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Malta DC, Gomes CS, Felisbino-Mendes MS, Veloso GA, Machado IE, Cardoso LDO, Azeredo RT, Jaime PC, Vasconcelos LLCD, Naghavi M, Ribeiro ALP. Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, analysis of the Global Burden of Disease, 1990 to 2019. Public Health 2024; 229:176-184. [PMID: 38452562 DOI: 10.1016/j.puhe.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/30/2023] [Accepted: 12/27/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES The objective of this study was to analyse the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019. STUDY DESIGN This is an epidemiological time-series study. METHODS This study analysed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardised mortality rate, and disability-adjusted life years (DALYs). This study also analysed the correlation between the percentage variation of mortality rates and SDI. RESULTS A decrease in the number of deaths (-75 %), mortality rate (-75.1 %), and DALYS (-72 %) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6 %); however, the mortality rate (-9.7) and DALYs (-6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI. CONCLUSION Our study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality.
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Affiliation(s)
- D C Malta
- Departamento de Enfermagem Materno-Infatil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - C S Gomes
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - M S Felisbino-Mendes
- Departamento de Enfermagem Materno-Infatil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - G A Veloso
- Universidade Federal Fluminense, Instituto de Matemática e Estatística, Departamento de Estatística, Brazil.
| | - I E Machado
- Programa de Pós-graduação em Saúde e Nutrição, Universidade Federal de Ouro Preto, Ouro Preto, MG, Brazil.
| | - L de O Cardoso
- Secretaria de vigilância em saúde e ambiente, Ministério da Saúde, Brasilia/DF, Brazil.
| | - R T Azeredo
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - P C Jaime
- Departamento de Nutrição, Universidade de São Paulo, São Paulo, SP, Brazil.
| | | | - M Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, United States
| | - A L P Ribeiro
- Departamento de Clinica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Guedes LFF, Vegi ASF, Felisbino-Mendes MS, Menezes MC, Meireles AL, Malta DC, Machado ÍE. Economic burden for the Unified Health System attributable to excessive sodium consumption in Brazil. Public Health 2024; 228:178-185. [PMID: 38377832 DOI: 10.1016/j.puhe.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This study aimed to estimate the economic costs of excessive sodium consumption in terms of hospitalizations and outpatient procedures of medium and high complexity (OPMHC) for the Brazilian Unified Health System (SUS) and its states in 2019. STUDY DESIGN Ecological study. METHOD This study used population attributable fractions (PAFs) of excessive sodium consumption estimated by the Global Burden of Disease study based on the theoretical minimum risk exposure level (3 g of sodium per day), the average population consumption, and relative risks of sodium-outcome pairs. PAFs were applied to the total costs of hospitalizations and OPMHC paid by SUS for each outcome obtained from the Outpatient and Hospital Information Systems. The costs per 10,000 inhabitants in all the Brazilian states were calculated and converted into international dollars (Int$), considering the purchasing parity power in the year 2019. RESULTS Excessive sodium consumption resulted in Int$ 98,882,386.36 (95% uncertainty interval: Int$ 3,398,343.53-312,065,319.80) in hospitalizations and OPMHC costs in Brazil in 2019. Males and the 55- to 69-year-old age group had the highest expenditures attributable to excessive sodium consumption. Cardiovascular diseases were the most significant contributors to the costs associated with the risk factor. Southern and southeastern states had the highest costs of diseases attributable to sodium. CONCLUSION Excessive sodium consumption has a significant economic burden on SUS, particularly among men and more developed states. This underscores the inequalities in socio-economic factors and access to health services throughout the country. Economic analyses at the subnational level can provide evidence for public policy planning to define the most appropriate actions for the population's sociodemographic reality.
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Affiliation(s)
- L F F Guedes
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil
| | - A S F Vegi
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil
| | - M S Felisbino-Mendes
- Universidade Federal de Minas Gerais, Postgraduate Program in Nursing, Department of Maternal and Child Nursing and Public Health, Belo Horizonte, Minas Gerais, Brazil
| | - M C Menezes
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil; Universidade Federal de Ouro Preto, School of Nutrition, Department of Clinical and Social Nutrition, Ouro Preto, Minas Gerais, Brazil
| | - A L Meireles
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil; Universidade Federal de Ouro Preto, School of Nutrition, Department of Clinical and Social Nutrition, Ouro Preto, Minas Gerais, Brazil
| | - D C Malta
- Universidade Federal de Minas Gerais, Postgraduate Program in Nursing, Department of Maternal and Child Nursing and Public Health, Belo Horizonte, Minas Gerais, Brazil
| | - Í E Machado
- Universidade Federal de Ouro Preto, Postgraduate Program in Health and Nutrition, Ouro Preto, Minas Gerais, Brazil; Universidade Federal de Ouro Preto, Department of Family Medicine, Mental and Collective Health, Ouro Preto, Minas Gerais, Brazil.
