Nursing School, Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Postgraduate Program in Epidemiology and Hospital das Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Popul Health Metr. 2020 Sep 30;18(Suppl 1):16. doi: 10.1186/s12963-020-00216-1.
Monitoring and reducing premature mortality due to non-communicable diseases (NCDs) is a global priority of Agenda 2030. This study aimed to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and to project those for 2030 as well as the risk factors (RFs) attributed deaths according to estimates of the Global Burden of Disease Study.
We analyzed cardiovascular diseases, chronic respiratory diseases, neoplasms, and diabetes, and compared the mortality rates in 1990 and 2017 for all of Brazil and states. The study used the definition of premature mortality (30-69 years) that is used by the World Health Organization. The number of deaths, mortality rates, DALYs, and years of life lost (YLL) were used to compare 1990 and 2017. We analyzed the YLL for NCDs attributable to RFs.
There was a reduction of 35.3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCDs in 2017. The DALY rate decreased by 33.6%, and the YLL rate decreased by 36.0%. There were reductions in NCDs rates in all 27 states. The main RFs related to premature deaths by NCDs in 2017 among women were high body mass index (BMI), dietary risks, high systolic blood pressure, and among men, dietary risks, high systolic blood pressure, tobacco, and high BMI. Trends in mortality rates due to NCDs declined during the study period; however, after 2015, the curve reversed, and rates fluctuated and tended to increase.
Our findings highlighted a decline in premature mortality rates from NCDs nationwide and in all states. There was a greater reduction in deaths from cardiovascular diseases, followed by respiratory diseases, and we observed a minor reduction for those from diabetes and neoplasms. The observed fluctuations in mortality rates over the last 3 years indicate that if no further action is taken, we may not achieve the NCD Sustainable Development Goals. These findings draw attention to the consequences of austerity measures in a socially unequal setting with great regional disparities in which the majority of the population is dependent on state social policies.
监测和降低非传染性疾病（NCDs）导致的过早死亡率是 2030 年议程的全球优先事项。本研究旨在描述 1990 年至 2017 年期间巴西因 NCDs 导致的死亡率趋势和丧失的伤残调整生命年（DALYs），并预测 2030 年的情况，以及根据全球疾病负担研究估计的风险因素（RFs）导致的死亡。
我们分析了心血管疾病、慢性呼吸道疾病、肿瘤和糖尿病，并比较了巴西和各州在 1990 年和 2017 年的死亡率。本研究使用了世界卫生组织（WHO）使用的过早死亡（30-69 岁）定义。使用死亡人数、死亡率、DALYs 和生命损失年（YLL）来比较 1990 年和 2017 年的数据。我们分析了归因于 RFs 的 NCDs 所致的 YLL。
2017 年，NCDs 导致的死亡人数从 509.1 人/100,000 居民（1990 年）减少到 329.6 人/100,000 居民，降幅为 35.3%。DALY 率下降了 33.6%，YLL 率下降了 36.0%。27 个州的 NCDs 率均有所下降。2017 年，女性中与 NCDs 导致的过早死亡相关的主要 RFs 是高体重指数（BMI）、饮食风险、收缩压升高，而男性中则是饮食风险、收缩压升高、烟草和高 BMI。在研究期间，NCDs 导致的死亡率呈下降趋势；然而，2015 年之后，曲线发生逆转，死亡率波动并呈上升趋势。
我们的研究结果强调了全国范围内以及各州 NCDs 导致的过早死亡率的下降。心血管疾病导致的死亡人数降幅最大，其次是呼吸道疾病，糖尿病和肿瘤导致的死亡人数降幅较小。过去 3 年观察到的死亡率波动表明，如果不采取进一步行动，我们可能无法实现 NCD 可持续发展目标。这些研究结果引起了人们对社会不平等环境下紧缩措施后果的关注，巴西在社会不平等方面存在巨大的地区差异，其大部分人口依赖于国家社会政策。
