[Time trends in death rates from homicides in the city of Sao Paulo, Brazil, 1979-1994]

Padrão espacial e diferencial de renda dos domicílios de adolescentes e adultos jovens vítimas de traumatismo maxilofacial por agressão com arma de fogo

Resumo O estudo investigou o padrão espacial dos casos de traumatismo maxilofacial decorrentes de agressão com arma de fogo em adolescentes e adultos jovens a partir do local de domicílio das vítimas e analisou comparativamente os diferenciais de renda dessas áreas. Estudo transversal com dados de vítimas atendidas em três hospitais de Belo Horizonte-MG, entre janeiro de 2008 e dezembro de 2010. Endereços foram georeferenciados por geocodificação. Tendências de aleatoriedade e densidade de pontos foram analisadas por Função K de Ripley e mapas de Kernel. A interação espacial entre os domicílios de adolescentes e adultos jovens foi verificada através da Função K12. Encontrouse registros de 218 casos de agressão com arma de fogo, com predomínio do sexo masculino (89,9%) e adultos jovens (70,6%). Os domicílios se distribuíram de forma agregada no espaço urbano com nível de confiança de 99% e níveis de agregação espacial semelhantes. Os clusters de domicílios convergiram para 7 favelas ou regiões vizinhas com população de maior renda revelando propagação de eventos. Os hotspots se concentraram em favelas com histórico de crimes ligados ao narcotráfico. A incorporação do espaço na dinâmica dos eventos mostrou que a condição econômica isoladamente não limitou a vitimização.

[Deaths by homicide in Mexico: trends, socio-geographical variations and associated factors]

This study seeks to analyze the trend of homicide rates (total and by firearm) in Mexico between 1990 and 2009 and identify the variables that best explain the geographical variations of these rates in the 2008-2009 two-year period. Homicide rates, adjusted for age, were calculated for both sexes between 1990 and 2009 and for each state in 2008-2009. Factors associated with the interstate variations in the homicide rates were identified using multiple linear regression analysis. Results show that the homicide rate in Mexico decreased between 1990 and 2007, but doubled over the last two years (from 7.6 to 16.6 per 100,000). In 2009, the male homicide rate was almost 9 times higher than the female rate and about two-thirds of homicides involved firearms. Multivariate analysis reveals that impunity, drug trafficking, alcohol and drug consumption and school dropout in basic education - in that order - are key factors for understanding the geographical variations in homicide rates in Mexico in 2008-2009. Findings suggest that to reduce the number of homicide victims and spatial variations in the rate, it is necessary not only to fight the drug cartels, but above all to implement structural reforms in the criminal justice system and reduce the socioeconomic disparities among states.

Mortalidade feminina e anos de vida perdidos por homicídio/agressão em capital brasileira após promulgação da Lei Maria da Penha

A violência contra a mulher é um fenômeno que atinge todas as pessoas, em todas as partes do mundo. No Brasil, no ano de 2006, entra em vigor a Lei n. 11.340/2006, batizada como Lei Maria da Penha, com a função basilar de coibir a violência doméstica, familiar e afetiva. O objetivo deste estudo foi comparar a mortalidade feminina por agressão/homicídio, antes e após a implantação da lei, em Rio Branco, Acre. Para tanto, foi realizado um estudo ecológico com vítimas de agressão e homicídios registrados no Sistema de Informação de Mortalidade, de 2002 a 2010. As mulheres vítimas de homicídio tinham entre 21 e 25 anos de idade (28,6%), baixo nível de escolaridade (39,3%) e estavam sem ocupação (64,3%). A incidência de óbitos apresentou declínio seguido de aumento nos últimos dois anos, com reflexo nos Anos Potenciais de Vida Perdidos na faixa etária de 16 a 39 anos. A Lei Maria da Penha é uma realidade no país e tem papel relevante na sociedade, por isso, deve ser analisada em pesquisas quanto a sua efetividade e influência.

