1
|
Szwarcwald CL, Almeida WS, Boccolini CS, Soares Filho AM, Malta DC. The unequal impact of the pandemic at subnational levels and educational attainment-related inequalities in COVID-19 mortality, Brazil, 2020-2021. Public Health 2024; 231:39-46. [PMID: 38615470 DOI: 10.1016/j.puhe.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES We estimated COVID-19 mortality indicators in 2020-2021 to show the epidemic's impact at subnational levels and to analyze educational attainment-related inequalities in COVID-19 mortality in Brazil. STUDY DESIGN This was an ecological study with secondary mortality information. METHODS Crude and age-standardized COVID-19 mortality rates were calculated by gender, major regions, and states. The COVID-19 proportional mortality (percentage) was estimated by gender and age in each region. Measures of education-related inequalities in COVID-19 mortality were calculated per state, in each of which the COVID-19 maternal mortality rate (MMR) was estimated by the number of COVID-19 maternal deaths per 100,000 live births (LBs). RESULTS The analysis of mortality rates at subnational levels showed critical regional differences. The North region proved to be the most affected by the pandemic, followed by the Center-West, with age-standardized COVID-19 mortality rates above 2 per 1000 inhabitants. The peak of COVID-19 mortality occurred in mid-March/April 2021 in all regions. Great inequality by educational level was found, with the illiterate population being the most negatively impacted in all states. The proportional mortality showed that males and females aged 50-69 years were the most affected. The MMR reached critical values (>100/100,000 LB) in several states of the North, Northeast, Southeast, and Center-West regions. CONCLUSIONS This study highlights stark regional and educational disparities in COVID-19 mortality in Brazil. Exacerbated by the pandemic, these inequalities reveal potential areas for intervention to reduce disparities. The results also revealed high MMRs in certain states, underscoring pre-existing healthcare access challenges that worsened during the pandemic.
Collapse
Affiliation(s)
- C L Szwarcwald
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - W S Almeida
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C S Boccolini
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - A M Soares Filho
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - D C Malta
- School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
2
|
McGrath C, Suen RPC, Wong MCM, Yeung AWK, McKenna G, Moore C. Operationalisation of Successful Ageing in the Oral Health Context: A Citation Analysis. Int Dent J 2024:S0020-6539(24)00124-2. [PMID: 38762370 DOI: 10.1016/j.identj.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/10/2024] [Accepted: 04/13/2024] [Indexed: 05/20/2024] Open
Abstract
OBJECTIVES The rapidly ageing world has placed considerable demands on health and social care. To address this, the World Health Organization (WHO) and United Nations (UN) have declared action for this decade (2021-2030) to promote healthy ageing. Operationalisation of successful ageing in the oral health context in terms of its dimensions and their interconnectedness was determined. METHODS A citation analysis was conducted following a scoping review to determine oral health's relationship with 5 key dimensions of successful ageing. This included examining the occurrence and co-occurrence amongst dimensions and over time. Specific consideration of citations by country, journal type, and authors through overlay visualisation was performed to map their interconnectedness. RESULTS The scoping review identified 263 publications covering 1730 specific terms. There was a growing interest in successful ageing in the oral health context, mostly in the past decade (2010 onwards; 65.8%, 173 publications). The dimension of key consideration was "health and ADLs" (activities of daily living); this dimension appeared in 97.3% of publications (n = 256) and was found earliest to emerge, with the greatest link strengths compared to other dimensions. Country-level variations in citation data were observed, and there was good citation interconnectedness between them. Key oracles for dissemination have been medical rather than dental-specific journals. Amongst authors, there was considerable interconnectedness in the field. CONCLUSIONS Findings highlight how successful ageing in the oral health context has been studied, with implications for addressing the significance of oral health to older peoples' lives in line with the WHO and UN's agenda. Citation analyses identified the "known unknowns" area for further consideration, and these findings have the potential to inform how dental research may best move forward with the successful ageing agenda to bring about translational impact.
