Population-based Study In Brazil Research Articles

Adherence to the EAT-Lancet sustainable diet and ultra-processed food consumption: findings from a nationwide population-based study in Brazil.

To evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet in a representative sample of the Brazilian population. The study used data from the Brazilian National Dietary Survey 2017-2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively. Nationally representative sample of the Brazilian population. The study included 46 164 Brazilians ≥ 10 years old. The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT-Lancet diet. The PHDI total score was 5·38 points lower (95 % CI -6·01, -4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods. Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.

The Rising Incidence of Skin Cancers in Young Adults: A Population-Based Study in Brazil

The Rising Incidence of Skin Cancers in Young Adults: A Population-Based Study in Brazil

Effects of maternal HIV infection on low, very low, and extremely low birth weight: a population-based study in Brazil

Effects of maternal HIV infection on low, very low, and extremely low birth weight: a population-based study in Brazil

Poor sleep quality is an important modifiable risk factor for dementia: Population attributable fraction of poor sleep in a Brazilian population-based study.

The populational impact of poor sleep quality and the risk of dementia is unclear. We analyzed the Population Attributable Fraction (PAF) of poor sleep quality for dementia, and its association with other two sleep parameters through self-reported and single questions collected in a large-scale Brazilian cohort (ELSI-Brazil). A subset of the ELSI-Brazil with complete responses to sleep quality was retrieved for this study. This is a large representative sample of the Brazilian elderly population with an extensive assessment of sociodemographic and health risk variables. Prevalence of poor sleep quality was estimated according to the complex sample design, and its PAF was measured using a meta-analytic relative risk. A total of 6024 (56.3% women, mean 62.8±9.5years of age) individuals had complete responses. The prevalence of poor sleep quality was 24.9% (95%CI 23%-26%), and the PAF of poor sleep quality including other 10 modifiable risk factors of dementia was 52.5% in Brazil. Secondary analyses identified that sleep quality, restorative sleep and sleep drug usage varied considerably according to age ranges, race, and gender. Poor sleep quality is an important populational modifiable risk factor for dementia in Brazil. Targeted interventions may provide an important impact in preventing dementia in low- and middle-income countries.

A nationwide study on immunosenescence biomarkers profile in older adults: ELSI-Brazil

Immunosenescence is a phenomenon caused by changes in the immune system, and part of these changes involves an increase in circulating immunological biomarkers, a process known as “Inflammaging.” Inflammaging can be associated with many diseases related to older people. As the older population continues to grow, understanding changes in the immune system becomes essential. While prior studies assessing these alterations have been conducted in countries with Caucasian populations, this investigation marks a pioneering effort. The object of the study is to describe for the first time that the distribution of cytokines, chemokines, and growth factors serum levels, assessed by Luminex platform, has been examined in a Brazilian population-based study of older adult females and males by age. Blood samples from 2111 participants (≥50 years old) were analyzed at the baseline (2015/2016) of the ELSI-Brazil study. The exploratory variables considered in the study were age, sex, educational level, residence area, geographic region, alcohol and smoking consumption, physical activity, and self-reported medical diagnoses of hypertension, diabetes, asthma, arthritis, and cancer. The association between serum biomarker levels and age was assessed by a quantile regression model adjusted in the total population and stratified by sex. The significance level considered in the analysis was 0.05. The mean age of the participants was 62.9 years, with a slight majority of female (52.7 %). Differences were found between the sexes in the median circulating levels of the CCL11, CXCL10, and FGF biomarkers. Eight biomarkers showed significant associations with age, including the pro-inflammatory CXCL10, TNF-α, IL-6, IL-17, and IL-2; and type 2/regulatory CCL11 and IL-4, showing positive associations, and anti-inflammatory IL-1Ra showing a negative association. The results suggest similar associations between the sexes, revealing an inflammatory profile characterized by types 1 and 2. Remarkably, these findings reinforce the concept of the Inflammaging process in Brazilian population. These findings add novel insights to about the immunosenescence aspects in middle-income countries and help define biomarkers capable of monitoring inflammation in older adults.