Tendência da mortalidade por homicídios em Belo Horizonte e região metropolitana: 1980-2005

OBJETIVO: Analisar a evolução das taxas de mortalidade por homicídio em Belo Horizonte e Região Metropolitana no período de 1980 a 2005. MÉTODOS: Estudo de série temporal, cujos dados sobre óbitos foram obtidos do Sistema de Informações sobre Mortalidade e as estimativas populacionais segundo sexo, idade e anos-calendário, do Instituto Brasileiro de Geografia e Estatística. Os coeficientes específicos de mortalidade, segundo sexo e faixa etária, foram calculados anualmente para cada região geográfica. A análise de tendência foi realizada por meio da construção de modelos de regressão polinomial para séries históricas, adotando-se nível de significância de 0,05. RESULTADOS: Houve elevada magnitude das taxas de mortalidade por homicídios em Belo Horizonte e Região Metropolitana, principalmente para o sexo masculino, permitindo identificar, em relação à tendência secular, crescimento acelerado dessas taxas em ambos os sexos e em quase todas as faixas etárias, mais expressivamente a partir do início da década de 1990, na Região Metropolitana da capital. CONCLUSÕES: Os resultados indicam a necessidade de implementação de políticas públicas conjuntas, direcionadas para o controle da violência. Recomendam-se investimentos em educação e garantia de acesso ao emprego, visando o controle da ascensão acelerada da mortalidade por homicídios, principalmente, entre os jovens do sexo masculino, residentes na Região Metropolitana.

Factors associated with infant and adolescent mortality

Few studies have described factors associated with infant and adolescent mortality since birth. We report here mortality during a 20-year period in a birth cohort from Ribeirão Preto in order to identify birth variables that influenced mortality among infants and children between 10 and 19 years of age, the main causes of death, and the influence of social inequality at birth on death. Mothers were interviewed shortly after delivery. Social, biological and demographic information was collected, and mortality up to 19 years of age was investigated in registry systems. Of the 6748 liveborn singletons born in the municipality from 1978 to 1979, 343 died before or when 19 years of age were completed. Most of the cohort mortality (74.9%) occurred during the first year of life and 19.6% occurred from 10 to 19 years. Mortality was higher among boys. Preterm birth (hazard ratio, HR = 7.94) and low birth weight (HR = 10.15) were strongly associated with infant mortality. Other risk factors for infant mortality were: maternal age (3)35 years (HR = 1.74), unskilled manual occupation of family head (HR = 2.47), and for adolescent mortality: unskilled manual occupation of family head (HR = 9.98) and male sex (HR = 6.58). "Perinatal conditions" were the main causes of deaths among infants and "external causes" among adolescents, especially boys. Socioeconomic factors at birth, represented by occupation, influenced adolescent mortality due to external causes, which was higher among boys (7:1). The influence of social inequality at birth on death, measured by occupation, was greater in adolescence than in infancy.

Causes of death among crack cocaine users

OBJECTIVE: The study accompanied 131 crack-cocaine users over a 5-year period, and examined mortality patterns, as well as the causes of death among them. METHOD: All patients admitted to a detoxification unit in Sao Paulo between 1992 and 1994 were interviewed during two follow-up periods: 1995-1996 and 1998-1999. RESULTS: After 5 years, 124 patients were localized (95%). By the study endpoint (1999), 23 patients (17.6%) had died. Homicide was the most prevalent cause of death (n = 13). Almost one third of the deaths were due to the HIV infection, especially among those with a history of intravenous drug use. Less than 10% died from overdose. CONCLUSIONS: The study suggests that the mortality risk among crack cocaine users is greater than that seen in the general population, being homicide and AIDS the most common causes of death among such individuals.

The urban environment from the health perspective: the case of Belo Horizonte, Minas Gerais, Brazil

This study aims to determine spatial patterns of mortality and morbidity for five health problems in an urban environment: homicides, adolescent pregnancy, asthma hospitalization, and two vector-borne diseases, dengue and visceral leishmaniasis. All events were obtained through the city health database and geoprocessed using residential addresses and 80 planning units consisting of census tracts. We used thematic maps, proportionate mortality/morbidity ratios by planning unit, and the overlapped rank of the 20th worse planning unit rates for each event. A spatial pattern of high rates of homicides, proportion of young mothers, and hospitalization due to asthma overlapped in socially and economically disadvantaged areas. For the two vector-borne diseases, high rates with great dispersion were found in underprivileged areas, in contrast with very low rates among higher income areas. The results indicated the coexistence of heavier disease burden for residents of urban areas where poverty and lack of effective public health policies may be modulating social health problems. For the two vector-borne diseases, an environmental intervention in one mosquito-borne disease might be playing a role in the other's incidence.

