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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.
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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
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Gerk A, Rosendo A, Telles L, Miranda AG, Carroll M, Trindade BO, Motter SB, Freire E, Hyman G, Ferreira J, Botelho F, Ferreira R, Mooney DP, Bustorff-Silva J. Social determinants of gastrointestinal malformation mortality in Brazil: a national study. WORLD JOURNAL OF PEDIATRIC SURGERY 2024; 7:e000759. [PMID: 38779587 PMCID: PMC11110575 DOI: 10.1136/wjps-2023-000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction In Brazil, approximately 5% are born with a congenital disorder, potentially fatal without surgery. This study aims to evaluate the relationship between gastrointestinal congenital malformation (GICM) mortality, health indicators, and socioeconomic factors in Brazil. Methods GICM admissions (Q39-Q45) between 2012 and 2019 were collected using national databases. Patient demographics, socioeconomic factors, clinical management, outcomes, and the healthcare workforce density were also accounted for. Pediatric Surgical Workforce density and the number of neonatal intensive care units in a region were extracted from national datasets and combined to create a clinical index termed 'NeoSurg'. Socioeconomic variables were combined to create a socioeconomic index termed 'SocEcon'. Simple linear regression was used to investigate if the temporal changes of both indexes were significant. The correlation between mortality and the different indicators in Brazil was evaluated using Pearson's correlation coefficient. Results Over 8 years, Brazil recorded 12804 GICM admissions. The Southeast led with 6147 cases, followed by the Northeast (2660), South (1727), North (1427), and Midwest (843). The North and Northeast reported the highest mortality, lowest NeoSurg, and SocEcon Index rates. Nevertheless, mortality rates declined across regions from 7.7% (2012) to 3.9% (2019), a 51.7% drop. The North and Midwest experienced the most substantial reductions, at 63% and 75%, respectively. Mortality significantly correlated with the indexes in nearly all regions (p<0.05). Conclusion Our study highlights the correlation between social determinants of health and GICM mortality in Brazil, using two novel indexes in the pediatric population. These findings provide an opportunity to rethink and discuss new indicators that could enhance our understanding of our country and could lead to the development of necessary solutions to tackle existing challenges in Brazil and globally.
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Affiliation(s)
- Ayla Gerk
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Amanda Rosendo
- Department of Surgery, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Luiza Telles
- Instituto de Educação Médica (IDOMED/Estácio, Campus Vista Carioca), Rio de Janeiro, Brazil
| | - Arícia Gomes Miranda
- Faculty of Medicine, Universidade Federal do Delta do Parnaiba, Parnaíba, Piauí, Brazil
| | - Madeleine Carroll
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Sarah Bueno Motter
- Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
| | | | - Gabriella Hyman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Julia Ferreira
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Roseanne Ferreira
- Department of Health Research Methods, McMaster University, Hamilton, Southern Ontario, Canada
| | - David P Mooney
- Department of Pediatric Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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Borboudaki L, Linardakis M, Tsiligianni I, Philalithis A. Utilization of Health Care Services and Accessibility Challenges among Adults Aged 50+ before and after Austerity Measures across 27 European Countries: Secular Trends in the SHARE Study from 2004/05 to 2019/20. Healthcare (Basel) 2024; 12:928. [PMID: 38727485 PMCID: PMC11083176 DOI: 10.3390/healthcare12090928] [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: 03/15/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services.
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Affiliation(s)
- Lena Borboudaki
- Department of Social Medicine, School of Medicine, University of Crete, 71500 Heraklion, Greece; (M.L.); (I.T.); (A.P.)