Patient’s perception of medication and nonadherence to chronic disease treatments. A population-based study in Brazil

Abstract Objective To identify the association between patients’ perception of medication for hypertension, diabetes, and dyslipidemia and nonadherence by regions of Brazil. Methods This is a cross-sectional study using open data from the urban population-based survey National Survey on Access, Use and Promotion of Rational Use of Medicines in Brazil (PNAUM), conducted from September 2013 to February 2014. Patients’ self-reported perceptions recorded on each of the medicines for hypertension, diabetes, and dyslipidaemia were used for analysis. The dependent variable was nonadherence to treatment, and the patient’s perceptions about medication were the independent variable. Logistic regression was performed to calculate the crude and adjusted odds ratios. Key findings Nonadherence was observed in 6.6% of the 16 491 drugs, with missed doses (84.5%) being the main cause. In the adjusted analysis, perception of medication effectiveness considered regular or poor (OR 3.025; 95% CI 1.672–5.473), perception that caused discomfort (OR 2.731; 95% CI 1.464–5.092), and medicines used for <6 months (OR 1.557; 95% CI 1.089–2.227) had higher chances of nonadherence in Brazil (all regions). Conclusion Patient perception of the effectiveness, safety, and time of use of medications are key factors associated with nonadherence and can contribute to building medication beliefs that may affect current and future adherence.

Factors associated with preventable infant mortality in 2020: a Brazilian population-based study

Factors associated with preventable infant mortality in 2020: a Brazilian population-based study

International burden of cancer deaths and years of life lost from cancer attributable to four major risk factors: a population-based study in Brazil, Russia, India, China, South Africa, the United Kingdom, and United States

We provide a comprehensive view of the impact of alcohol consumption, tobacco smoking, excess body weight, and human papillomavirus (HPV) infection on cancer mortality and years of life lost (YLLs) in Brazil, Russia, India, China, South Africa, the United Kingdom (UK), and United States (US). We collected population attributable fractions of the four risk factors from global population-based studies and applied these to estimates of cancer deaths in 2020 to obtain potentially preventable cancer deaths and their 95% confidence intervals (CIs). Using life tables, we calculated the number and age-standardised rates of YLLs (ASYR). In Brazil, Russia, India, China, South Africa, the UK, and the US in 2020, an estimated 5.9 million (3.3 million-8.6 million) YLLs from cancer were attributable to alcohol consumption, 20.8 million (17.0 million-24.6 million) YLLs to tobacco smoking, 3.1 million (2.4 million-3.8 million) YLLs to excess body weight, and 4.0 million (3.9 million-4.2 million) YLLs to HPV infection. The ASYR from cancer due to alcohol consumption was highest in China (351.4 YLLs per 100,000 population [95% CI 194.5-519.2]) and lowest in the US (113.5 [69.6-157.1]) and India (115.4 [49.7-172.7). For tobacco smoking, China (1159.9 [950.6-1361.8]) had the highest ASYR followed by Russia (996.8 [831.0-1154.5). For excess body weight, Russia and the US had the highest ASYRs (385.1 [280.6-481.2] and 369.4 [299.6-433.6], respectively). The highest ASYR due to HPV infection was in South Africa (457.1 [453.3-462.6]). ASYRs for alcohol consumption and tobacco smoking were higher among men than women, whereas women had higher ASYRs for excess body weight and HPV infection. Our findings demonstrate the importance of cancer control efforts to reduce the burden of cancer death and YLLs due to modifiable cancer risk factors and promote the use of YLLs to summarise disease burden. Cancer Research UK.

Exploring factors and trends in place of death by cancer: A population-based study in Brazil.