[Regional variations in homicide mortality in Jalisco, Mexico]

The present study describes regional variations in homicide rates in Jalisco State, Mexico, in 1989-1991, 1994-1996, and 1999-2000, analyzing the trends by gender and socioeconomic stratum. Using mortality data generated by the National Institute for Statistics, Geography, and Information Technology, homicide rates adjusted by age and gender were calculated, along with rate/female rate ratios; rate ratios by socioeconomic stratum and 95% confidence intervals were also calculated. According to the results, the homicide rate showed: a downward trend in the 1990s; a regional homicide mortality pattern, with the highest rates in peripheral regions, considered among the poorest areas in the State; municipalities with the lowest socioeconomic conditions also presenting a statistically significant excess homicide mortality; and an evident over-mortality from homicide among males. The results point to tasks and challenges for public health and law enforcement institutions, including the need to implement different inter-institutional policies that take into consideration the characteristics of homicide and violent crime in Jalisco.

[Homicide progression per geographical area in the State of Pernambuco, Brazil, 1980-1998]

OBJECTIVE

To analyze the magnitude and growth of homicides among male population according to the geopolitical areas.

METHODS

An ecological study including a time series analysis was carried out among 15 to 49 year-old males living in the state of Pernambuco, Brazil. Mortality data was collected from the Ministry of Health's Mortality Information System. Data on population was from the 1980 and 1991 censuses and the 1996 Brazilian Institute of Geography and Statistics' census. For inter-census years, the population size was estimated by interpolation, and for the period 1997-1998 it was estimated by projection, using the geometric method. Statistical analysis was performed using mobile mean and regression analysis techniques.

RESULTS

In the 1980s, the greatest increase in homicide rates was in the state capital (390%). In the 1990s, the greatest increase occurred in the metropolitan region (68.5%) suggesting violence spread from the capital to other municipalities of greater Recife. Homicide rates tended to grow linearly in the interior, whilst there was an exponential growth in the capital and metropolitan region. A striking feature is the high rates of homicides with firearms in the three areas.

CONCLUSIONS

The progression of homicides in the three areas of study shows a characteristic increase. It should be stressed that even though it is the same phenomenon - male homicides -, the generating dynamic of this process has geographical particularities between more urban and interior areas and they should be taken into account while developing local policies for supporting victims and preventing these events.

Desigualdades sociais e homicídios em adolescentes e adultos jovens na cidade de São Paulo em 1995

Análise das correlações entre taxas de homicídio por sexo para adolescentes (10-19 a) e adultos jovens (20 a 39 a) em São Paulo, 1995, e áreas definidas segundo indicador socioeconômico. Os 96 distritos da cidade de São Paulo foram agrupados em 5 clusters de acordo com o índice socioeconômico construído através da soma de postos atribuídos às variáveis: renda média mensal dos chefes de famílias, taxa de analfabetos (>5 anos), número médio de cômodos por domicílio e tamanho médio das famílias. Os clusters foram formados pela análise hierárquica por proximidade de vizinhança baseada no cálculo da distância euclidiana para contagens (Programa SPSS). As taxas de homicídio segundo idade e sexo foram calculadas para cada cluster. A correlação de Spearman e o valor de R² foram calculados para cada grupo de idade e sexo. As taxas de homicídios são altas tanto para homens quanto para mulheres, entretanto, o risco é de 12 a 19 vezes maior para os homens, conforme a faixa etária. Há forte correlação negativa entre as taxas de homicídio e o índice socioeconômico (r = -0,81) em todos os grupos analisados. Parte importante das diferenças entre as taxas pode ser atribuída às condições socioeconômicas das áreas de residência (R² = 0,65). Os grupos mais afetados foram os homens de 20 a 29 anos, residentes nas áreas intermediárias ou periféricas da cidade Comparados ao anel central os RR são: 1,7 no anel intermediário interno; 1,9 no anel intermediário externo; 2,8 no anel periférico interno e 4 no anel periférico externo.