Geographical patterns of proportionate mortality for the most common causes of death in Brazil

Reddy S, P. Socal M, Schumacher-Schuh AF, Mello Rieder CR. Occupational pesticide exposure and the risk of death in patients with Parkinson's disease: an observational study in southern Brazil

BACKGROUND

Multiple studies have suggested that various pesticides are associated with a higher risk of developing Parkinson's disease (PD) and may influence the progression of the disease. However, the evidence regarding the impact of pesticide exposure on mortality among patients with PD is equivocal. This study examines whether pesticide exposure influences the risk of mortality among patients with PD in Southern Brazil.

METHODS

A total of 150 patients with idiopathic PD were enrolled from 2008 to 2013 and followed until 2019. In addition to undergoing a detailed neurologic evaluation, patients completed surveys regarding socioeconomic status and environmental exposures.

RESULTS

Twenty patients (13.3%) reported a history of occupational pesticide exposure with a median duration of exposure of 10 years (mean = 13.1, SD = 11.2). Patients with a history of occupational pesticide exposure had higher UPDRS-III scores, though there were no significant differences in regards to age, sex, disease duration, Charlson Comorbidity Index, and age at symptom onset. Patients with occupational pesticide exposure were more than twice as likely to die than their unexposed PD counterparts (HR = 2.32, 95% CI [1.15, 4.66], p = 0.018). Occupational pesticide exposure was also a significant predictor of death in a cox-proportional hazards model which included smoking and caffeine intake history (HR = 2.23, 95% CI [1.09, 4.59], p = 0.03)) and another which included several measures of socioeconomic status (HR = 3.91, 95% CI [1.32, 11.58], p = 0.01).

CONCLUSION

In this prospective cohort study, we found an increased all-cause mortality risk in PD patients with occupational exposure to pesticides. More studies are needed to further analyze this topic with longer follow-up periods, more detailed exposure information, and more specific causes of mortality.

Path of infectious diseases in Brazil in the last 50 years: an ongoing challenge

In this article, we comment on the main features of infectious diseases in Brazil in the last 50 years, highlighting how much of this path Revista de Saúde Pública could portray. From 1967 to 2016, 1,335 articles focusing on infectious diseases were published in Revista de Saúde Pública. Although the proportion of articles on the topic have decreased from about 50.0% to 15.0%, its notability remained and reflected the growing complexity of the research required for its control. It is noteworthy that studies design and analysis strategies progressively became more sophisticated, following the great development of epidemiology in Brazil in the recent decades. Thus, the journal has followed the success of public health interventions that permitted to control or eliminate numerous infectious diseases - which were responsible, in the past, for high rates of morbidity and mortality -, and also followed the reemergence of diseases already controlled and the emergence of until then unknown diseases, with a strong impact on the Brazilian population, establishing a little predictable and very challenging path. RESUMO Neste artigo, comentamos as principais características das doenças infecciosas no Brasil, nos últimos 50 anos, destacando o quanto a Revista de Saúde Pública conseguiu capturar essa trajetória. De 1967 a 2016, foram publicados 1.335 artigos na Revista de Saúde Pública com foco em doenças infecciosas. Ainda que a proporção de artigos sobre esse tema tenha declinado de cerca de 50,0% para 15,0%, seu destaque se manteve e refletiu a crescente complexidade das pesquisas necessárias para o seu controle. Nota-se que os desenhos dos estudos e as estratégias de análise ganharam progressivamente maior sofisticação, acompanhando o grande desenvolvimento da epidemiologia no Brasil, nas últimas décadas. Assim, foi registrado não apenas o sucesso de intervenções de saúde pública que permitiram o controle ou a eliminação de inúmeras doenças infecciosas responsáveis, no passado, por elevadas taxas de morbimortalidade, como também a reemergência de males já controlados e o surgimento de doenças até então desconhecidas, com forte impacto na população brasileira, desenhando uma trajetória pouco previsível e muito desafiadora.

