Determinants of homicides in the state of Bahia, Brazil, in 2009

Violence and social determinants of health in Brazil: association between homicides, urbanization, population, inequality, and development

The aim was to analyze the relations between homicidal violence, human development, inequality, population size, and urbanization rates in Brazilian municipalities. This is a retrospective ecological study of 5,570 Brazilian municipalities which analyzes the relations between the average rate of homicides registered in the Brazilian Mortality Information System (from 2005 to 2015) and selected indicators: municipal human development indices (HDI-M), Gini index, urbanization rates, and quantitative population. Analysis of the relative effect (%) of the variables on the risk for homicidal violence showed a greater association with more populous municipalities (log 10) (80.8%, 95%CI: 73.0; 88.8), more urbanized ones (8%, 95%CI: 6.7; 9.2), with higher Gini index (6%, 95%CI: 2.6; 9.5); whereas the relation with HDI-M is inverse (-17.1%, 95%CI: -21.4; -12.6). National policies which aim to limit population growth and the urbanization of the most populous Brazilian cities could reduce homicide rates across the country. Reducing inequalities and investing in municipal social education, health, and income policies could also reduce the number of homicides. We estimated that improving the HDI-M of the municipalities by 0.1 would cause a national reduction between 7,560 and 12,834 annual homicides, whereas decreasing income inequality (Gini index) by 0.1 would mean saving between 1,569 to 5,448 lives per year.

[Socioeconomic factors associated with the death rate by homicide in Colombia, 2000-2014]

The scope of this paper was to analyze the trends, impact on life expectancy and effect of the main associated socioeconomic factors with the death rate by homicide in Colombia between 2000 and 2014 at the state level, by gender and age groups. Standardized mortality rates and years of life lost among those under 85 years of age were calculated and multivariate regression analysis was performed using negative binomial fixed effects regression models with panel data to analyze the associated socioeconomic factors with the incidence of homicide. The reduction of the death rate by homicide in Colombia was corroborated, which was generalized at state level, though it did not occur homogenously. A higher mortality risk was found among males, particularly between 15 and 49 years of age. Economic growth and inequality were negatively associated with death rates by homicide; unemployment was positively associated; and poverty had no effect on the mortality rate. Investigating the main associated factors with homicidal violence is complex, but is indispensable due to its impact on economic and social development, given that it mainly affects the population of productive age, with broad public health consequences and at a high cost to healthcare services.

Hidden deaths: corrected estimates of homicides in Bahia, Brazil, 1996- 2015

The objective of this study was to correct and estimate five-year homicide rates in Bahia, Brazil, for the 1996-2015 period. An ecological study of the homicides was carried out using official data from the Mortality Information System of the Ministry of Health. Deaths due to assault are classified in the codes X85-Y09 of the International Classification of Disease 10th Revision (ICD-10). A proportional redistribution of deaths classified as events of undetermined intent (Y10-Y34) was carried out and mortality correction factors were applied. In the analyzed period, 67,599 homicides were registered in the Mortality Information System; after the second correction, 88,429 homicide deaths were estimated. Comparing the official and adjusted figures, there was an underreporting of 30.8%. The highest corrected homicide rates were observed in the eastern region, in Pojuca (129.8 homicides per 100,000 inhabitants), Lauro de Freitas (117.7) and Simões Filho (114.3); in the southern region, in Santa Luzia (121.4), Valença (87.6) and Itabuna (86.5); and in the far south, Santa Cruz Cabrália (128.2), Itabela (113.3) and Porto Seguro (106.8). After correction, there was an increase in homicides in all of the five-year periods in the municipalities analyzed, which resulted in an even higher mortality rate.

Homicides and socio-environmental determinants of health in Brazil: a systematic literature review

Brazil currently has the highest absolute number of homicides in the world, which results from a complex range of factors. This study aimed at understanding the associations between socio-environmental determinants of health (SDH) and homicides in Brazil through a systematic literature review. The review followed PRISMA guidelines, selecting quantitative and qualitative studies published in Portuguese, English, and Spanish carried out between 2002 and 2017, available in the PubMed, MEDLINE, LILACS, SciELO and BVS-BIREME databases. Two trilingual reviewers tracked studies independently by basing on the eligibility criteria. We critically assessed the selected studies with the Critical Appraisal Skills Programme (CASP) or the Checklist for Analytical Cross-Sectional Studies, depending on the study design. We considered 60 studies and grouped their SDH into categories to develop a narrative synthesis about each SDH. These categories were: territory; race/ethnicity; gender; age; social inequalities and economic factors; development; education; work and employment; drugs and trafficking; other SDH. We found some SDH were more associated with homicides, such as being young, black, male, of low education level, and also people who lived in places of high social inequality, such as urban suburbs and agricultural frontiers. Unemployment and drug trafficking, as well as intersections between various SDH were also prominent. Education seems to be a protective factor for homicide. Despite the limited capacity of interpretation due to the high range of methodological approaches, this review shows the importance of considering SDH and their intersections when developing homicide prevention policies.