Social and territorial inequalities in the mortality of children and adolescents due to COVID-19 in Brazil

OBJECTIVE

To analyze the mortality rate of COVID-19 among children and adolescents aged 0 to 14 years.

METHODS

Ecological and exploratory study of children's mortality rate by COVID-19 in Brazil, from February to October 2020. The study used the Severe Acute Respiratory Syndrome database to collect the data and made the analysis using descriptive spatial statistics by age and race/color classification.

RESULT

The mortality rate due to COVID-19 represented 1.34 deaths per one hundred thousand in the total group evaluated. The age group with the highest frequency and mortality rate was 1 to 4 years of age. There is a higher frequency of deaths in the brown and Indigenous population.

CONCLUSION

The distribution of deaths due to COVID-19 is unequal in the national territory, and there is a wide variation in the mortality rate by age and race/color groups.

Mortalidade perinatal no Brasil em 2018: análise epidemiológica segundo a classificação de Wiggleworth modificada

Resumo: A mortalidade perinatal engloba a mortalidade fetal e a neonatal precoce (0 a 6 dias). Este estudo descreveu os óbitos perinatais ocorridos no Brasil em 2018, segundo a classificação de Wigglesworth modificada. As fontes de dados foram os Sistemas de Informações sobre Mortalidade e sobre Nascidos Vivos. Foram calculadas as taxas de mortalidade fetal e perinatal por mil nascimentos totais (nascidos vivos mais natimortos) e a taxa de mortalidade neonatal precoce por mil nascidos vivos, e comparadas usando seus respectivos intervalos de 95% de confiança (IC95%). Os óbitos perinatais foram classificados nos grupos de causas anteparto, anomalias congênitas, prematuridade, asfixia e causas específicas. Foi calculado, para cada grupo de causas, o número de óbitos por faixa de peso, além das taxas de mortalidade e os respectivos IC95%, e feita a distribuição espacial das taxas de mortalidade por Unidade da Federação (UF). Foram registrados 35.857 óbitos infantis, sendo 18.866 (52,6%) neonatais precoces; os natimortos somaram 27.009. Os óbitos perinatais totalizaram 45.875, perfazendo uma taxa de mortalidade de 15,5‰ nascimentos. A maior taxa de mortalidade (7,6‰; 7,5‰-7,7‰) foi observada no grupo anteparto, seguido da prematuridade (3,6‰; 3,6‰-3,7‰). No grupo anteparto, 14 das 27 UFs (sendo oito na Região Nordeste e quatro na Região Norte) apresentaram as taxas de mortalidade perinatal acima da nacional. A taxa de mortalidade perinatal no Brasil mostrou-se elevada, e a maioria dos óbitos poderia ser prevenida com investimento em cuidados pré-natais e ao nascimento.

Desigualdades sociais e territoriais na mortalidade de crianças e adolescentes por COVID-19 no Brasil

RESUMO Objetivo: Analisar a taxa de mortalidade por COVID-19 entre crianças e adolescentes de 0 a 14 anos. Métodos: Estudo ecológico e exploratório da taxa de mortalidade de crianças por COVID 19 no Brasil, no período de fevereiro a outubro de 2020. A coleta foi feita utilizando-se o Banco de Dados de Síndrome Respiratória Aguda Grave, e a análise foi realizada com recurso à estatística espacial descritiva, por classificação etária e de raça/cor. Resultados: A taxa de mortalidade por COVID-19 representou 1,34 mortes a cada 100 mil no grupo total avaliado. A faixa etária com maior frequência e taxa de mortalidade foi de 1 a 4 anos. Há maior frequência de óbitos na população parda e indígena. Conclusão: A distribuição de óbitos por COVID-19 é desigual no território nacional, e há grande variação da taxa de mortalidade por grupos etários e de raça/cor.

