Ecological Time-series Study Research Articles

Mortality from cerebral stroke in the State of Pernambuco, Brazil: an ecological study

Introduction: cerebrovascular accident (CVA) is the second leading cause of death globally, characterized by cerebrovascular events due to dysfunctions in the cerebral blood supply. It can be ischemic or hemorrhagic and has high morbidity and mortality rates. In Brazil, it is the main cause of death, disabling many over 50 years of age and leading to around 40% of early retirements. Despite advances in initial treatment, mortality rates remain high, indicating flaws in prevention and treatment strategies. Therefore, the World Health Organization (WHO) emphasizes the need for immediate implementation of preventive and treatment measures for this condition. Objective: to evaluate the trend in the mortality coefficient and proportional mortality from stroke in the population of Pernambuco, from 2000 to 2021. Methods: This is an ecological time series study with data from the population of the state of Pernambuco, located in northeast region of Brazil, from 2000 to 2021. The eligibility criteria were deaths with a stroke occurring in the state of Pernambuco. Information on mortality, population estimates and number of deaths by sex and age group were extracted from the database of the Department of Informatics of the Unified Health System (DATASUS). For statistical analysis, it was calculated the mortality coefficient, proportional mortality, mean, standard deviation, skewness and kurtosis. The temporal trend of stroke was assessed by jointpoint regression. Results: Between 2000 and 2021, there were 39,410 deaths from stroke. Around 49.0% were male and 51.0% female. The female sex had an average of 913.45 in the number of deaths, being quantitatively higher than the average identified for the male sex of 877.04 deaths. The years with the highest number of deaths were 2006, 2007 and 2008, while 2018 had the lowest number. There was a progressive increase in the number of deaths from stroke from 2018 to 2021. There was a decline in the average annual percentage variation in the mortality rate for stroke in all groups studied, in addition to a drop in the average annual percentage of proportional mortality for stroke in the entire population. Throughout the period, there was a decline in the average annual percentage of proportional mortality from stroke in the entire population studied. Conclusion: In the period from 2000 to 2021 there was a greater number of deaths due to stroke in women in contrast to men in the population of Pernambuco, Brazil. Furthermore, there was a downward trend in stroke rates in both the mortality rate and proportional mortality. In the period from 2018 to 2021 there was a progressive increase in the mortality rate and proportional mortality from stroke.

Epidemiological evolution of COVID-19: a three-year perspective on coping with the pandemic in the States of Rio Grande do Sul and Paraná, Southern Region of Brazil

Introduction: The novel Coronavirus disease (COVID-19) is caused by SARS-CoV-2 and represents the agent responsible for a respiratory and metabolic disease with a high fatality rate, remaining a public health problem to this day. There has been an exacerbation of social inequalities experienced in Brazil and worldwide. Notably, the absence of a consolidated and universal healthcare system has contributed to the increased inequalities and survival opportunities for those affected by SARS-CoV-2 infection and manifestation of COVID-19. The southern region has become the second region with the highest number of cases in Brazil. Objective: To avaluate the epidemiological outcomes of incidence, lethality, and mortality among the states of Rio Grande do Sul and Paraná in the southern region of Brazil. Methods: An ecological time-series study was conducted using official secondary data on COVID-19 cases and deaths publicly disclosed by the health departments of the states of Rio Grande do Sul and Paraná. Time series were constructed applying the Prais-Winsten regression model. Statistical analyses were performed using STATA 14.0 software. Results: It was observed that for the state of Rio Grande do Sul, the trends regarding incidence were increasing in 2020 and decreasing in 2021 (p<0.05). Regarding mortality, it increased in 2020 and decreased in 2021 and 2022 (p<0.05). When assessing lethality, a decreasing trend was observed for the entire period (p<0.05). In relation to Paraná, incidence increased in 2020 and over the entire period, while it decreased in 2021 and 2022 (p<0.05). Mortality was stationary in 2020 and decreased in 2021 and 2022 (p<0.05). Conclusion: The COVID-19 pandemic is a serious public health problem in the states of Paraná and Rio Grande do Sul. Paraná presented a more severe epidemiological outcome compared to Rio Grande do Sul.