237 Background: Place of death serves as an indicator of the quality of end-of-life care. This study seeks to elucidate the place of deaths by cancer in Brazil, also identifying factors contributing to regional disparities in end-of-life settings. Methods: Using data obtained from the National Mortality Information System, this study extracted sociodemographic characteristics and the location of cancer deaths in Brazil from 2012 to 2021. The place of death was classified into hospital death, home death, and other settings (not shown). Results: A total of 2.165.643 deaths by cancer were included. Almost half of the cases were from Southeast (47.4%), while 22.0% were from Northeast, 19.0% from South and the minority from Central-west (6.5%) and North (5.0%) regions; remarkably, 73.3% of deaths occurred out of capitals. A downward trend was observed from 2012 to 2021 with a Relative Percent Difference (RPD) of -4,0. The frequency of deaths occurring at home in the Northeast region (26.6%) was found to be higher than the reference region, the Southeast (10.6%), RPD -22.2. Furthermore, Indigenous individuals showed a higher frequency of death at home (25.4%) compared to White ethnicity (14.2%), RPD -18.4. A clear inverse relation between in-hospital deaths and aging can be noted, as more at-home deaths are observed in the elderly (17.8%) compared to the young group (4.1%). Conclusions: Most cancer deaths in Brazil occur in hospitals. Death at home is related to pronounced regional differences, being higher in the North and Northeast, and may be related to advanced age, race and educational level.[Table: see text]

Maternal and congenital syphilis attributable to ethnoracial inequalities: a national record-linkage longitudinal study of 15 million births in Brazil

This study estimated ethnoracial inequalities in maternal and congenital syphilis in Brazil, understanding race as a relational category product of a sociopolitical construct that functions as an essential tool of racism and its manifestations. We linked routinely collected data from Jan 1, 2012 to Dec 31, 2017 to conduct a population-based study in Brazil. We estimated the attributable fraction of race (skin colour) for the entire population and specific subgroups compared with White women using adjusted logistic regression. We also obtained the attributable fraction of the intersection between two social markers (race and education) and compared it with White women with more than 12 years of education as the baseline. Of 15 810 488 birth records, 144 564 women had maternal syphilis and 79 580 had congenital syphilis. If all women had the same baseline risk as White women, 35% (95% CI 34·89-36·10) of all maternal syphilis and 41% (40·49-42·09) of all congenital syphilis would have been prevented. Compared with other ethnoracial categories, these percentages were higher among Parda/Brown women (46% [45·74-47·20] of maternal syphilis and 52% [51·09-52·93] of congenital syphilis would have been prevented) and Black women (61% [60·25-61·75] of maternal syphilis and 67% [65·87-67·60] of congenital syphilis would have been prevented). If all ethnoracial groups had the same risk as White women with more than 12 years of education, 87% of all maternal syphilis and 89% of all congenital syphilis would have been prevented. Only through effective control of maternal syphilis among populations at higher risk (eg, Black and Parda/Brown women with lower educational levels) can WHO's global health initiative to eliminate mother-to-child transmission of syphilis be made feasible. Recognising that racism and other intersecting forms of oppression affect the lives of minoritised groups and advocating for actions through the lens of intersectionality is imperative for attaining and guaranteeing health equity. Achieving health equality needs to be addressed to achieve syphilis control. Given the scale and complexity of the problem (which is unlikely to be unique to Brazil), structural issues and social markers of oppression, such as race and education, must be considered to prevent maternal and congenital syphilis and improve maternal and child outcomes globally. Wellcome Trust, CNPq-Brazil. For the Portuguese translation of the abstract see Supplementary Materials section.

Combined association between physical inactivity and non-white skin color exacerbates the chance of diabetes during the Covid-19 pandemic: a population-based study in Brazil

Combined association between physical inactivity and non-white skin color exacerbates the chance of diabetes during the Covid-19 pandemic: a population-based study in Brazil

Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study.