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Resende H, Arai RJ, Barrios CH, Schwyter F, Teich NLS, Gomes A, Dallari AB, Bonilha LAS, Souza CMA, Francisco FR, Munhoz RR, Werutsky G, Madi M, Fernandes P, Figueiredo JM, Fedozzi F, Arruda L, Aguiar VQ, Melo AC. Improving access to cancer clinical research in Brazil: recent advances and new opportunities. Expert opinions from the 4th CURA meeting, São Paulo, 2023. Ecancermedicalscience 2024; 18:1698. [PMID: 38774565 PMCID: PMC11108048 DOI: 10.3332/ecancer.2024.1698] [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: 02/05/2024] [Indexed: 05/24/2024] Open
Abstract
Clinical research is the cornerstone of improvements in cancer care. However, it has been conducted predominantly in high-income countries with few clinical trials available in Brazil and other low-and-middle-income countries (LMIC). Of note, less than one-third of registered clinical trials addressing some of the most commonly diagnosed cancers (breast, lung and cervical) recruited patients from LMIC in the last years. The Institute Project CURA promoted the fourth CURA meeting, discussing barriers to cancer clinical research and proposing potential solutions. A meeting was held in São Paulo, Brazil, in June 2023 with representatives from different sectors: Brazilian Health Regulatory Agency (Anvisa), National Commission of Ethics in Research (CONEP), non-governmental organisations, such as the Latin American Cooperative Oncology Group, the Brazilian Society of Clinical Oncology (SBOC), Contract Research Organisations, pharmaceutical companies and investigators. A total of 16 experts pointed out achievements as shortening the time of regulatory processes involving Anvisa and CONEP, development of staff training programs, maintenance of the National Program of Oncological Attention (PRONON), and the foundation of qualified centres in North and Northeast Brazilian regions. Participants also highlighted the need to be more competitive in the field, which requires optimising ongoing policies and implementing new strategies as decentralisation of clinical research centres, public awareness campaigns, community-centered approaches, collaborations and partnerships, expansion of physicians-directed policies, exploring the role of the steering committee. Active and consistent reporting of the initiatives might help to propagate ongoing advances, increasing Brazilian participation in clinical cancer research. Engagement of all players is crucial to maintain continuous progress with further improvements in critical points including regulatory timelines and increments in qualified human resources which aligned with new educational initiatives focused on physicians and the general population will expand access to cancer clinical trials in Brazil.
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Affiliation(s)
- Heloisa Resende
- Instituto Projeto Cura, São Paulo 05507-020, SP, Brazil
- https://orcid.org/0000-0003-4692-3743
| | - Roberto J Arai
- Independent Clinical Researcher, São Paulo 01153-000, SP, Brazil
- https://orcid.org/0000-0001-5617-1042
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
- https://orcid.org/0000-0001-6021-667X
| | | | - Nelson L S Teich
- Instituto Teich de Políticas Públicas em Saúde, Rio de Janeiro 22640-102, RJ, Brazil
- https://orcid.org/0000-0003-1352-1334
| | - Andre Gomes
- Bristol Myers Squibb, São Paulo 04719-002, SP, Brazil
| | | | - Laís A S Bonilha
- Comissão Nacional de Ética em Pesquisa (CONEP), Brasília 70719-040, DF, Brazil
| | | | - Fernando R Francisco
- Associação Brasileira de Organizações Representativas de Pesquisa Clínica- Abracro, São Paulo 01311-902, SP, Brazil
| | - Rodrigo R Munhoz
- Hospital Sírio Libanês, São Paulo 01308-050, SP, Brazil
- https://orcid.org/0000-0001-8898-2798
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre 90619-900, RS, Brazil
- https://orcid.org/0000-0001-6271-105X
| | - Marisa Madi
- Sociedade Brasileira de Oncologia Clínica (SBOC), São Paulo 01311-300, SP, Brazil
- https://orcid.org/0000-0003-1049-4932
| | - Paulo Fernandes
- Associação Brasileira de Organizações Representativas de Pesquisa Clínica- Abracro, São Paulo 01311-902, SP, Brazil
- Sail for Health, São Paulo 04543-011, SP, Brazil
| | | | - Fabio Fedozzi
- Associação Brasileira de Linfoma e Leucemia, ABRALE, São Paulo 05423-040, SP, Brazil
| | - Lilian Arruda
- Hospital São Camilo, São Paulo 05022-001, SP, Brazil
- https://orcid.org/0000-0002-7101-4325
| | - Vinícius Q Aguiar
- Centro Universitário de Volta Redonda – UNIFOA, Volta Redonda 27240-560, RJ, Brazil
- https://orcid.org/0000-0002-6257-0119
| | - Andreia C Melo
- Brazilian National Cancer Institute (INCA), Division of Clinical Research and Technological Development, Rio de Janeiro 20230-130, RJ, Brazil
- https://orcid.org/0000-0002-1201-4333
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Mrejen M, Nunes L, Giacomin K. Socioeconomic inequalities in health and healthcare utilization among the elderly in Brazil: results from the 2019 National Health Survey. Public Health 2024; 226:165-172. [PMID: 38071949 DOI: 10.1016/j.puhe.2023.11.015] [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: 08/18/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES To assess socioeconomic-related inequalities in health and healthcare utilization among the elderly in Brazil. STUDY DESIGN Cross-sectional nationally representative household-based survey. METHODS We evaluated the Brazilian National Health Survey data collected in 2019. We computed the prevalence of measures of health conditions and healthcare utilization by age-bracket and markers of socioeconomic status-income, educational attainment, and race/ethnicity-among individuals aged 60 or older. We further employed logistic regression models, adjusted for a wide set of covariates, to estimate the relationship between socioeconomic status and those outcomes. RESULTS Higher-income and more educated individuals exhibit better health conditions compared to their lower-income and less-educated counterparts within each age bracket. Results from regression models showed strong associations with income and educational attainment for most health conditions: health status, physical activity, difficulties with activities of daily living and instrumental activities of daily living, and depression. For most conditions, weaker or no associations with race/ethnicity were found. Individuals in the highest income quintile and that completed higher education also had higher odds of having consulted a physician, while high-income individuals had lower odds of having received emergency care at home. CONCLUSIONS The findings of this study highlight the significant socioeconomic inequalities in the health of the elderly population in Brazil. The substantial and pervasive nature of these inequalities stresses the need for action to address them.