AIR POLLUTION BY FINE PARTICULATE MATERIAL ON HOSPITALIZATION FOR RESPIRATORY DISEASES IN THE ELDERLY

Objective: To analyze the effects of air pollution exposure on hospitalizations for respiratory diseases in the elderly. Methods: this was an ecological time series study in Cuiabá, Mato Grosso, during the years 2015 and 2016. Daily levels of fine particulate matter PM2.5 and carbon monoxide were estimated and made available by the National Institute for Space Research. Variables related to temperature, relative humidity and adjustments for temporal trend, seasonality and calendar effects were included in the stochastic model of the ARIMA class (integrated autoregressive moving averages). Results: During the period selected for data collection, there were 1556 hospitalizations for respiratory diseases in Cuiabá. It was verified with this study that the number of cases of respiratory hospitalizations in the elderly was higher between the months of May and September 2015, despite a smaller number of occurrences, in the same period of 2016. As for the monthly average number of hospitalizations of elderly people aged 60 or over, these ranged from 41 hospitalizations in December 2016 to 103 hospitalizations in May 2015. Conclusion: The present study found an association between an increase in PM2.5 and a greater number of hospitalizations of elderly people with 60 years or older due to respiratory diseases. These results are consistent with some other studies found in other investigations on the subject.

[Trend in breast cancer mortality rate among women aged 20 years or older in Brazil, 2005-2019].

The aim is to analyze the trend in breast cancer mortality rates and its correlation with the socioeconomic development status in Brazil. It involved an ecological time series study carried out in the 26 units of the federation, Federal District and regions of Brazil. Data sources included the Mortality Information System (number of deaths), the Brazilian Institute of Geography and Statistics (resident population) and the study of the Global Burden of Disease (Socio-demographic Index - SDI). Data from 2005 to 2019 were used. The trend was analyzed using Prais-Winsten regression models. The relationship between the mortality rate and the SDI was analyzed using Spearman's correlation coefficient. During the study period, 207,683 deaths from breast cancer occurred. The average standardized mortality rate was 19.95 deaths per 100,000 women in Brazil. All the regions of Brazil showed an increasing trend in mortality. Of the total federative units, 22 showed an increasing trend. There was a positive relationship between the mortality rate and the SDI. The standardized mortality rate for breast cancer showed an increasing trend in Brazil, in all regions and in most states. There was a direct association between mortality and SDI, indicating a greater magnitude in more developed regions.

Extreme Heat Impacts on Acute Care: Examining Emergency Department Visits and Hospital Admissions During the 2021 British Columbia Heatwave.

IntroductionEmergency department (E.D.) visits and hospitalization patterns shifted dramatically during the 2021 extreme heat event (EHE) across the Greater Vancouver Area of southern British Columbia, Canada. MethodsIn this ecological timeseries study we analyze E.D. visits (n=36,432) and hospitalizations (n=18,624) between June 4th, 2021, and July 29th, 2021, using data from two administrative databases: 1) the Canadian National Ambulatory Care Reporting System; and 2) and the Canadian Discharge Abstract Database data. Using Mann-U Whitney tests, we compared how E.D. visits, hospitalizations, and patient diagnoses changed during a seven-day EHE and two subsequent lag periods compared to the surrounding baseline period. We also use a distributed lag non-linear model to analyze the relationship between daily maximum temperatures and daily E.D. visits during the study period. ResultsWe observed a statistically significant increase in overall E.D. visits during the EHE and during the week following the EHE, and a positive relationship between daily maximum temperature and relative risk of an E.D. visit. Further, there were significant increases in critically ill patients presenting to the E.D. during the EHE, based on Canadian Triage Acuity Scale (CTAS) and increases in key diagnoses, including acute kidney failure, heatstroke, and dehydration. ConclusionsHeatwaves have significant impacts on public health and acute care systems beyond heat-related deaths. Complications associated with heat exposure and surges in patient volume have implications for internal medicine, emergency medicine, and psychiatry departments. Better understanding the disease patterns associated with extreme heat events is essential to health system planning and response.

