Disciplina de Ginecologia, Faculdade de Medicina (FMUSP), Universidade de São Paulo, Dr. Enéas de Carvalho Aguiar Avenue, 255, 10° andar, sala 10.166 - CEP: 05403-000, São Paulo, SP, Brazil.
Laboratório de Epidemiologia e Analise de Dados, Centro Universitário Saúde ABC (CUSABC), Santo André, São Paulo, Brazil.
BMC Public Health. 2021 Mar 16;21(1):518. doi: 10.1186/s12889-021-10556-8.
The National Policy for Integral Attention to Women's Health Care (PNAISM) was implemented in 2004, with monitoring of potential benefits. One of the life cycles of women contemplated in this health policy was the importance of health care during the climacteric. Prevention and health promotion are actions carried out by the Brazil National Health System and enshrined in health Brazilian policies for women. Thus, our purpose was to identify climacteric women's main causes of death as well as the mortality trends of such causes, especially after implementation of PNAISM.
An ecological study was conducted from 2018 to 2020. Data were retrieved from the Brazilian Health Department by accessing the mortality information system of the National Health Information, divided into periods 1996-2004 and 2005-2016 the latter to correspond with the implementation of the National Policy. The death records of Brazilian women aged 40 to 64 years who had a designated cause of death were retrieved. Trends and differences between periods were evaluated using linear regression. The significance level was set at 5%.
The main causes of death in women from 1996 to 2016 were circulatory system diseases (22.47%, 697,636 deaths), neoplasms (19.69%, 611,495 deaths), respiratory system diseases (5.5%, 170,716 deaths), endocrine, nutritional, and metabolic disorders (5.27%, 163,602 deaths), and digestive system diseases (3.74%, 116.280 deaths). Analyzing the changes in the major causes of death of climacteric women after implementation of the PNAISM we observed that mortality from circulatory system diseases and endocrine and nutritional diseases were significantly declined in post-PNAISM period: (β = - 3.63; 95% CI - 4.54 to - 2.73 r = 0.87; p < 0.001; β = - 0.51; 95% CI, - 0.71 to - 0.31; R = 0.73; p < 0.001, respectively). No changes were observed in mortality from neoplasms and respiratory system diseases in post-PNAISM period (p = 0,765; p = 0,233, respectively).
After implementation of the PNAISM, we observed a downward trend in rates of mortality from diseases of the circulatory and digestive systems and from endocrine, nutritional, and metabolic diseases but stability in the rates of death from neoplasm and respiratory system diseases.
国家妇女健康综合关怀政策（PNAISM）于 2004 年实施，对潜在收益进行监测。该健康政策考虑的女性生命周期之一是更年期保健的重要性。预防和健康促进是巴西国家卫生系统开展的行动，并纳入巴西妇女健康政策。因此，我们的目的是确定更年期妇女的主要死因以及这些死因的死亡趋势，特别是在 PNAISM 实施之后。
这是一项从 2018 年至 2020 年进行的生态研究。数据来自巴西卫生部，通过访问国家卫生信息的死亡率信息系统获取，分为 1996-2004 年和 2005-2016 年两个时期，后者与国家政策的实施相对应。检索了年龄在 40 至 64 岁之间、指定死因的巴西妇女的死亡记录。使用线性回归评估各时期的趋势和差异。显著性水平设为 5%。
1996 年至 2016 年期间，女性的主要死因是循环系统疾病（22.47%，697636 人死亡）、肿瘤（19.69%，611495 人死亡）、呼吸系统疾病（5.5%，170716 人死亡）、内分泌、营养和代谢紊乱（5.27%，163602 人死亡）以及消化系统疾病（3.74%，116280 人死亡）。分析 PNAISM 实施后更年期妇女主要死因的变化，我们观察到循环系统疾病和内分泌、营养疾病的死亡率在 PNAISM 后显著下降：（β=-3.63；95%CI-4.54 至-2.73 r=0.87；p<0.001；β=-0.51；95%CI-0.71 至-0.31；R=0.73；p<0.001）。PNAISM 后呼吸系统疾病和肿瘤的死亡率没有变化（p=0.765；p=0.233）。
PNAISM 实施后，我们观察到循环系统和消化系统疾病以及内分泌、营养和代谢疾病的死亡率呈下降趋势，但肿瘤和呼吸系统疾病的死亡率保持稳定。
