease between 1998 and 2009 were extracted from mortality data from Argentina, southern Brazil, Chile, Costa Rica, Ecuador, Mexico and Paraguay. Robust linear models were then fitted to the rates of mortality from respiratory disease recorded between 2003 and 2009. FINDINGS Between 1998 and 2008, rates of mortality from respiratory disease gradually decreased in all age groups in most of the study areas. Among children younger than 5 years, for example, the annual rates of such mortality - across all seven study areas - fell from 56.9 deaths per 100,000 in 1998 to 26.6 deaths per 100,000 in 2008. Over this period, rates of mortality from respiratory disease were generally highest among adults older than 65 years and lowest among individuals aged 5 to 49 years. In 2009, mortality from respiratory disease was either similar to that recorded in 2008 or showed an increase - significant increases were seen among children younger than 5 years in Paraguay, among those aged 5 to 49 years in southern Brazil, Mexico and Paraguay and among adults aged 50 to 64 years in Mexico and Paraguay. CONCLUSION In much of Latin America, mortality from respiratory disease gradually fell between 1998 and 2008. However, this downward trend came to a halt in 2009, probably as a result of the (H1N1) 2009 pandemic.

Mortality due to cardiovascular diseases in the Americas by region, 2000-2009

CONTEXT AND OBJECTIVE Cardiovascular diseases are the leading cause of death worldwide. The aim here was to evaluate trends in mortality due to cardiovascular diseases in three different regions of the Americas. DESIGN AND SETTING This was a time series study in which mortality data from three different regions in the Americas from 2000 to the latest year available were analyzed. METHODS The source of data was the Mortality Information System of the Pan-American Health Organization (PAHO). Data from 27 countries were included. Joinpoint regression analysis was used to analyze trends. RESULTS During the study period, the age-adjusted mortality rates for men were higher than those of females in all regions. North America (NA) showed lower rates than Latin America countries (LAC) and the Non-Latin Caribbean (NLC). Premature deaths (30-69 years old) accounted for 22.8% of all deaths in NA, 38.0% in LAC and 41.8% in NLC. The trend analysis also showed a significant decline in the three regions. NA accumulated the largest decline. The average annual percentage change (AAPC) and 95% confidence interval was -3.9% [-4.2; -3.7] in NA; -1.8% [-2.2; -1.5] in LAC; and -1.8% [-2.7; -0.9] in NLC. CONCLUSION Different mortality rates and reductions were observed among the three regions.