Multilevel analyses of the cardiometabolic health of Indigenous Brazilian peoples

Abstract

In Caroline K Kramer and colleagues’1Kramer CK Leitão CB Viana LV The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry.Lancet. 2022; 400: 2074-2083Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar Article, they concluded that in Brazil, “changes of Indigenous peoples’ traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes”. As researchers in Indigenous health in Brazil and authors of several articles cited in the Article, we found serious flaws in the study. These flaws include the highly questionable use of “remaining forest”1Kramer CK Leitão CB Viana LV The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry.Lancet. 2022; 400: 2074-2083Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar within Indigenous lands as a proxy for urbanisation. Problematically, the study area includes Indigenous lands in the tropical savannahs of central Brazil, where the absence of Amazon rainforest does not equate to urbanisation. The same dataset2Instituto Nacional de Pesquisas EspaciaisAmazon deforestation monitoring project (PRODES).http://www.obt.inpe.br/OBT/assuntos/programas/amazonia/prodesDate accessed: December 20, 2022Google Scholar used by the authors to show that the Xavante lands Sangradouro Volta Grande and Pimentel Barbosa have, respectively, just 7% and 14% of so-called forest (which is consistent with its limited occurrence along waterways bound by savannahs) also shows these lands have just 0·1% and 3·7% of deforestation, extremely low values that refute the authors’ identification of these lands as urbanised. Another crucial point is the authors’ blending of urbanisation and the absence of forest with the concept of acculturation, which is (to say the least) anachronic and politically tainted due to the concept's long association with oppressive and colonialist agendas. Investigations about the environmental and social determinants of health conditions of Indigenous Peoples in Brazil are crucial.3Santos RV Welch JR Pontes AL Garnelo L Cardoso AM Coimbra Jr, CEA Health of Indigenous peoples in Brazil: inequities and the uneven trajectory of public policies.in: McQueen D Oxford Research Encyclopaedias of Global Public Health. Oxford University Press, Oxford2022Crossref Google Scholar Yet, to advance racial and ethnic equity in health, it is fundamental that studies be theoretically and methodologically well grounded with correspondingly sound interpretation. The conceptual flaws present in the paper seriously compromise the validity of its findings and conclusions. We declare no competing interests. The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registryThe macrosocial changes of Indigenous peoples’ traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes. These data highlight the urgent need for environmental policies to ensure the conservation of the natural ecosystem within Indigenous territories, as well as the development of socio-health policies to improve the cardiovascular health of Indigenous Brazilians peoples living in urban areas. Full-Text PDF Multilevel analyses of the cardiometabolic health of Indigenous Brazilian peoples – Authors' replyWe thank Carlos E A Coimbra Jr and colleagues and Alvaro J Idrovo for their interest in our publication1 in which we showed an association between adverse cardiovascular health of Indigenous Brazilian Peoples and urbanisation with data obtained from systematic reviews and meta-analysis, the Brazilian census,2 and national death records. We also showed the effects of Amazon deforestation. The impact of urbanisation on cardiovascular risk was consistently evident on diverse epidemiological analyses, with independent proxies of urbanisation: meta-analyses of cardiovascular risk factors by geographical region (as shown in figure 1 of our paper); meta-regression analyses of cardiovascular risk over time (as shown in figure 1 of our paper); the prevalence of obesity and hypertension related to the proportion of Amazon rainforest in a territory (as shown in figure 2 of our paper); the trend in blood pressure levels in communities with diverse nutritional characteristics (as shown in figure 3 of our paper); age-adjusted cardiovascular mortality by geographical regions (as shown in figure 4 of our paper), including data from rural and urban settings as defined by the Brazilian census2 (as shown in the appendix [p 11] of our paper); and incremental change in cardiovascular deaths over time by geographical regions (as shown in figure 4 of our paper). Full-Text PDF