To assess the evolution of COVID-19 among Brazilian pregnant women, identifying sociodemographic and clinical predictors related to admission to ICU - Intensive Care Unit and death. Cross-sectional, population-based study, carried out with a secondary database, based on data from the Influenza Epidemiological Surveillance Information System. Descriptive analysis was performed, followed by multiple linear regression with Poisson response, adopting critical p < 0.05. Intensive care admission rates of 28.2% and death rates of 9.5% were identified. Region of residence, gestational trimester, number of comorbidities and respiratory signs and symptoms were associated with the risk of admission to intensive care. Age over 34 years, comorbidities, oxygen saturation equal to or less than 95%, admission to intensive care and ventilatory support, invasive or not, increased the risk of death. Sociodemographic and clinical predictors showed an association with hospitalization in intensive care and death of pregnant women with COVID-19.

Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study

RESUMO Objetivo: Avaliar a evolução da COVID-19 entre gestantes brasileiras, identificando-se os preditores sociodemográficos e clínicos relacionados à internação em unidade de terapia intensiva e ao óbito. Método: Estudo transversal e de base populacional, realizado com banco de dados secundários, a partir de dados do Sistema de Informação da Vigilância Epidemiológica da Gripe. Realizou-se análise descritiva, seguida de regressão linear múltipla com resposta Poisson, adotando-se p crítico &lt;0,05. Resultados: Identificaram-se taxas de internação em terapia intensiva de 28,2% e de óbito de 9,5%. Região de residência, trimestre gestacional, número de comorbidades e sinais e sintomas respiratórios associaram-se ao risco de internação em terapia intensiva. Idade superior a 34 anos, comorbidades, saturação de oxigênio igual ou inferior a 95%, internação em terapia intensiva e suporte ventilatório, invasivo ou não, aumentaram o risco de óbito. Conclusão: Preditores sociodemográficos e clínicos mostraram associação com a hospitalização em terapia intensiva e com o óbito de gestantes com COVID-19.

Preventable risk factors of dementia: Population attributable fractions in a Brazilian population-based study

Knowledge regarding the modifiable risk factors of dementia is fundamental to guide public health policy. We aimed to estimate the population attributable fraction of modifiable risk factors of dementia among adults from a nationwide epidemiological study. We used the public database of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) to calculate the Population Attributable Fraction (PAF) for ten risk factors, including education level, hearing loss, hypertension, alcohol consumption, obesity, active smoking, depression, social isolation, physical inactivity, and diabetes. PAF was estimated for this sample after accounting for the communality of each risk factor. The ten preventable risk factors for dementia accounted for 50·5% of the Population Attributable Fraction in Brazil. Hearing loss (14·2%), physical inactivity (11·2%), and hypertension (10·4%) accounted for the highest PAF among all the risk factors. Considerable variation in the relative contribution of the different risk factors was found in different regions. This study might provide an opportunity to change the impact of dementia in Brazil. By targeting modifiable risk factors of dementia, the health of individuals in Brazil might be considerably improved. This study did not receive any funding.

Youth depression and inflammation: Cross-sectional network analyses of C-Reactive protein, interleukin-6 and symptoms in a population-based sample

BackgroundInflammation-related proteins constitute a promising avenue in studying biological correlates of major depressive disorder (MDD). However, MDD is a heterogeneous condition – a crucial aspect to be considered in association studies. We examined whether inflammatory proteins are associated with categorical diagnosis, a dimensional total sum-score, and specific depressive symptoms among youths. MethodsWe analyzed data from the 1993 Pelotas Birth Cohort, a population-based study in Brazil that followed individuals up to age 22 years. Categorical psychiatric diagnoses were derived using adapted modules of the Mini International Neuropsychiatric Interview (MINI). Dimensional symptomatology was assessed using the Brazilian Portuguese version of the Center for Epidemiological Studies–Depression Scale–Revised (CESD-R). We estimated network structures that included individual depressive symptoms as measured by CESD-R items, peripheral inflammatory markers (C-Reactive Protein [CRP] and Interleukin-6 [IL-6]), as well as relevant covariates. ResultsWe evaluated 2586 participants (mean age = 22.5[SD = 0.33]) There were no associations between concentrations of inflammatory proteins and categorical diagnosis of MDD or with CESD-R total sum-scores. In symptom-specific analysis, CRP and IL-6 were positively connected to somatic and cognitive items. DiscussionWe found cross-sectional connections of two commonly studied inflammatory proteins and specific depressive symptoms. Conducting symptom-specific analyses in relation to biological markers might advance our understanding of the heterogeneity of MDD.