Collapse
Affiliation(s)
- Colman McGrath
- Applied Oral Sciences and Community Dental Care Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China.
| | - Rita P C Suen
- Applied Oral Sciences and Community Dental Care Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - May C M Wong
- Applied Oral Sciences and Community Dental Care Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Andy W K Yeung
- Applied Oral Sciences and Community Dental Care Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Gerry McKenna
- Restorative Dentistry Department, School of Dentistry, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| | - Ciaran Moore
- Restorative Dentistry Department, School of Dentistry, Royal Victoria Hospital, Belfast, Northern Ireland, UK
| |
Collapse
|
3
|
Flores-Ortiz R, Fiaccone RL, Leyland A, Millett C, Hone T, Schmidt MI, Ferreira AJF, Ichihara MY, Teixeira C, Sanchez MN, Pescarini J, Aquino EML, Malta DC, Velasquez-Melendez G, de Oliveira JF, Craig P, Ribeiro-Silva RC, Barreto ML, Katikireddi SV. Subsidised housing and diabetes mortality: a retrospective cohort study of 10 million low-income adults in Brazil. BMJ Open Diabetes Res Care 2023; 11:e003224. [PMID: 37349106 PMCID: PMC10314413 DOI: 10.1136/bmjdrc-2022-003224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 05/29/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Housing-related factors can be predictors of health, including of diabetes outcomes. We analysed the association between subsidised housing residency and diabetes mortality among a large cohort of low-income adults in Brazil. RESEARCH DESIGN AND METHODS A cohort of 9 961 271 low-income adults, observed from January 2010 to December 2015, was created from Brazilian administrative records of social programmes and death certificates. We analysed the association between subsidised housing residency and time to diabetes mortality using a Cox model with inverse probability of treatment weighting and regression adjustment. We assessed inequalities in this association by groups of municipality Human Development Index. Diabetes mortality included diabetes both as the underlying or a contributory cause of death. RESULTS At baseline, the mean age of the cohort was 40.3 years (SD 15.6 years), with a majority of women (58.4%). During 29 238 920 person-years of follow-up, there were 18 775 deaths with diabetes as the underlying or a contributory cause. 340 683 participants (3.4% of the cohort) received subsidised housing. Subsidised housing residents had a higher hazard of diabetes mortality compared with non-residents (HR 1.17; 95% CI 1.05 to 1.31). The magnitude of this association was more pronounced among participants living in municipalities with lower Human Development Index (HR 1.30; 95% CI 1.04 to 1.62). CONCLUSIONS Subsidised housing residents had a greater risk of diabetes mortality, particularly those living in low socioeconomic status municipalities. This finding suggests the need to intensify diabetes prevention and control actions and prompt treatment of the diabetes complications among subsidised housing residents, particularly among those living in low socioeconomic status municipalities.
Collapse
Affiliation(s)
- Renzo Flores-Ortiz
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Rosemeire L Fiaccone
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Institute of Mathematics, Federal University of Bahia, Salvador, Brazil
| | | | - Christopher Millett
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Thomas Hone
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Maria Inês Schmidt
- Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrêa J F Ferreira
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Maria Y Ichihara
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Camila Teixeira
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Mauro N Sanchez
- Tropical Medicine Center, University of Brasilia, Brasília, Brazil
| | - Julia Pescarini
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
| | - Estela M L Aquino
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Deborah C Malta
- Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Juliane Fonseca de Oliveira
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Center of Mathematics of University of Porto (CMUP), University of Porto, Porto, Portugal
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rita C Ribeiro-Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Mauricio L Barreto
- Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Bahia, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | | |
Collapse
|
4
|
Kreutz IM, Santos IS. Contextual, maternal, and infant factors in preventable infant deaths: a statewide ecological and cross-sectional study in Rio Grande do SUL, Brazil. BMC Public Health 2023; 23:87. [PMID: 36631798 PMCID: PMC9835378 DOI: 10.1186/s12889-022-14913-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Ending preventable deaths of newborns and children under five by 2030 is among the United Nations Sustainable Development Goals. This study aimed to describe infant mortality rate due to preventable causes in Rio Grande do Sul (RS), the Southernmost state in Brazil. With 11,329,605 inhabitants and 141,568 live births in 2017, RS was the fifth most populous state in the country. METHOD An ecological and cross-sectional statewide study, with data extracted from records of the Mortality Information System, Death Certificates, and Live Birth Certificates for the year 2017. Preventability was estimated by applying the List of Causes of Deaths Preventable through Intervention of SUS (acronym for Sistema Unico de Saude - Brazilian Unified Health System) Intervention. Rates of preventable infant mortality (PIMR), preventable early neonatal mortality (PENMR), preventable late neonatal mortality (PLNMR), and preventable post-neonatal mortality (PPNMR) per 1000 live births (LB) were quantified. Incidence ratios, according to contextual characteristics (human development index of the health region and of the municipality; Gini index of the municipality), maternal characteristics at the time of delivery (age, education, self-reported skin color, presence of a partner, number of antenatal care consultations, and type of delivery), and characteristics of the child at the time of birth (gestational age, weight, and pregnancy type) were calculated. RESULTS In 2017, there were 141,568 live births and 1425 deaths of infants younger than 1 year old, of which 1119 were preventable (PIMR = 7.9:1000 LB). The PENMR, PLNMR, and PPNMR were 4.1:1000 LB; 1.5:1000 LB; and 2.3:1000 LB, respectively. More than 60% of deaths in the first week and 57.5% in the late neonatal period could be reduced through adequate care of the woman during pregnancy. The most frequent preventable neonatal causes were related to prematurity, mainly acute respiratory syndrome, and non-specified bacterial septicemia. In the post-neonatal period, 31.8% of deaths could be prevented through adequate diagnostic and treatment. CONCLUSIONS The strategies needed to reduce preventable infant deaths should preferably focus on preventing prematurity, through adequate care of the woman during pregnancy.