The rehabilitation workforce in Brazil

BackgroundThe surge in individuals facing functional impairments has heightened the demand for rehabilitation services. Understanding the distribution of the rehabilitation workforce is pivotal for effective health system planning to address the population’s health needs.ObjectiveTo investigate the spatial and temporal dispersion of physical therapists, speech therapists, psychologists and occupational therapists across various tiers of care within Brazil’s Unified Health System and its regions.MethodThis is an ecological time series study on the supply of rehabilitation professionals. Data were obtained from the National Register of Health Establishments from 2007 to 2020. The density of professionals was calculated per 10,000 inhabitants annually for Brazil and its five regions. The Joinpoint regression model was used to analyze the temporal trends of the density of professionals, considering a 95% confidence interval.ResultsIn 2020, the most notable concentrations of psychologists, speech therapists, and occupational therapists in Brazil were observed in the domain of Specialized Health Care, with densities of 0.60, 0.20, and 0.16 professionals per 10,000 inhabitants, respectively. Conversely, the highest density of physical therapists was found within Hospital Health Care, with a density of 1.19 professionals per 10,000 inhabitants. Notably, variations in professional dispersion across different regions were apparent. Primary Health Care exhibited the highest density of professionals in the Northeast region, while the Southern region accounted for the highest densities in all professional categories within Specialized Health Care. The southeast region exhibited the largest workforce within Hospital Health Care. A marked upsurge in professional availability was noted across all categories, notably in the occupational therapy sector within hospital care (AAPC: 30.8), despite its initial low density.ConclusionThe implementation of public health policies played a significant role in the expansion of the rehabilitation workforce at all three levels of care in Brazil and its various regions from 2007 to 2020. Consequently, regional disparities and densities of professionals have emerged, mirroring patterns observed in low-income countries.

Hospitalizations for conditions sensitive to primary care and sustainable development objectives

Hospitalizations for Primary Care Sensitive Conditions (ICSAP) are widely recognized as an indicator of health system performance. Considering that the evaluation of health practices is mandatory, monitoring these indicators becomes relevant, with a view to directing actions that can contribute to the Sustainable Development Goals. The objective of this study was to analyze the profile of ICSAP that occurred in the Federal District (DF) in the period from 2018 to 2022. This is an ecological time series study, using Hospital Admission Authorizations as a data source, via the Information System Hospital of the Unified Health System. Data collection was carried out in November 2022 and covered the period from 2018 to 2022. Descriptive statistical analysis was carried out. It was possible to identify the profile of ICSAP in DF. The elderly population and children aged 1 to 14 years were predominant, as well as diagnoses related to anemia, ear, nose and throat infections and asthma. The main causes of deaths and expenses were cerebrovascular diseases, heart failure and bacterial pneumonia.

Impact of primary care coverage on hospital admissions for conditions sensitive to primary care in the municipality of Rio Verde – GO

The indicator Hospitalizations for Causes Sensitive to Primary Care (ICSAP) has been used as an indicator of access and quality of primary health care, and its high rates have been correlated with deficiencies in service coverage or an inadequate resolution capacity of primary care for certain basic health problems, The study was carried out with the objective of characterizing the rates of hospital admissions for causes sensitive to primary care in the city of Rio Verde – GO, as well as describing its historical series and verifying the impact of Primary Care coverage, in period from 2008 to 2018. Ecological time series study, whose data were collected from the Hospital Admissions System of the Unified Health System, based on the Brazilian List of Admissions for Conditions Sensitive to Primary Care. For data analysis, the research was divided into two axes: clinical-epidemiological and demographic aspects. The causes of hospitalizations for conditions sensitive to primary care were based on the list from the Ministry of Health. It was concluded that hospitalizations for conditions sensitive to primary care showed a reduction, while the coverage of primary care and the health strategy teams of the family, an increase was observed throughout the period analyzed. The three main groups with the highest percentage of hospitalizations for conditions sensitive to primary care were infectious gastroenteritis, followed by heart failure and lung diseases.

Temporal Trends in the Completeness of Epidemiological Variables in a Hospital-Based Cancer Registry of a Pediatric Oncology Center in Brazil.