Rheumatic diseases and associated factors in older adults: a Brazilian population-based study

Introduction: Rheumatic diseases have high occurrence in older adults, which may lead to a reduction in independence and quality of life. Objective: To calculate prevalence and to identify factors associated with rheumatic diseases in older adults of the urban area of a municipality in Southern Brazil. Methods: Cross-sectional population-based study, conducted in 2008 in the city of Bagé-RS, Brazil with older adults aged 60 years or over. The outcome was defined from the question "Has any doctor told you that you have rheumatism, arthritis or arthrosis?" Poisson regression was used for the crude and adjusted analysis. Results: A total of 1,593 participants were interviewed. 27.3% (95% CI 25.0-29.5) reported having medical diagnosis of at least one of the rheumatic diseases studied. In the adjusted analysis, it was found that female sex (RP=2.86; 95% CI 2.28-3.59; p≤0.001), without schooling (RP=1.24; 95% CI 1.0-1.58; p=0.047), not living alone (RP=1.29; 95% CI 1.03-1.61; p=0.024), poor self-perception of health (PR=1.54; 95% CI 1.63-2.02; p=0.001), spinal problems (PR=1,96; 95% CI 1.67-2.31; p≤0.001), fall in the last year (PR=1.22; 95% CI 1.04-1.43; p=0.013), incapacity for instrumental activities of daily living (PR=1.20; 95% CI 1.02-1.41; p=0.028) and healthcare appointment in the last 3 months (PR=1.20; 95% CI 1.01-1.42; p=0.035) were associated with the presence of rheumatic diseases (rheumatism, arthritis and arthrosis). Conclusion: It is suggested that care of musculoskeletal problems of the spine should be increased, in order to reduce falls and functional disability in older adults, based on actions focused on the prevention of these problems.

Food consumption according to degree of food processing, behavioral variables, and sociodemographic factors: Findings from a population-based study in Brazil

ObjectivesThis study aimed to investigate the consumption levels of foods at different degrees of processing and their associations with sociodemographic and behavioral characteristics of Brazilian adults. MethodsThis is a cross-sectional, population-based study involving 976 adult individuals (ages 20 to 59 y) of both sexes, living in the municipality of Viçosa, Minas Gerais State, Brazil. Participants were selected using a probabilistic sampling technique. Consumed foods were categorized into four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultraprocessed foods. Associations were tested using linear regression. ResultsUnprocessed and minimally processed foods accounted for 61.3% of the total energy intake and were positively associated with age and negatively associated with level of education (β = −6.86; 95% confidence interval [CI] [−10.16 to −3.57]) and sedentary behavior (β = 3.24; 95% CI [−5.88 to −0.61]). Ultraprocessed foods accounted for 23.6% of the total energy intake, and consumption was negatively associated with age and positively associated with sedentary behavior (β = 0.005; 95% CI [0.00008–0.01]) and tertiary education (β = 5.42; 95% CI [2.71–8.13]). ConclusionsUltraprocessed foods contribute more to the daily energy intake of younger individuals, and ultraprocessed food consumption is positively associated with sedentary activity and level of education.

Factors associated with non-adoption of healthy behavior among individuals with diabetes: a population-based study in Brazil.