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Malta DC, Saltarelli RMF, Veloso GA, Gomes CS, Soares Filho AM, Vieira EWR, Felisbino-Mendes MS, Naghavi M, Ribeiro ALP. Mortality by avoidable causes in Brazil from 1990 to 2019: data from the Global Burden of Disease Study. Public Health 2024; 227:194-201. [PMID: 38237315 DOI: 10.1016/j.puhe.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/07/2023] [Accepted: 12/06/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES The aim of this study was to analyse the trends of avoidable mortality in Brazil from 1990 to 2019 and its correlation with sociodemographic indexes (SDIs). STUDY DESIGN Epidemiological mortality trends. METHODS This study analysed data from the Global Burden of Disease database. The list of causes of avoidable death, as proposed by Nolte and McKee, was applied and included 32 causes. The current study used age-standardised mortality rates and the rates of change, in addition to a correlation analysis between avoidable death and the SDI. RESULTS Mortality rates decreased from 343.90/100,000 inhabitants in 1990 to 155.80/100,000 inhabitants in 2019. Infectious diseases showed the largest decline in mortality rates, but notable decreases were also found for diarrhoeal diseases (-94.9%), maternal conditions (-66.5%) and neonatal conditions (-60.5%). Mortality rates for non-communicable diseases (NCDs) also decreased (-48%) but maintained a similar absolute number of deaths in 2019 compared with 1990. Decreased mortality rates were also found for ischaemic heart disease (-49.1%), stroke (-61.4%) and deaths due to adverse effects caused by medical treatments (-26.2%). Avoidable mortality rates declined in all of the 27 Brazilian states, and a high correlation was found between deaths and SDI (R = -0.74; P < 0.000001). CONCLUSIONS A reduction in avoidable deaths was found throughout Brazil over the study period, although major regional inequalities were revealed. Richer states presented the best overall reduction in mortality rates. The biggest decreases in mortality were seen in maternal and paediatric infectious diseases in the poorest states due to the expansion of the Primary Health System and improvements in sanitation. Today, NCDs predominate and efforts should be made to formulate public policies for the prevention and control of NCDs.
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Affiliation(s)
- D C Malta
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - R M F Saltarelli
- Departamento de Medicina e Enfermagem, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - G A Veloso
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - C S Gomes
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brazil
| | - A M Soares Filho
- Programa de Pós-graduação em Saúde Pública, Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brazil
| | - E W R Vieira
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - M S Felisbino-Mendes
- Departamento de Enfermagem Materno Infantil e Saúde Pública, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - M Naghavi
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - A L P Ribeiro
- Faculdade de Medicina, Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais, Brazil
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Carvalho Malta D, Felisbino-Mendes MS, Teixeira R, Machado ÍE, Duncan BB, Ribeiro ALP, Velasquez-Melendez G, Passos V, Glenn S, Nagavi M. Trends in mortality due to noncommunicable diseases in Brazil and the sustainable development targets. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Monitoring premature mortality due to noncommunicable diseases (NCDs) is a global priority, as part of the Agenda 2030.
Objective
The current study aims to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and states, projections for 2030.
Methods
We analyzed the following NCDs: cardiovascular diseases, chronic respiratory diseases, neoplasms, diabetes mellitus, comparing deaths and mortality rates between 1990 and 2017, for Brazil and states. The study used the concept of premature mortality used by the World Health Organization (30 to 69 years). The absolute number of deaths, mortality rates, DALYs, years of life lost (YLL), were used, comparing 1990 and 2017. We also analyzed the premature death fraction (YLL) for NCDs attributable to risk factors.
Results
There was a reduction of 35,3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCD in 2017. DALYs rate decreased by 33.6% and the YLL rate by 36.0% in the same period. There was a reduction in the NCD rates in all 27 states. The main risk factors related to premature deaths by NCDs in 2017 among women were - high body mass index, diet risks, high systolic blood pressure, tobacco, and among men, diet risks, high systolic blood pressure, tobacco, high body mass index. Trends in mortality rates due to NCDs were declining in the period, however, after 2015, the curve reversed and fluctuation and tendency to increase rates were observed.
Conclusions
Trends of mortality rates by NCD were declining in the period, however, after 2015, the curve was inverted and the fluctuation and trend of increasing rates was observed, which can compromise the SDG goals in 2030.
Key messages
The austerity policies adopted and the economic crisis in Brazil after 2015, resulted in increased poverty and worsening NCD mortality indicators. With the NCD indicators worsening in 2015, SDG targets may not be achieved.
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Affiliation(s)
| | | | - R Teixeira
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - ÍE Machado
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - B B Duncan
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - A L P Ribeiro
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - V Passos
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - S Glenn
- Institute for Health Metrics and Evaluation, Seattle, USA
| | - M Nagavi
- Institute for Health Metrics and Evaluation, Seattle, USA
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Felisbino-Mendes MS, Gea-Horta T, Matozinhos FP, Velasquez-Melendez G. Association of Maternal Working Status with Early Childhood Overweight in Brazil. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Felisbino-Mendes MS, Matozinhos FP, Velasquez-Melendez G. Maternal Obesity and Fetal Deaths: A Brazilian Cross-Sectional Study. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv097.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - F. P. Matozinhos
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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