Alcohol consumption and driving in Brazilian capitals and Federal District according to two national health surveys

Evolution of mortality rates among women of reproductive age in Brazilian municipalities: an ecological analysis using Global Burden of Disease estimates

OBJECTIVES

Women's mortality at a reproductive age has been a global concern, and its decrease has been incorporated as a target of the UN Sustainable Development Goals. The aim of this study was to describe the spatial-temporal evolution of mortality rates among women of reproductive age in Brazilian municipalities by groups of causes and socioeconomic indicators from 2000 to 2018.

STUDY DESIGN

Ecological analysis.

METHODS

This work was an ecological, descriptive study that analyzed estimates of mortality rates among women of reproductive age (15-49 years) by main groups of causes of death from the Global Burden of Disease (GBD) study in three consecutive trienniums, T1 (2000-2002), T2 (2009-2011), and T3 (2016-2018). To quantify the temporal evolution in mortality rates, the present study calculated the percentage change for each triennium. The spatial analysis of mortality rates was carried out using Moran's index. The Pearson coefficient was used to analyze the correlation between the data.

RESULTS

A significant decline in mortality rates was found for all groups of causes in all regions of the country. Despite the downward trend, the percentage change from 2009 to 2011 to 2016 to 2018 showed a decrease in the group of Noncommunicable Diseases (NCDs) and external causes. The decline in mortality rates of women due to external causes showed only a minimal change in the North and Northeast regions from T2 to T3, whereas a cluster of neighboring municipalities with high mortality rates persisted in the municipalities of the South region and in the state of Roraima. The ranking of the main causes of death in Brazilian municipalities showed an increase in neoplasms in detriment to cardiovascular diseases (CVDs).

CONCLUSIONS

The main causes of death in women of reproductive age at a more local level could be used to recognize inequalities and to develop interventions aimed at tackling premature and preventable deaths.

Prevalence and factors associated with driving under the influence of alcohol in Brazil

OBJECTIVES

To estimate the prevalence and factors associated with Driving Under the Influence of Alcohol (DUIA) among car drivers and motorcyclists in Brazil and to evaluate the association between DUIA and self-reported Road Traffic Injuries (RTIs) in these groups.

METHODS

A cross-sectional study was conducted using data from adults aged 18 or older who participated in the 2019 National Health Survey. Probability sampling was used to recruit participants, and data collection was carried out through home visits. Data from 31,246 car drivers and 21,896 motorcyclists were analyzed. Key indicators included the proportion (%) of car drivers who consumed alcohol and then drove in the past 12 months and the proportion (%) of motorcyclists who consumed alcohol and then drove in the past 12 months. Multiple Poisson regression was used to determine factors associated with DUIA and the association of this variable with RTIs in both groups.

RESULTS

DUIA prevalence was 9.4% (95% Confidence Interval [95% CI] = 8.8-10.0) among car drivers and 11.2% (95% CI = 10.4-12.1) among motorcyclists. Among car drivers, DUIA prevalence was higher in men, young adults, those without a spouse/partner, and lower in individuals with lower income and education level. Among motorcyclists, DUIA prevalence was higher in men, young adults, those living outside the capitals and metropolitan regions, and lower in individuals with lower income. DUIA increased the prevalence of self-reported RTIs in the previous 12 months among car drivers and motorcyclists.

CONCLUSIONS

A high prevalence of DUIA was evident among drivers, particularly motorcyclists. The DUIA was more prevalent among men and young adults. The DUIA was associated with an increased magnitude of self-reported RTIs among car drivers and motorcyclists. Despite the extensive legislation for zero tolerance toward DUIA in the country, actions need stricter enforcement.

The habit of drinking and driving in Brazil: National Survey of Health 2013 and 2019

OBJECTIVE

To assess factors associated with the habit of drinking and driving and estimating the variations in the prevalence of this behavior in 2013 and 2019, considering information from the two editions of the Pesquisa Nacional de Saúde (PNS - National Survey of Health).

METHODS

PNS is a nationwide cross-sectional home-based study. In 2013 and 2019, 60,202 and 85,854 individuals were interviewed, respectively. To assess the association between the indicator "drinking and driving" and the study variables, crude and adjusted odds ratios (ORs) were estimated using logistic regression models. To compare the prevalence between the studied years, a Pearson's chi-squared test adjusted by the Rao-Scott correction (which considers the effect of the sampling plan) and converted into an F statistic, tested at a 5% significance level, was used.

