Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
Cad Saude Publica. 2011;27 Suppl 2:S222-36. doi: 10.1590/s0102-311x2011001400010.
Worldwide, indigenous peoples display a high burden of disease, expressed by profound health inequalities in comparison to non-indigenous populations. This study describes mortality patterns among the Guarani in Southern and Southeastern Brazil, with a focus on health inequalities. The Guarani population structure is indicative of high birth and death rates, low median age and low life expectancy at birth. The crude mortality rate (crude MR = 5.0/1,000) was similar to the Brazilian national rate, but the under-five MR (44.5/1,000) and the infant mortality rate (29.6/1,000) were twice the corresponding MR in the South and Southeast of Brazil. The proportion of post-neonatal infant deaths was 83.3%, 2.4 times higher than general population. The proportions of ill-defined (15.8%) and preventable causes (51.6%) were high. The principal causes of death were respiratory (40.6%) and infectious and parasitic diseases (18.8%), suggesting precarious living conditions and deficient health services. There is a need for greater investment in primary care and interventions in social determinants of health in order to reduce the health inequalities.
在全球范围内，与非土著人口相比，土著人民的疾病负担沉重，表现为健康不平等现象严重。本研究描述了巴西南部和东南部瓜拉尼人的死亡模式，重点关注健康不平等问题。瓜拉尼人的人口结构表明出生率和死亡率高，中位年龄低，出生时预期寿命低。粗死亡率（粗 MR = 5.0/1000）与巴西全国水平相似，但五岁以下儿童死亡率（44.5/1000）和婴儿死亡率（29.6/1000）是巴西南部和东南部相应死亡率的两倍。新生儿后死亡比例为 83.3%，比一般人群高 2.4 倍。病因不明（15.8%）和可预防原因（51.6%）的比例较高。主要死因是呼吸道疾病（40.6%）和传染病和寄生虫病（18.8%），这表明生活条件不稳定和卫生服务不足。需要加大对初级保健的投资，并干预健康的社会决定因素，以减少健康不平等。
