Macinko James, Mullachery Pricila H
University of California, Los Angeles, U.S.A.
Drexel University, Philadelphia, U.S.A.
Cad Saude Publica. 2022 May 6;38Suppl 1(Suppl 1):e00137721. doi: 10.1590/0102-311X00137721. eCollection 2022.
This study assesses changes in the prevalence and distribution of noncommunicable diseases (NCDs) and related risk factors among Brazilian adults from the 2013 and 2019 Brazilian National Health Surveys (PNS). It is based on the hypothesis that deteriorating socioeconomic conditions over this period would lead to increased NCDs among the least advantaged populations. We estimated adjusted prevalence ratios by education category and three inequality measures - the slope index of inequality (SII), the relative index of inequality (RII), and population attributable fraction (PAF) - for obesity, hypertension, arthritis, asthma, cancer, depression, diabetes, heart disease, having any chronic condition, and multimorbidity by survey year. We also estimated the 27 Brazilian Federative Units RII and prevalence rates for diabetes and multimorbidity per year and plotted the RII against prevalence by year. Results showed that all NCDs increased over the period observed, ranging from an 8% increase in the adjusted prevalence of arthritis to a 24% increase in the adjusted prevalence of obesity. Measures of inequality showed that most conditions exhibited significant educational inequities in both 2013 and 2019. However, on average, education-based inequities did not significantly change between the two periods. Considering the deterioration of the socioeconomic conditions of most Brazilians, the erosion of social protections, and the continuing economic, political, and health crises occurring in the nation, we observed an urgent need for discussion about the best way to adopt equity-promoting health policies and programs and action to reduce socioeconomic and geographic inequalities in NCDs throughout the country.
本研究评估了2013年和2019年巴西全国健康调查（PNS）中巴西成年人非传染性疾病（NCDs）的患病率和分布变化以及相关风险因素。其基于这样一种假设，即在此期间社会经济状况的恶化将导致最弱势群体中患非传染性疾病的人数增加。我们按教育类别以及三种不平等衡量指标——不平等斜率指数（SII）、相对不平等指数（RII）和人群归因分数（PAF）——估算了肥胖、高血压、关节炎、哮喘、癌症、抑郁症、糖尿病、心脏病、患有任何慢性病以及合并症在各调查年份的调整患病率比值。我们还估算了每年巴西27个联邦单位的糖尿病和合并症的RII及患病率，并绘制了各年份RII与患病率的关系图。结果显示，在所观察的时间段内所有非传染性疾病都有所增加，从关节炎调整患病率增加8%到肥胖调整患病率增加24%不等。不平等衡量指标表明，大多数疾病在2013年和2019年都存在显著的教育不平等。然而，总体而言，两个时期基于教育的不平等没有显著变化。考虑到大多数巴西人的社会经济状况恶化、社会保护的削弱以及该国持续的经济、政治和健康危机，我们发现迫切需要讨论采取促进公平的健康政策和计划的最佳方式，以及采取行动减少全国非传染性疾病方面的社会经济和地理不平等。
