Data de publicação

20 de julho de 2018

Periódico

The Lancet

Resumo

Background – Political, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses.

Methods – We analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries.

Findings – Nationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0–68·9) in 1990 to 75·2 years (74·7–75·7) in 2016, and HALE increased from 59·8 years (57·1–62·1) to 65·5 years (62·5–68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4–34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7–32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index.

Interpretation – Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities.

Funding – Bill & Melinda Gates Foundation and the Brazilian Ministry of Health.

DOI/link

https://doi.org/10.1016/S0140-6736(18)31221-2

GBD 2016 Brazil Collaborators:

Fatima Marinho, Valéria Maria de Azeredo Passos, Deborah Carvalho Malta, Elizabeth Barboza França, Daisy M X Abreu, Valdelaine E M Araújo, Maria Teresa Bustamante-Teixeira, Paulo A M Camargos, Carolina Cândida da Cunha, Bruce Bartholow Duncan, Mariana Santos Felisbino-Mendes, Maximiliano Ribeiro Guerra, Mark D C Guimaraes, Paulo A Lotufo, Wagner Marcenes, Patricia Pereira Vasconcelos Oliveira, Marcel de Moares Pedroso, Antonio L Ribeiro, Maria Inês Schmidt, Renato Azeredo Teixeira, Ana Maria Nogales Vasconcelos, Mauricio L Barreto, Isabela M Bensenor, Luisa C C Brant, Rafael M Claro, Alexandre Costa Pereira, Ewerton Cousin, Maria Paula Curado, Kadine Priscila Bender dos Santos, André Faro, Cleusa P Ferri, João M Furtado, Julia Gall, Scott D Glenn, Alessandra Carvalho Goulart, Lenice Harumi Ishitani, Christian Kieling, Roberto Marini Ladeira, Isis Eloah Machado, Sheila Cristina Ouriques Martins, Francisco Rogerlândio Martins-Melo, Ana Paula Souto Melo, Molly K Miller-Petrie, Meghan D Mooney, Bruno P Nunes, Marcos Roberto Tovani Palone, Claudia C Pereira, Davide Rasella, Sarah E Ray, Leonardo Roever, Raphael de Freitas Saldanha, Itamar S Santos, Ione J C Schneider, Diego Augusto Santos Silva, Dayane Gabriele Alves Silveira, Adauto Martins Soares Filho, Tatiane Cristina Moraes Sousa, Celia L Szwarcwald, Jefferson Traebert, Gustavo Velasquez-Melendez, Yuan-Pang Wang, Rafael Lozano, Christopher J L Murray, Mohsen Naghavi

Affiliations:

Disease Control and Prevention, PAHO, and Ministry of Health, Brazil, Brazil (F Marinho PhD); Faculdade Ciências Médicas de Minas Gerais, Minas Gerais, Brazil (Prof V M d A Passos PhD); Nursing School (Prof D C Malta PhD, Prof M S Felisbino-Mendes PhD, Prof R M Claro DSc, I E Machado PhD, Prof G Velasquez-Melendez PhD), School of Medicine (E B França PhD, D M X Abreu PhD, C C Da Cunha PhD, Prof M D C Guimaraes MD, Prof A L Ribeiro MD, R A Teixeira PhD Student, Prof A P S Melo DSc, Prof P A M Camargos PhD), School of Medicine and Hospital de Clínicas (Prof L C C Brant PhD), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (L H Ishitani PhD); Ministry of Health of Brazil, Brasília, Distrito Federal, Brazil (V E M Araújo PhD, P P V Oliveira MS, A M Soares Filho MPH); Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil (Prof M T Bustamante-Teixeira PhD, M R Guerra PhD); Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil (B B Duncan MD, Prof M I Schmidt MD, C Kieling MD); University of North Carolina, Chapel Hill, NC, USA (B B Duncan MD); Center for Clinical and Epidemiological Research Center and Internal Medicine Department from the Hospital Universitario (A C Goulart PhD), Internal Medicine Department (Prof I S Santos PhD), Heart Institute (A Costa Pereira PhD), Universidade de São Paulo, São Paulo, São Paulo, Brazil (Prof P A Lotufo DrPH, I M Bensenor PhD, Y-P Wang PhD); Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil (M R T Palone MSc); Division of Patient and Population Health (Prof W Marcenes PhD), King’s College London, London, UK; Instituto de Comunicação e Informação Científica e Tecnológica em Saúde (M d Pedroso PhD), National School of Public Health (Prof T C M Sousa MPH), Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil (Prof C L Szwarcwald PhD, C C Pereira PhD, R d F Saldanha MS); Center for Data and Knowledge Integration for Health (CIDACS), Fundação Oswaldo Cruz, Salvador, BA, Brazil (Prof M L Barreto PhD); Universidade de Brasília, Brasília, Distrito Federal, Brazil (Prof A M N Vasconcelos PhD, D G A Silveira MD); Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (E Cousin MS); Instituto de Saúde Coletiva da Universidade Federal da Bahia, Salvador, Bahia, Brazil (Prof D Rasella PhD); Accamargo Cancer Center, São Paulo, São Paulo, Brazil (M P Curado PhD); International Prevention Research Institute, Ecully, France (M P Curado PhD); Universidade do Estado de Santa Catarina, Florianópolis, Santa Catarina, Brazil (Prof K P B dos Santos MA); Universidade Federal de Sergipe, Aracaju, Sergipe, Brazil (Prof A Faro PhD); Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil (C P Ferri PhD); Faculdade de Medicina de Ribeirão Preto (J M Furtado MD), Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil; Institute for Health Metrics and Evaluation (J Gall MSPH, S D Glenn MSc, Prof R Lozano PhD, M K Miller-Petrie MSc, M D Mooney BS, S E Ray BS, Prof C J L Murray DPhil, Prof M Naghavi PhD), University of Washington, Seattle, Washington, USA; Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil (C Kieling MD, Prof S C O Martins PhD); Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (R M Ladeira PhD); National Institute of Public Health, Cuernavaca, Morelos, Mexico (Prof R Lozano PhD); Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil (Prof S C O Martins PhD); Federal Institute of Education, Science and Technology of Ceará, Caucaia, Ceará, Brazil (F R Martins-Melo PhD); Universidade Federal de São João Del Rei, Divinópolis, Minas Gerais, Brazil (Prof A P S Melo DSc); Universidade Federal de Pelotas, Pelotas, RS, Brazil (Prof B P Nunes PhD); Universidade Federal de Uberlândia, Uberlândia, MG, Brazil (L Roever MPH); Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil (I J C Schneider PhD, D A S Silva PhD); University of Southern Santa Catarina, Palhoça, Santa Catarina, Brazil (Prof J Traebert PhD).