Violence deaths and its impact on life expectancy: a comparison between Mexico and Brazil

Uneven state distribution of homicides in Brazil and their effect on life expectancy, 2000-2015: a cross-sectional mortality study

OBJECTIVE

To determine cause-specific and age-specific contributions to life expectancy changes between 2000 and 2015, separately by state and sex in Brazil, with a focus on homicides.

DESIGN

Retrospective cross-sectional demographic analysis of mortality.

SETTING AND POPULATION

Brazilian population by age, sex and state from 2000 to 2015.

MAIN OUTCOME MEASURE

Using mortality data from the Brazilian Mortality Information System and population estimates from the National Statistics Office, we used death distribution methods and the linear integral decomposition model to estimate levels and changes in life expectancy. We also examine how multiple causes of death, including those attributable to homicides and amenable/avoidable mortality, contributed to these changes from 2000 to 2015.

RESULTS

Between 2000 and 2015, life expectancy in Brazil increased from 71.5 to 75.1 years. Despite state-level variation in gains, life expectancy increased in almost all states over this period. However across Brazil, homicide mortality contributed, to varying degrees, to either attenuated or decreased male life expectancy gains. In Alagoas in 2000-2007 and Sergipe in 2007-2015, homicides contributed to a reduction in life expectancy of 1.5 years, offsetting gains achieved through improvements due to medically amenable causes. In the period 2007-2015, male life expectancy could have been improved by more than half a year in 12 of Brazil's states if homicide mortality had remained at the levels of 2007.

CONCLUSIONS

Homicide mortality appears to offset life expectancy gains made through recent improvements to mortality amenable to medical services and public health interventions, with considerable subnational heterogeneity in the extent of this phenomenon. Efforts combating the causes of homicides can increase life expectancy beyond what has been achieved in recent decades.

Factors associated with healthy aging in septuagenarian and nonagenarian Mexican adults

OBJECTIVE

To examine the factors associated with healthy aging in a cohort of Mexican adults after a follow-up of 14 years.

STUDY DESIGN

Participants were part of a prospective cohort of the Mexican Healthy Aging Study (MHAS), from which we included 5142 individuals aged 63 years or more.

MAIN OUTCOME

Healthy aging, defined as reaching age 77 or 90 without major chronic conditions or physical limitations.

MEASURES

Information on age, education, marital status, smoking, alcohol consumption, physical activity, self-perceived depression, health conditions and history of age-related diseases was collected at baseline and follow-up.

RESULTS

Among the overall cohort, 57.8% experienced healthy survival to age 77 and 42.2% had died before age 77 or were undergoing normal aging. Participants with long-lived parents and who exercised had a lower risk of being non-healthy agers. Being overweight, obese or a smoker increased the risk of being a non-healthy ager. Physically active participants had increased odds of healthy aging at age 77 (OR: 1.17; 95% CI: 1.01-1.46) and at age 90 (OR: 1.5; 95% CI: 1.01-2.24). Depression had a negative relationship with healthy aging at age 90 (OR: 0.66; 95% CI: 0.45- 0.97). Maternal longevity was associated with healthy aging only at age 77 (OR = 1.34; 95% CI: 1.04-1.72).

CONCLUSIONS

Our findings support the view that a combination of genetic and behavioral factors is associated with healthy aging. In accordance with findings in Caucasian populations, our data suggest for the first time that there might also be a genetic determinant for healthy ageing in Latin Americans.

Youth homicide in Mexico and its impact in male life expectancy: geographical variations and associated factors

This study analyzes the impact of youth homicide (between 15 and 29 years of age) on male life expectancy in Mexico and its 32 states in the periods 2004-2006 and 2014-2016, and identifies the factors that best explain the variations in the years of male life expectancy lost (YMLEL) due to youth homicide at the state level in 2014-2016. Based on official data, male temporary life expectancy (MTLE) between 0 to 85 years of age and years of male life expectancy lost, in total and due to youth homicide, were calculated in each three-year period. Through a linear regression analysis, factors associated with the variations of the years of male life expectancy lost due to youth homicide among states were identified. The male temporary life expectancy decreased between the three-year periods in the country and in 25 states; years of male life expectancy lost due to youth homicide increased in 31 states, in eight of them with a figure higher than 0.5 years in the 2014-2016 period. Factors such as the presence of drug trafficking, illegal firearms and the perception of insecurity explain the variations in the years of male life expectancy lost due to youth homicide within the Mexican states in the 2014-2016 period.

Trends in suicide rates in Brazil from 1997 to 2015

OBJECTIVES

To analyze time trends of suicide rates in Brazil overall and in Brazilian states and compare the estimated suicide rates projected for 2020 with the World Health Organization (WHO) Mental Health Action Plan target.

METHODS

This was an ecological time-series study from 1997 to 2015, stratified by Brazilian states, specific age groups, and sex. Data were obtained from the Mortality Information System (Sistema de Informações sobre Mortalidade [SIM]) of the Brazilian Ministry of Health. Polynomial regression models were used to analyze the trends in suicide rates and to project suicide rates for 2020.

RESULTS

Considering 224 units of analysis, 21 (9.4%) showed a decreasing trend, 108 (48.2%) were stable, and 95 (42.4%) showed an increasing trend. Thus, 67% of units of analysis will not meet the WHO target in 2020. Mean suicide rates were higher in males than in females. People aged 60 years and older presented the highest suicide rates, while 84.7% of total deaths by suicide occurred among 15-to-59-year-olds.

CONCLUSION

Overall, 90.6% of units of analysis had a stable or increasing trend in suicide rates from 1997 to 2015. If these trends remain, most of Brazil will fail to achieve the WHO-recommended reduction in suicide rates by 2020.