RESULTS

The prevalence of drinking and driving was higher among men in 2013 (27.4%; 95%CI 25.6-29.3%) and 2019 (20.5%; 95%CI 19.4-21.7%) than among women (11.9%; 95%CI 9.9-14.2% and 7.2%; 95%CI 6.7-9.0%, respectively). Inidviduals aged 30 to 39, who lived without a partner, in rural areas, and were motorcycle drivers had significantly higher estimates. Men with higher income had higher prevalence of drinking and driving. From 2013 to 2019, the act of drinking and driving significantly decreased. Regarding traffic accidents, ORs were significant (p < 0.01) in the studied years for both men and women.

DISCUSSION

Results show the need to continue policies to monitor blood alcohol level and traffic education, with specific actions directed to rural areas and motorcycle drivers.

Prevalence and sociodemographic factors associated with heavy drinking in Brazil: cross-sectional analyses of the National Health Survey

OBJECTIVE

This article aims to characterize the heavy drinking behavior in the Brazilian population, using data from the two editions of the "National Health Survey" (PNS), 2013 and 2019.

METHODS

The sample sizes in 2013 and 2019 were 60,202 and 88,943 individuals aged 18 years or older, respectively. The prevalence of the habit of heavy drinking (defined as 8 or more doses per week for women, and 15 or more doses for men) was estimated, and the confidence intervals were defined by sex, age group, schooling, skin color/race, marital status and household status (urban/rural). Poisson regression models were used to compare prevalence rates.

RESULTS

6.1% of Brazilians were heavy drinkers in 2013, and 7.3% in 2019. In the two editions of the PNS there was a gradient of reduction in heavy drinking throughout life, being the highest prevalence among young adults, men, with low schooling, single and living in the urban area.

CONCLUSIONS

The high prevalence rates expose the need to consider the habit of heavy drinking as a risk factor for the health of the Brazilian population, and the urgency to adopt strategies to reduce it.

Traumatic brain injury hospital incidence in Brazil: an analysis of the past 10 years

Objetivo

Caracterizar os aspectos demográficos e sociais e o ônus econômico do traumatismo craniencefálico no sistema público de saúde brasileiro na última década.

Métodos

Analisaram-se os dados provenientes da base de dados do Departamento de Informática do Sistema Único de Saúde referentes ao período entre janeiro de 2008 e dezembro de 2019.

Resultados

Entre 2008 e 2019 ocorreram, em média, no Brasil, 131.014,83 internações por traumatismo craniencefálico ao ano, com incidência de 65,54 por 100 mil habitantes. Deve-se salientar a elevada incidência de traumatismo craniencefálico em adultos idosos (acima de 70 anos), acompanhada de altas taxas de mortalidade. Além disso, há também elevada incidência de traumatismo craniencefálico em adultos jovens (20 a 29 anos e 30 a 39 anos). Os dados aqui apresentados demonstram uma proporção de traumatismos craniencefálicos de 3,6 homens/mulheres.

Conclusão

Embora se acredite que os dados apresentados subestimem a incidência e mortalidade associadas com o traumatismo craniencefálico no Brasil, este estudo pode ajudar na implantação de futuras estratégias de promoção da saúde para a população brasileira e mundial, com o objetivo de diminuir a incidência, a mortalidade e os custos do traumatismo craniencefálico.

Prevalence and Factors Associated with Driving Under the Influence of Alcohol in Brazil: An Analysis by Macroregion

Objective: To analyze the prevalence and factors associated with driving under the influence of alcohol (DUIA) in Brazil, according to macroregion. Methods: A cross-sectional study was conducted using data from individuals aged 18 years or older who participated in the 2013 National Health Survey in Brazil. Subjects were selected by probabilistic sampling and interviewed through home visits. Prevalence of DUIA was estimated according to the number of drivers and/or motorcyclists who reported consuming alcohol in the previous 30 days (n = 9537). Poisson regression was used to analyze the factors associated with DUIA to Brazil and in each macroregion of the country. Results: The prevalence of DUIA was 27.5%, 29.4%, 29.6%, 22.9%, and 20.8% in the North, Northeast, Central-West, South, and Southeast macroregions, respectively. The overall prevalence of Brazil was 24.3%. In most macroregions, the main predictors of DUIA were male sex, high educational level, living in outside the capital or metropolitan regions (other regions), and binge drinking in the previous 30 days. Depression was a predictor in Brazil and two macroregions. Conclusion: A high prevalence of DUIA was observed in Brazil, especially in the Central-West, Northeast and, North macro-regions. Factors associated with DUIA can be incorporated to develop effective interventions to reduce this behavior in Brazil.