This ecological time series study aimed to examine the temporal trends in the completeness of epidemiological variables from a hospital-based cancer registry (HbCR) of a reference center for pediatric oncology in Brazil from 2010 to 2016. Completeness categories were based on the percentage of missing data, with the categories excellent (<5%), good (5-10%), regular (11-20%), poor (21-50%), and very poor (>50%). Descriptive and bivariate analyses were performed using R.4.1.0; a Mann-Kendall trend test was performed to examine the temporal trends. Variables with the highest incompleteness included race/color (17.24% in 2016), level of education (51.40% in 2015), TNM (56.88% in 2012), disease status at the end of the first treatment (12.09% in 2013), cancer family history (79.12% in 2013), history of alcoholic consumption (39.25% in 2015), history of tobacco consumption (38.32% in 2015), and type of admission clinic (10.28% in 2015). Nevertheless, most variables achieved 100% completeness and were classified as excellent across the time series. A significant trend was observed for race/color, TNM, and history of tobacco consumption. While most variables maintained excellent completeness, the increasing incompleteness trend in race/color and decreasing trend in TNM underscore the importance of reliable and complete HbCRs for personalized cancer care, for planning public policies, and for conducting research on cancer control.

Arboviruses epidemic associates with Guillain-Barre syndrome: temporal series in northeast Brazil

Arboviruses cause public health problems in several countries, and records show thatthey can generate central and peripheral neurological complications with permanent sequelae. However, it is not certain which arbovirus is responsible for outbreaks of the Guillain-Barré Syndrome (GBS), especially in Brazil. Thus, the objective of this study is to verify if there is a coincidence between the GBS outbreak and the most common arboviruses in Northeastern Brazil, as well as their relationship. An ecological time series study was designed with the federative units of Northeastern Brazil, using hospitalizations for Guillain-Barré syndrome and notifications of arbovirus infections between 2014 and 2019 as a data source. Distribution incidence curves were constructed for the conditions studied, and generalized estimating equations (GEE) models were applied to estimate the relationship between arboviruses and Guillain-Barré. The results showed a similar distribution for the incidences of Chikungunya virus (z=7.82; p=0.001), Zika virus (z=3.69; p=0.03), and Guillain-Barré syndrome (z=2.98; p=0.05) from 2014 to 2019. The GEE model revealed that the distribution of Chikungunya incidence is associated with the distribution of GBS incidence in each year (x2Wald=3,969; p=0.046). This pattern was repeated in seven of the nine states, while the Zika virus had a significant relationship with GBS in only two states. The outbreak of GBS in Northeastern Brazil appears to be probabilistically related to outbreaks of the Chikungunya virus.

Gender and homicides in Paraná: a descriptive analysis from an ecological perspective (2018-2021)

Violence is considered a public health issue as it is one of the main causes of premature mortality in the world, resulting in several impacts that affect the population. This is an ecological time series study on homicides between 2018 and 2021 carried out in the State of Paraná. Data were extracted from the Mortality Information System (SIM) by categories: gender, age, race/color, marital status, place of occurrence and IDC (X85 to Y09 and Y35 to Y36). Data analysis shows that 9,169 violent deaths occurred in the state during the period, 91.2% (8,365) of which were male and 8.7% (801) were female. Considering only the age group, the majority of homicides are between the ages of 20 and 29, totaling 3,349 deaths in the last 4 years, 93.3% (3,123) of male gender and 6.7% (226) of female gender. In this same age group, there is the largest percentage difference between genders. A greater similarity was observed between 5 and 9 years old, with the percentage of both genders equal to 50% (7). The data shows that the highest rate of female homicides, 36.1% (289) occurred at home, while 42.7% (3,572) of male deaths occurred on public roads. Firearm discharge (ICD: X93, X94 and X95) is the main cause of death for both genders, with males accounting for 61.5% (5,142) and females 43.6% (349) of the cases. Better understanding the categories that lead to homicide is a fundamental step towards creating more effective public policies to minimize homicides in Brazil and around the world.