The non-adoption of behavioral changes to control diabetes mellitus contributes to a low adherence to self-care. This study aimed to investigate the factors associated with non-adoption of healthy behaviors among diabetic individuals. Cross-sectional study using data from the National Health Survey (Pesquisa Nacional de Saúde) carried out in 2013 in Brazil, with adults (≥18 years) (n = 3098). The outcome variable was the non-adoption-two or fewer-of healthy behaviors. Logistic regression model was used to identify the factors associated with non-adoption of healthy behaviors. Approximately, 50% of the participants adopted two or fewer healthy habits and the most frequently mentioned were not drinking excessively (94.1%) and not smoking (89.1%). Not using diabetic medication (odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.02-1.85), not making regular doctor visits (OR = 1.42, 95% CI = 1.08-1.87), no limitation of usual activities (OR = 1.39, 95% CI = 1.01-1.94) and good self-rated health (OR = 1.47, 95% CI = 1.09-1.98) increased the chance of individuals non-adoption of healthy behaviors independently of gender, age, schooling and economic status. Health professionals need to be aware of issues, such as diabetic medication use, frequency of doctor visits, limitation of usual activities and good self-rated health, which are factors that can interfere with the adoption of healthy behaviors of diabetic patients.

Gender differences in the use of atypical antipsychotics in early-onset schizophrenia: a nationwide population-based study in Brazil

BackgroundThe use of atypical antipsychotics for the treatment of schizophrenia and other mental disorders in populations under 18 years of age is increasing worldwide. Little is known about treatment patterns and the influence of gender differences, which may be a predictor of clinical outcomes. The aim of this study was to investigate gender differences in the use of atypical antipsychotics in patients with early-onset schizophrenia (EOS) assisted by the public health system in Brazil.MethodsWe conducted a cross-sectional study of outpatients with EOS aged 10 to 17 years who received at least one provision of atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine or ziprasidone) from a large Brazilian pharmaceutical assistance programme. Data were retrieved from a nationwide administrative database from 2008 to 2017.ResultsOf the 49,943 patients with EOS, 63.5% were males, and the mean age was 13.6 years old. The patients were using risperidone (62.5%), olanzapine (19.6%), quetiapine (12.4%), ziprasidone (3.3%) and clozapine (2.2%). We found gender differences, especially in the 13–17 year age group (65.1% for males vs. 34.9% for females, p < 0.001), in the use of risperidone (72.1% for males vs. 27.9% for females, p < 0.001) and olanzapine (66.5% for males vs. 33.5% for females, p < 0.001). Only in the 13 to 17 years age group were the prescribed doses of olanzapine (p = 0.012) and quetiapine (p = 0.041) slightly higher for males than for females.ConclusionsOur findings showed gender differences among patients diagnosed with EOS and who received atypical antipsychotics. More attention should be devoted to gender differences in research and clinical practice.

Double Burden of Malnutrition and Inequalities in the Nutritional Status of Adults: A Population-Based Study in Brazil, 2019.

Objective: To describe the inequalities in the double burden of malnutrition (DBM) in the adult population. Methods: Study carried out with data from the VIGITEL study, conducted in 2019 in all Brazilian capitals. Underweight and excess weight were evaluated on the basis of years of schooling and age. Multi-level analysis was performed including Human Development Index of each capital and individual-level variables. The inequality slope index was used to assess the magnitude of the inequalities found. All analyses considered the svy command owing to the complexity of the sampling process. Results: 47.119 individuals were studied. Men with no education had 6 percentage points more underweight compared to those with higher education. Higher prevalence of excess weight was found among men with higher education and women with no education. In women, the difference was 18 percentage points between extreme categories. Elderly people with no education had 10 percentage points more excess weight than those with higher education. Conclusions: The findings suggest the need for intersectoral actions that can cope with the social inequalities and help confronting with the DBM in Brazil.