Tendência temporal da prevalência de indicadores relacionados à condução de veículos motorizados após o consumo de bebida alcoólica, entre os anos de 2007 e 2018

RESUMO: Objetivo: Analisar a tendência temporal da prevalência de indicadores relacionados à condução de veículos motorizados após o consumo de bebida alcoólica, na população em geral e entre motoristas. Métodos: Estudo de tendência temporal de indicadores relacionados à condução de veículos motorizados após o consumo de bebida alcoólica, entre 2007 e 2018, com base nas informações do sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel). A população foi constituída de adultos (≥ 18 anos) residentes nas capitais brasileiras com telefone fixo. A análise de tendência foi realizada pela regressão linear. Resultados: Entre 2007 e 2018 houve redução do indicador “condução de veículo após consumo abusivo de bebida alcóolica pela população” de 2 para 0,7% (p < 0,001). Esse consumo, quando calculado apenas entre motoristas, reduziu de 3,5 em 2011 para 1,6 em 2018 (p < 0,003). A condução de veículo por motoristas após consumo de qualquer quantidade de bebida alcóolica apresentou elevadas prevalências, variando de 15,7% (2011) para 11,4% (2018). As prevalências em todos indicadores foram mais elevadas entre homens, adultos mais jovens (18 a 34 anos) e com maior escolaridade. Conclusão: A prática do consumo abusivo de bebida alcóolica e direção reduziu no Brasil, entretanto a prática de dirigir após o consumo de qualquer quantidade de álcool ainda continua elevada. Portanto, torna-se necessário manter as medidas regulatórias de fiscalização de álcool e direção, visando à redução dos acidentes de trânsito.

Prevalence of cardiovascular risk factors in the population of Vitória according to data from VIGITEL and the National Health Interview Survey of 2013

OBJECTIVE

To compare the prevalence of cardiovascular risk factors in the adult population of Vitória, Espírito Santo, Brazil, in two surveys conducted by telephone interview (VIGITEL) or by clinic and laboratory exams during the National Health Interview Survey (NHIS).

METHOD

Data were collected from adults (≥ 18 years). In VIGITEL, 1,996 subjects (males = 38%) were interviewed. In NHIS, home visit followed by clinical and laboratory tests was made with 318 individuals (males = 48%) selected in 20 census tracts of the city. The prevalence of risk factors was adjusted to the estimated population of the city in 2013. Data are shown as prevalence and 95% confidence interval (95%CI).

RESULTS

Similar values of prevalence were found in VIGITEL and NHIS, respectively, for smoking (8.2%; 95%CI 6.7-9.7% vs 10.0; 95%CI 6.4 - 13.6%) and hypertension (24.8%; 95%CI 22.6 - 27.0% vs 27.2%; 95%CI 21.8 - 32.5%). Statistical differences between surveys (p < 0.01) were found for diabetes (6.7%; 95%CI 5.6 - 7.9% vs 10.7%; 95%CI 7.1 - 14.5%), obesity (16.8%; 95%CI 14.1 - 18.1% vs 25.7%; 95%CI 20.4 - 30.9%) and high cholesterol (≥ 200mg/dL) (20.6%; 95%CI 18.6- 22.6% vs 42.3%; 95%CI 36.9 - 47.7%). The prevalence of diabetes was also higher (p < 0.01) in NHIS (6.7 vs 10.7%).

CONCLUSION

Prevalence of smoking and hypertension, but not obesity, was adequately detected in VIGITEL, because there might have been information bias related to body weight during telephone interviews. Datashow the necessity to improve the diagnosis of dyslipidemias in primary care services, as the control of this risk factor is of utmost importance to prevent cardiovascular diseases.

Burden of disease in Brazil, 1990-2016: a systematic subnational analysis for the Global Burden of Disease Study 2016

BACKGROUND

Political, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses.

METHODS

We analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries.

FINDINGS

Nationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0-68·9) in 1990 to 75·2 years (74·7-75·7) in 2016, and HALE increased from 59·8 years (57·1-62·1) to 65·5 years (62·5-68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4-34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7-32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index.

INTERPRETATION

Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities.

FUNDING

Bill & Melinda Gates Foundation and the Brazilian Ministry of Health.