Hanseníase em menores de quinze anos no município mais hiperendêmico do Brasil

ABSTRACT Objective: To describe leprosy involvement and physical disability profiles in children and adolescents under 15 years old. Methods: Ecological time series study, based on data from the Brazilian Notifiable Diseases Information System, including new cases of leprosy residing in Palmas (TO), from 2001 to 2020. Results: A total of 471 notified cases in children and adolescents under 15 years of age were evaluated, resulting in a detection coefficient of 26.5 per 100,000 inhabitants. Of these, 52% (n=243) were women, 5% (n=24) corresponded to grade two disability, and 36% (n=168) were diagnosed through spontaneous demand. The temporal trend analysis showed a 0.5% reduction in the detection coefficient. There was a significant decrease in the diagnosis of the undetermined and tuberculoid clinical forms and a significant increase in the dimorphous form. Diagnosis through contact examination increased significantly by 13.1% and that through spontaneous demand decreased by 4.9%. The detection coefficient of cases with grade two disability reduced significantly by 7.4% while those with grade one increased by 16.8%. Conclusions: Despite the downward trend in the detection coefficient in children and adolescents under 15 years of age and in cases with grade two disability, other factors indicate failure in the adequate management of leprosy in Palmas.

Characterization of cases and epidemiological and operational indicators of leprosy: analysis of time series and spatial distribution, Piauí state, Brazil, 2007-2021.

To analyze epidemiological characteristics, temporal trends and spatial distribution of leprosy cases and indicators in the state of Piauí, 2007-2021. This was an ecological time-series study using data from the Notifiable Health Conditions Information System, describing the spatial distribution and the temporal trend of leprosy using Prais-Winsten regression. A total of 17,075 new cases of leprosy were reported. There was a falling trend in the overall detection rate [annual percentage change (APC) = -6.3; 95%CI -8.1;-4.5)], detection in children under 15 years of age (APC = -8,6; 95%CI -12,7;-4,3) and detection of cases with grade 2 physical disability (APC = -4,4; 95%CI -7,0;-1,8). There was a rising trend in the proportion of multibacillary cases. Spatial distribution of the average detection rate identified hyperendemic areas in the Carnaubais, Entre Rios, Vale dos Rios Piauí e Itaueiras regions. High leprosy detection rates were found, despite the falling trend of indicators, except the proportion of multibacillary cases. Between 2007 and 2021, Piauí showed an improving trend in all indicators analyzed, except the proportion of new multibacillary cases. Spatial distribution identified hyperendemic areas in different regions of the state. This study provides health services with a broad overview of the epidemiological situation of leprosy in Piauí, with evidence of the populations and locations most affected by the disease, whereby public authorities need to reinforce the promotion of health actions. It is expected that actions to prevent and control the disease will be adopted, such as offering early diagnosis, ensuring correct treatment and implementing measures to prevent physical disabilities.

Maintenance of medium- and high-complexity health services in the context of high patient transition: a time series ecological study of the state of Rio de Janeiro, Brazil.

The study addresses the historical disparities in the distribution of the medium- and high-complexity health network and the limits to budget adjustments between the municipality of Rio de Janeiro and its neighboring municipalities of the Metropolitan region 1. An ecological study was conducted with data related to the municipality of Rio de Janeiro, chosen because it has a large assistance network, while located on the borders of vulnerable and underprivileged areas, characterizing a locus that is representative of the situations faced throughout the country. A decrease in the gross values of the programmed quotas in all municipalities of Rio de Janeiro was observed from 2016 onwards. The temporal trend of the programmed quotas remained stable for all municipalities in the Metropolitan Region 1, even with significant increases in the accomplished quotas for neighboring municipalities. The resulting overload in local expenditure prevents the increase of capacity to anticipate fluctuations in demand, both known and unexpected ones, compromising the responsiveness of the health system regarding its regular operation, as well as the ability to adjust to cope with extraordinary events, essential characteristics of resilience.

Análise da tendência da mortalidade por causas externas em pessoas idosas no Brasil, 2000 a 2022

Abstract Objective To analyze the trend of mortality due to external causes in older adults in Brazil within the temporal interval spanning from 2000 to 2022 and to identify the sociodemographic profile of mortality. Method Ecological time-series study utilizing secondary data, encompassing mortality in older adults due to external causes in Brazil, spanning the period from 2000 to 2022. The data were collected from the databases of the Department of Informatics of the Unified Health System, population estimates, and census population data provided by the Brazilian Institute of Geography and Statistics. The absolute and relative frequency of the data were analyzed using Microsoft Excel 2010 software. The analysis of trends in mortality rates and segmented linear regression was conducted using Joinpoint, with statistical significance assessed through the Monte Carlo test. Results During the investigated period, 572,608 deaths due to external causes were identified in individuals aged 60 years or older. Regarding the mortality pattern due to external causes in older adults, an increasing trend in mortality rates was observed for the majority of the studied period (2000 to 2013) with an annual percent change (APC) of 1.86 (95% CI: 1.5–2.2). Conclusion The results indicate a growing trend in mortality among older individuals due to external causes, highlighting the need for prioritizing public policies that address this issue.