GeoSES: A socioeconomic index for health and social research in Brazil

The individual’s socioeconomic conditions are the most relevant to predict the quality of someone’s health. However, such information is not usually found in medical records, making studies in the area difficult. Therefore, it is common to use composite indices that characterize a region socioeconomically, such as the Human Development Index (HDI). The main advantage of the HDI is its understanding and adoption on a global scale. However, its applicability is limited for health studies since its longevity dimension presents mathematical redundancy in regression models. Here we introduce the GeoSES, a composite index that summarizes the main dimensions of the Brazilian socioeconomic context for research purposes. We created the index from the 2010 Brazilian Census, whose variables selection was guided by theoretical references for health studies. The proposed index incorporates seven socioeconomic dimensions: education, mobility, poverty, wealth, income, segregation, and deprivation of resources and services. We developed the GeoSES using Principal Component Analysis and evaluated its construct, content, and applicability. GeoSES is defined at three scales: national (GeoSES-BR), Federative Unit (GeoSES-FU), and intra-municipal (GeoSES-IM). GeoSES-BR dimensions showed a good association with HDI-M (correlation above 0.85). The model with the poverty dimension best explained the relative risk of avoidable cause mortality in Brazil. In the intra-municipal scale, the model with GeoSES-IM was the one that best explained the relative risk of mortality from circulatory system diseases. By applying spatial regressions, we demonstrated that GeoSES shows significant explanatory potential in the studied scales, being a compelling complement for future researches in public health.

Evaluation study of the garbage codes research project in the Northern region of Brazil

INTRODUCTION

The term "garbage code" (GC) is used to designate an underlying cause of death that is not very useful for the health policy, since it does not adequately identify actions to prevent and control diseases and health problems.

OBJECTIVE

To evaluate the results of GC investigation on changing causes of death in 17 municipalities in the Brazilian Northern region in 2017.

METHODS

This is a cross-sectional study on the results of the investigation of deaths with GC in selected hospitals in 17 cities in the seven states of the Northern region, as part of the Data for Health Initiative of the Ministry of Health (MH). In these hospitals, the underlying causes of deaths occurring in 2017 were reviewed, and the GC investigation protocol was applied to deaths with GC.

RESULTS

In 2017, 37,082 deaths occurred in the 17 municipalities studied, of which 29.3% (n = 10,878) were GC and 83.2% were priority GC. Among the priority GCs, 25.9% were investigated, of which 79.1% had a change in the underlying cause.

DISCUSSION

There is great variation among the 17 municipalities in relation to the proportion of GC. In 13 of the municipalities studied, the underlying cause of death was reclassified in at least 70% of the cases investigated for the priority GC.

CONCLUSION

Despite the improvement in reducing the proportion of underlying causes of death with GC in this study, there is still a need for greater investment in training professionals and increasing services to carry out death investigations, in order to ensure the sustainability of the project in the region.

[The impact of the type of hospital and delivery on the gestational age in São Paulo city, 2013-2014]

Introduction:

There was a left-shift on the distribution curve of gestational age (GA) and a reduction of the proportion of live births of 40 weeks, when compared to the expected standard in many countries.

Objective:

To study the distribution of gestational age births in São Paulo city (SP) and its relationship with the type of hospital and delivery.

Methods:

Data were extracted from Live Birth Information System (SINASC) linked to the National Database of Health Establishments (CNES) in 2013 and 2014. Data are presented according to birth in public (SUS) and private (non SUS) hospitals, type of delivery and gestational age, standardized according to the mother's age.

Results:

There was a left-shift in GA curve for total births which was more pronounced among cesarean births and private hospitals. The median GA of public hospitals was 39 weeks, while in the private hospitals, 38 weeks. The proportion of preterm births (9,5%) was similar in public and private hospitals, but among public hospital there was a higher proportion of very preterm births (<32 weeks), while (34-36) in private hospitals late preterm and early term were more frequent.

Conclusions:

The change in the distribution of gestational age in SP is related to the type of hospital and the proportion of cesarean sections in private hospitals.

Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis

OBJECTIVE

Identify the factors associated with the age-standardised breast cancer mortality rate in the municipalities of State of São Paulo (SSP), Brazil, in the period from 2006 to 2012.