Geographic correlation between deprivation and risk of meningococcal disease: an ecological study

Background

Meningitis caused by Neisseria meningitidis is a serious infection which is most common in young children and adolescents. This study investigated the relationships between the incidence and age distribution of meningococcal disease, and socioeconomic environment.

Methods

An ecological design was used, including mapping using a Geographical Information System (GIS) at census ward level.

Results

Incidence of meningococcal disease was highest in the most deprived wards, with a relative risk of 1.97 (1.55 – 2.51). Mapping revealed geographical coincidence of deprivation and meningococcal disease, particularly in urban areas. Two-thirds of the increased incidence was due to cases in the under fives.

Conclusions

The results suggest that area deprivation is a risk factor for meningococcal disease, and that its effects are seen most in young children.

Income inequality, illiteracy rate, and life expectancy in Brazil

OBJECTIVES

The link between income disparities and health has been studied mostly in developed nations. This study assesses the relationship between income disparities and life expectancy in Brazil and measures the impact of illiteracy rates on the association.

METHODS

The units of analysis (n = 27) are all the Brazilian states and the federal capital. Simple and multiple linear regressions were performed to measure the association between income disparity, measured by the Gini coefficient, gross domestic product (GDP) per capita, and illiteracy rate. Data came from publicly available sources at the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics.

RESULTS

Income disparities and illiteracy rates were negatively associated with life expectancy in Brazil. GDP per capita was positively associated with life expectancy. The inclusion of illiteracy rates in the regression model removed the effect of income disparities.

CONCLUSIONS

Illiteracy rate is strongly associated with life expectancy in Brazil. This finding is in accord with reports from the United States and has implications for health policy and planning for both developed and developing countries.

Beta - caroteno e câncer

Há mais de vinte anos tem-se pesquisado sobre a relação entre β-caroteno e câncer. Inúmeros trabalhos têm tentado esclarecer a hipótese, formulada a partir de achados epidemiológicos e experimentais, de que o carotenóide poderia agir como anticarcinogênico de origem alimentar. Estudos epidemiológicos observacionais, tipo caso-controle e coorte, sugerem que o consumo elevado de frutas e vegetais ricos em β-caroteno reduz o risco de câncer, especialmente de pulmão. Estudos de intervenção em humanos, administrando doses farmacológicas crônicas a milhares de indivíduos, têm demonstrado resultados contraditórios. Pesquisas em animais experimentais e em cultura de células apontam o carotenóide como quimiopreventivo, agindo sobretudo como retinóides, através de conversão metabólica extra-intestinal e como antioxidante de membrana. Conclui-se que o β-caroteno pode proteger contra o câncer, quando suplementado em doses fisiológicas, isto é, cerca de 4 a 6mg/dia. Doses farmacológicas crônicas não estão recomendadas para indivíduos saudáveis e particularmente para tabagistas.

Diet and mortality from common cancers in Brazil: an ecological study

A prospective ecological evaluation of mortality from common malignancies with dietary risk factors and alcohol consumption was carried out among 10 state capitals of Brazil. Regression analysis was used to examine the association of dietary intake with mortality rates of the most common cancers among adults age 30 years and older. Age-adjusted cancer mortality rates varied 2.4 to 3.3 fold across the state capitals. A positive relationship was observed between energy intake and colon, lung, and esophageal cancer (p</=0.02 for each). Colon cancer mortality was positively associated with consumption of total fat, eggs, alcohol, mate tea, cereals, and vegetables (p</=0.01). Lung cancer was positively associated with mate and cereal intake (p<0.05). Stomach cancer was associated with consumption of eggs (p=0.04); and negatively associated with consumption of high fiber foods, fruits, and vitamin A and C (p</=0.05). Esophageal cancer was positively associated with fat intake, mate and cereals (p</=0.05) and negatively associated with vitamin A (p=0.02); prostate cancer was negatively associated with vitamin C (p=0.007). Breast cancer was not associated with any of the factors studied. The marked variation in cancer mortality rates in Brazil may be partially related to the high variation in dietary components or other diet associated factors.