Three years of COVID-19 pandemic: comparative analysis of incidence, lethality and mortality among the States of the South Region of Brazil

Introduction: in Brazil, the first case of COVID-19 was confirmed on February 26, 2020 As of March 17, 2023, the Ministry of Health recorded 699,634 deaths from COVID-19, with a fatality rate of 1.9%. The impact of the COVID-19 pandemic in Brazil in socioeconomic and health system spheres and a reflection of major regional differences. Objective: to analyze mortality, incidence and lethality due to COVID-19 in the states of Paraná and Santa Catarina, southern Brazil. Methods: this is an ecological time series study using official Brazilian secondary data for cases and deaths from COVID-19. The data were extracted from the panel of the State Department of Health of the states of Santa Catarina and Paraná. For trend analysis, time series were developed using the Prais-Winsten regression model. Statistical analyzes were performed using STATA 14.0 software (College Station, TX, USA, 2013). Results: in the analysis of rates in the total period analyzed, the trends for mortality, lethality and incidence in the state of Santa Catarina are decreasing, decreasing and stationary, respectively. In the state of Paraná, rates in the total period showed a stationary, decreasing and increasing trend for mortality, lethality and incidence, respectively. Conclusion: COVID-19 had a devastating effect on the states of Santa Catarina and Paraná. Both states suffered from the progress of the COVID-19 pandemic, with higher lethality and mortality rates being observed in the state of Paraná, while Santa Catarina had a higher incidence rate over the three years it was in effect. COVID-19 pandemic.

COVID-19 in Rio de Janeiro, Brazil: a perspective on epidemiological events

Introduction: the progression of SARS-CoV-2 highlighted the Americas region for the number of COVID-19 cases and deaths. In Brazil, the Southeast region was one of the most affected, especially the state of Rio de Janeiro, due to its cosmopolitan characteristics. Objective: to analyze temporal variations in the incidence, mortality and lethality of COVID-19 in the state of Rio de Janeiro from January 2020 to December 2022. Methods: ecological time-series study with publicly available data on COVID-19 cases and deaths. Crude incidence, mortality, and fatality rates, and estimates of percent daily change (DPC) were analyzed using Prais-Winsten linear regression. With calculation of crude rates were performed using Microsoft Excel 2019, and DPC estimates were performed using STATA MP 17.0 software. Results: 2.5 million cases and 76 thousand COVID-19 deaths were confirmed in the state of Rio de Janeiro from 2020 to 2022, with lethality declining from 4.89% to 0.60%. The highest lethality occurred in May 2020 (11.59%), October 2021 (9.13%) and March 2022 (6.78%), showing a stationary trend. In 2020, incidence and mortality rates peaked in December (797.76 per 100,000 inhabitants) and May (43.96 per 100,000 inhabitants), respectively, followed by subsequent declines. Incidence trend was increasing in 2020 and stationary in 2022, while mortality decreased in 2021 and 2022 after stability in 2020. Conclusion: The incidence of COVID-19 peaked in 2020 and subsequently declined, suggesting partial transmission control. Mortality stabilized after 2020, indicating evolution in health care. Lethality showed a stationary trend, indicating an improvement in hospital capacity. The divergent behavior of the epidemiological indicators reflected the complex dynamics of the pandemic in the analyzed state. There were 790 thousand deaths from COVID-19 in the State of Rio de Janeiro in the period from 2020 to 2022.

Association between hospitalizations for sensitive conditions and quality of primary care.