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Affiliation(s)
- M Mrejen
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, SP, Brazil.
| | - L Nunes
- Insper, São Paulo, SP, Brazil
| | - K Giacomin
- NESPE, FIOCRUZ/UFMG, Belo Horizonte, MG, Brazil
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Juvakoski A, Rantanen H, Mulas M, Corona F, Vahala R, Varis O, Mellin I. Evidence of waste management impacting severe diarrhea prevalence more than WASH: An exhaustive analysis with Brazilian municipal-level data. WATER RESEARCH 2023; 247:120805. [PMID: 37976622 DOI: 10.1016/j.watres.2023.120805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
Adequate housing protects from diarrhea, which is a substantial health concern in low- and middle-income countries. The purpose of this study was to quantify the relationship between severe diarrhea and housing features at the municipal level to help in public health planning. Regression analyses were performed on annual (2000-2012) datasets on Brazilian municipalities (5570) in six household feature categories (e.g., waste management) and four severe diarrhea outcomes (e.g., diarrhea deaths of under-5 children). Household data were not available elsewhere of this magnitude and granularity, highlighting the scientific value-add of this study. Municipalities were clustered prior to regression analysis because of data heterogeneity. The compositional household feature data were also subjected to principal component analysis to diminish feature variable multicollinearity. The highest explanatory power was found for diarrhea deaths of under-5 children (R2 = 10-22 %), while those in the over-5 population were the least best explained (R2 = 0.3-7 %). Household features predicted diarrhea outcomes more accurately in the "advanced" housing municipality cluster (R2 = 16-22 %) than in the "mid-level" (R2 = 7-20 %) and "basic" (R2 = 6-12 %) ones (over-5 diarrhea deaths excluded). Under-5 children's diarrhea death prevalence was three times higher in the "basic" cluster than in the "advanced" cluster. Importantly, the impact of waste management was overall the largest of all household features, even larger than those of WASH, i.e., water supply, sanitation, and household drinking water treatment. This is surprising in the context of existing literature because WASH is generally regarded as the most important household factor affecting gastrointestinal health. In conclusion, public health interventions could benefit from customizing interventions for diarrhea outcomes, municipality types, and household features. Waste management's identified stronger association with diarrhea compared to WASH may have important implications beyond the water field and Brazil.
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Affiliation(s)
- Anni Juvakoski
- Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland.
| | | | - Michela Mulas
- Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland; Department of Teleinformatics Engineering, Federal University of Ceará, Campus do Pici, Fortaleza, Brazil
| | - Francesco Corona
- Department of Chemical and Metallurgical Engineering, Aalto University, PO Box 16100, Espoo, FI-00076, Aalto, Finland
| | - Riku Vahala
- Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland
| | - Olli Varis
- Department of Built Environment, Aalto University, PO Box 15200, FI-00076, Aalto, Finland
| | - Ilkka Mellin
- Department of Mathematics and Systems Analysis, Aalto University, PO Box 11100, FI-00076, Aalto, Finland
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Moncayo AL, Pescarini JM. Cash transfers: addressing barriers for people living with disabilities. Lancet Public Health 2023; 8:e910-e911. [PMID: 38000885 DOI: 10.1016/s2468-2667(23)00243-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 11/26/2023]
Affiliation(s)
- Ana L Moncayo
- Centro de Investigación para la Salud en América Latina (CISeAL), Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Julia M Pescarini
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundacao Oswaldo Cruz, Salvador, Brazil.
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