DESIGN

Ecological study of the breast cancer mortality rate standardised by age, as the dependent variable, having each of the 645 municipalities in the SSP as the unit of analysis.

SETTINGS

The female resident population aged 15 years or older, by age group and municipality, in 2009 (mid-term), obtained from public dataset (Informatics Department of the Unified Health System).

PARTICIPANTS

Women 15 years or older who died of breast cancer in the SSP were selected for the calculation of the breast cancer mortality rate, according to the municipality and age group, from 2006 to 2012.

MAIN OUTCOME MEASURES

Mortality rates for each municipality calculated by the direct standardisation method, using the age structure of the population of SSP in 2009 as the standard.

RESULTS

In the final linear regression model, breast cancer mortality, in the municipal level, was directly associated with rates of nulliparity (p<0.0001), mammography (p<0.0001) and private healthcare (p=0.006).

CONCLUSIONS

The findings that mammography ratio was associated, in the municipal level, with increased mortality add to the evidence of a probable overestimation of benefits and underestimation of risks associated with this form of screening. The same paradoxical trend of increased mortality with screening was found in recent individual-level studies, indicating the need to expand informed choice for patients, primary prevention actions and individualised screening. Additional studies should be conducted to explore if there is a causality link in this association.

Associação espacial entre variáveis socioeconômicas e risco relativo de nascimentos pré-termo na Região Metropolitana de São Paulo (RMSP) e na Área Metropolitana de Lisboa (AML)

A prematuridade é um dos grandes problemas de saúde pública, contribuindo fortemente para a morbi-mortalidade infantil, tanto em países em desenvolvimento como o Brasil, quanto em países europeus como Portugal. O nascido prematuro é aquele que nasce com menos de 37 semanas de gestação. Os fatores de risco individuais associados à incidência da prematuridade são conhecidos. No entanto, os fatores contextuais que podem influenciar a sua incidência têm sido pouco estudados. O principal objetivo deste estudo foi identificar o padrão espacial do risco relativo de nascimento pré-termo e possíveis agrupamentos espaciais, assim como examinar se as condições socioeconômicas estão espacialmente associadas com o risco relativo de nascimento pré-termo em duas áreas metropolitanas: Região Metropolitana de São Paulo (RMSP), no Brasil, e Área Metropolitana de Lisboa (AML), em Portugal. Foi recolhida informação relativa aos nascidos vivos (2000-2010) de mães residentes em ambas as áreas metropolitanas e às condições socioeconômicas das mães. Para análise de associação espacial entre o risco relativo de nascimentos pré-termo e as variáveis do contexto geográfico, foram aplicados testes de associação espacial global (I Moran) para ambas as áreas metropolitanas. A distribuição geográfica do risco relativo de nascimentos pré-termo ocorreu de maneira não aleatória e heterogênea tanto na RMSP como na AML: na RMSP verificou-se existir uma associação espacial global negativa significativa entre risco relativo e taxa de desemprego; na AML, foi revelada associação global positiva significativa entre o risco relativo e a taxa de analfabetismo, o índice de privação sóciomaterial e a da taxa de desemprego.

Temperature variation in the 24 hours before the initial symptoms of stroke

A few studies have performed to evaluate the temperature variation influences over on the stroke rates in Brazil.

METHOD

176 medical records of inpatients were analyzed after having had a stroke between 2004 and 2006 at Hospital Israelita Albert Einstein. The temperature preceding the occurrence of the symptoms was recorded, as well as the temperature 6, 12 and 24 hours before the symptoms in 6 different weather substations, closest to their houses in São Paulo.

RESULTS

Strokes occurred more frequently after a variation of 3 C between 6 and 24 hours before the symptoms. There were most hospitalizations between 23-24 C.

CONCLUSION

Incidence of stroke on these patients was increased after a variation of 3 masculine Celsius within 24 hours before the ictus. The temperature variations could be an important factor in the occurrence of strokes in this population.