Ageing and inequality: unintentional death in the elderly in Campinas in the 21st century

According to WHO falls are the second leading cause of preventable unintentional death and people older than 65 years of age are more likely to suffer from fatal falls. Low and middle-income countries are most affected with 80% of fall related deaths. This study provides an overall view of fall-related deaths in the city of Campinas, Brazil, with special attention to the elderly in the last 2 decades. This study aims to highlight the unequal distribution of deaths related to fall, concerning the elderly in Campinas (total population of around 1,000,000), which in 2010 had a very high Human Develop Index (0.805), but also a very high inequality rate (Gini index of 0.56 in 2010).

This ecological study in Campinas evaluates fall-related deaths in the elderly between years 2000 and 2018. Trend analysis were applied to the specific mortality ratios related to falls obtained from Brazil's official databases. Specific mortality trends were also analyzed regarding Human Development Index by neighborhood. The number of deaths due to fall in the elderly throughout the period totaled 1700 (1 million of population). The annual average was 85 (minimum of 31 in 2000 and maximum of 157 in 2018). Although trend analysis of mortality in the elder due to “overall external causes” and of mortality due to “fall in the elderly” didn't show clear growing tendencies (R2=0.546 and R2=0.622), the ratio between “number of deaths due to fall in the elderly” and “total deaths due to fall” shows a reliable average of 1.17% increase per year (from 3.73% in 2000 to 26.03% in 2018, R2=0.93). Trend-analysis based on community HDI mortality rates additionally shows a tendency of increase both in “number of deaths” and “mortality rate” in low-HDI elder (with R2=0.85 and R2=0.786).

Despite decreasing violence levels in Campinas, fatal deaths due to fall seem to target low-HDI elder population. Effort must be taken in all levels of the healthcare system as well as in policies to soften inequality's effect.

Key messages

Violent, unintentional causes of death in the elderly population are increasing along with population ageing. Politicians and health managers must pay attention to inequality-related health problems and take into account population ageing for a sustainable universal health system coverage.

Different settings of violence and risk factor for suicide: a case-control study in Campinas, Brazil

Background

According to WHO, “800,000 people die due to suicide every year” and “is the third leading cause of death in 15-19-years-old”. And although the main risk factor to suicide is a prior attempt, this study tried to find other risk factors, which can guide a broader discussion amongst global and local communities as well as policy makers and healthcare professionals effort against all forms of violence. The aim of the study is to measure the risk of suicide in different sets of violence.

Methods

This is a case-control study held in Campinas-SP, by epiGeo research group on violence during 2019. Cases are defined as people who commited suicide; information on child abuse were collected through verbal autopsy interviews with kinships. For controls, R randomly selected addresses for interview with someone randomly selected. Odds Ratio was obtained by generalized logistic regression. Confidence Interval was set to 95%.

Results

Final analysis shows that suicides represented 14.2% of death due to external causes in 2019. A relation between male sex and suicide was observed (OR: 4.35; CI 2.55 - 7.41; p < 0.0001). Abuse during childhood also showed positive relation (RR: 2.16; CI 1.09 - 4.27; p = 0.0001). Another relation were observed in people with disabilities and suicide risk (RR: 2.04; CI 1.26 - 3.31; p = 0.004).

Conclusions

People who suffered child abuse and people with disabilities are amongst the ones who suffer higher risks of suicide, and the most probable hypothesis relating both conditions is violence. Action must be taken by the global and local communities, policy makers in a broad sense, against maltreatment, bullying, youth violence, intimate partner violence, sexual violence, emotional and psychological violence, and gender-based violence.

Key messages

Strengthening protective policy to overcome violence and abuse against child and other vulnerable people is of major importance to fight suicide risk. Accessibility and protective policies are of utmost importance to a more inclusive and welcoming society.

The socio-economical impact of work related deaths: the problem of work precarization

According to ILO, 6000 people die of work-related conditions. In Brazil, 4th in the rank of deaths related to work, 1 person day each 4 hours due to fatal accidents related to work (FARW). This study is an attempt to provide an overview on the impact of FARW in the family of the deceased workers. This is an epidemiological study, part of a research, conducted by epiGeo, in the city of Campinas, Brazil, 2015 and 2020, when the families of 73 workers (out of 82) that died of FARW were interviewed. The aim of the interviews was to evaluate the social impacts of FARW in the families, considering pre-determined parameters as follows.

Out of 73 families interviewed, 15 (20.83%) of them didn't have access to the national social compensations, due to informality. Although 58 of the workers contributed to the national social security system, only 38 (65.55%) of them had access to social security pensions due to the death of their relatives. Regarding income, 47 families (64.38%) reported impacting decrease in income, and 5 of them (6,8%) reported extreme economical hardship. In the last two years Brazilian national policy regarding work-related rights has been changing greatly. According to the Brazilian Geography and Statistics Institute (IBGE), the number of informal jobs had achieved an astonishing record number of 11.7mi workers in 2019, which can have impacts not only on the informalization and precarization of work which will also increase the difficulties to the access to the social security system rights.

Further research should be conducted to understand why people are not having access to their social security rights. Health policy makers and health personnel must be aware of the impact on workers health and working conditions, caused by work precarization legislations. The socio-economic impact of work related deaths: the problem of work precarization.

Key messages

The precarization of work caused by work-related legislative reforms can cause severe impacts on social security access. Families of workers that died of work-related fatal accidents have an important negative impact on income.