Collapse
Affiliation(s)
- Ivete Maria Kreutz
- grid.412519.a0000 0001 2166 9094Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS Brazil
| | - Iná S. Santos
- grid.412519.a0000 0001 2166 9094Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Escola de Medicina, Programa Pós-graduação Pediatria e Saúde da Criança, Porto Alegre, RS Brazil ,grid.411221.50000 0001 2134 6519Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS Brazil
| |
Collapse
|
5
|
Tanisaka LS, Oliveira FR, de Alcantara Sousa LV, de Abreu LC, Adami F, da Silva Paiva L. Changes in childhood stroke mortality from 1990 to 2019 in Brazil and its federative units. Sci Rep 2022; 12:20757. [PMID: 36456606 PMCID: PMC9715677 DOI: 10.1038/s41598-022-24761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
This research analyzed the temporal trend of stroke mortality in children aged 0-14 years, from 1990 to 2019, in Brazil and its federative units. This ecological study used data from the Global Burden of Disease, a study led by the Institute for Health Metrics and Evaluation. Stroke definition considered the International Classification of Diseases according to codes G45, G46, and I60-I69. Age-standardized mortality rates and the mean annual percentage change (APC) in mortality rates were estimated. Stroke mortality trends decreased, with an APC of - 3.9% (95% CI - 4.5; - 3.3; p < 0.001). Reducing trends were found in all but two states, where they were stationary. Maranhão (- 6.5%; 95% CI - 7.6; - 5.4; p < 0.001) had the greatest reduction and Rondônia, the smallest (- 1.2%; 95% CI - 2.3; - 0.1, p = 0.027). Decrease was more important in children < 5 (- 5.8%; 95% CI - 6.3; - 5.2; p < 0.001) compared to 5-14 years old (- 2.1%; 95% CI - 2.9; - 1.3; p < 0.001); additionally, it was greater in girls (- 4.1%; 95% CI - 4.6; - 3.5; p < 0.001) than in boys (- 3.8%; 95% IC - 4.5; - 3.1; p < 0.001). Ischemic stroke had the highest APC (- 6.1%; 95% CI - 6.8; - 5.3; p < 0.001), followed by intracranial hemorrhage (- 5.3%; 95% CI - 6.1; - 4.5; p < 0.001) and subarachnoid hemorrhage (- 2.7%; 95% CI - 3.3; - 2.1; p < 0.001). Largest reductions were seen in states with more vulnerable socioeconomic contexts. The stationary trends and lowest APCs were concentrated in the northern region, which had greater impact of diseases and less favorable outcomes.
Collapse
Affiliation(s)
- Laura Silveira Tanisaka
- Present Address: Laboratório de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Avenida Lauro Gomes, 2000 – Vila Sacadura Cabral, Santo André, SP 09060-870 Brazil
| | - Fernando Rocha Oliveira
- grid.11899.380000 0004 1937 0722Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP Brazil
| | - Luiz Vinicius de Alcantara Sousa
- Present Address: Laboratório de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Avenida Lauro Gomes, 2000 – Vila Sacadura Cabral, Santo André, SP 09060-870 Brazil
| | - Luiz Carlos de Abreu
- grid.10049.3c0000 0004 1936 9692School of Medicine, University of Limerick, Limerick, Ireland ,Present Address: Laboratório de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Avenida Lauro Gomes, 2000 – Vila Sacadura Cabral, Santo André, SP 09060-870 Brazil
| | - Fernando Adami
- Present Address: Laboratório de Epidemiologia e Análise de Dados do Centro Universitário FMABC, Avenida Lauro Gomes, 2000 – Vila Sacadura Cabral, Santo André, SP 09060-870 Brazil
| | - Laércio da Silva Paiva
- grid.11899.380000 0004 1937 0722Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, SP Brazil
| |
Collapse
|