To analyze the association between municipal rates of ambulatory care sensitive conditions (ACSC) hospitalization and the quality of primary health care (PHC), socioeconomic, and demographic variables and those related to local characteristics of the health system from 2010 to 2019. Ecological time series study in Brazilian municipalities analyzing the correlation of ACSC hospitalization rates with PHC quality measured by the three cycles of the Primary Care Access and Program for improving primary care access and quality (PMAQ-AB). The study included municipalities whose teams participated in 80% or more of at least two PMAQ-AB cycles. The correlation between standardized ACSC hospitalization rates and PHC quality and other variables was analyzed. Spearman's test was used between the response variable and numerical explanatory variables. Generalized equations estimation was used as a multivariate model associating ACSC hospitalization rates with the other variables over the years. A total of 3,500 municipalities were included in the models. The quality of PHC (PMAQ-AB score) showed an inverse association with the variation in ACSC hospitalization rates. Hospitalization rates fell by -2% per year every ten-point increase in the PMAQ-AB score, adjusted by the remaining variables. A one-unit increase in the beds per 1,000 inhabitants variable had an impact of approximately +6.4% on ACSC hospitalization rates. Regarding population size, larger municipalities had lower ACSC hospitalization rates. Increased PHC coverage and lower socioeconomic inequality were also associated with the reduction in hospitalizations. The reduction in ACSC hospitalization rates over time was associated with an increase in the quality of PHC. It was also associated with a reduction in the number of hospital beds and municipalities with better socioeconomic indicators.

Trends in tuberculosis incidence and mortality coefficients in Brazil, 2011-2019: analysis by inflection points.

To analyze the temporal trend of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. This was an ecological time series study of tuberculosis incidence and mortality rates in Brazil between 2011 and 2019. Data were extracted from the Notifiable Disease Information System and the Mortality Information System, and population estimates were from the Brazilian Institute of Geography and Statistics. Trends were analyzed by Joinpoint regression, which recognizes inflection points for temporal analysis. The average incidence rate of tuberculosis in Brazil in the period was 35.8 cases per 100 000 population. From 2011 to 2015, this coefficient had an annual percentage change of -1.9% (95% CI [-3.4, -0.5]) followed by an increase of 2.4% (95% CI [0.9, 3.9]) until 2019. The average mortality rate between 2011 and 2019 was 2.2 deaths per 100 000 population, with an average annual percentage change of -0.4% (95% CI [-1.0, 0.2]). Amazonas was the only state with an increase in the annual average percentage variation for the incidence rate (3.2%; 95% CI [1.3, 5.1]) and mortality rate (2.7%; 95% CI [1.0, 4.4]) over the years, while Rio de Janeiro state had an increasing inflection for incidence from 2014 to 2019 (2.4%; 95% CI [1.4, 3.5]) and annual average of decreasing percentage variation (-3.5%; 95% CI [-5.0, -1.9]). During the period analyzed, a decreasing trend in incidence was observed between 2011 and 2015, and an increasing trend for the period from 2015 to 2019. On the other hand, no change in the trend for mortality was found in Brazil.

Epidemiology of suicide mortality in Mexican young people (ages 15-29) from 1990 to 2020

Introduction. In 2020, suicide was the third leading cause of death in Mexico among young people ages 15 and 29, accounting for 43.0% of all suicides in the country, making it a major public health issue. Objective. To explore changes in the geographic distribution of suicide rates by state and to analyze the magnitude, distribution, and pattern of suicide mortality in young Mexicans ages 15 to 29 between 1990 and 2020. Method. Descriptive, ecological time-series study, based on official information. Standardized mortality rates were calculated using information on deaths (INEGI) and population estimates (CONAPO). The magnitude, distribution, and patterns of suicide mortality at the national level and by state were analyzed using the Joinpoint segmented regression model. Results. From 1990 to 2020, suicide mortality in young people increased by 198% and was higher in women (285%) than men (178%). The states with the highest suicide mortality rates from 2016 to 2020 were Chihuahua (18.5 suicides/100,000 young people ages 15-29), Aguascalientes (16.6), Yucatán (14.4), Guanajuato (14.1), and San Luis Potosí (12.9), accounting for 23.0% of total suicide deaths. Discussion and conclusion. The study of mortality trends could contribute to the management of a national suicide prevention strategy in young Mexicans, providing support for public health decision-making, such as the identification of the states and regions that should be prioritized.