de Carvalho Wellington Roberto Gomes, Meira Karina Cardoso, de Medeiros Aline Grimberg Pereira, Neves Luise Bernardes da Silva, Vardiero Nicole Almeida, Mendonça Guimarães Raphael
Federal University of Triângulo Mineiro, Institute of Health Sciences, Department of Collective Health, Uberaba, MG, Brazil.
Federal University of Rio Grande do Norte. Health School, Natal, RN, Brazil.
Prev Med Rep. 2024 Jan 20;38:102623. doi: 10.1016/j.pmedr.2024.102623. eCollection 2024 Feb.
Over the past few years, there has been a progressive increase in premature deaths attributable to suicide, drug overdose, and alcohol-related liver disease that impact life expectancy. Regarding the relationship with contextual effects, the evidence is developing, especially in countries with a peripheral economy, as is the case of Brazil. We carried out an analysis aimed at estimating the relationship between socioeconomic insecurity and deaths due to despair in Brazilian cities. We used 5,570 counties' data to create clusters concerning socioeconomic development and then analyzed age-adjusted mortality rates (ASMR) from each of them and compared them using the ANOVA test. Cluster analysis generated two groups of Brazilian municipalities. DoD rates are consistently higher in the group that experiences more deprivation. However, considering differences between 2010 and 2019, the increase in rates was higher in the group with less deprivation experience (48.82 % vs. 39.53 %) We verified an existing gap between the clusters before the beginning of economic stagnation in 2010 The gap between those two groups decreased from 20.58 % (p < 0.001) in 2010 to 14.03 % in 2019 (p = 0.034). The conjuncture of economic crises creates mortality differentials in certain population groups. Also, significant inequalities explain how causes of death from despair affect different subpopulations. Our first approach assessed this assumption, and we could check those differentials at an ecological level. Public policies should focus on reducing the difference in mortality from despair between higher and lower socioeconomic strata.
在过去几年中，因自杀、药物过量和酒精性肝病导致的过早死亡呈逐渐上升趋势，这些因素影响了预期寿命。关于与环境影响的关系，相关证据正在不断涌现，尤其是在像巴西这样经济处于边缘地位的国家。我们进行了一项分析，旨在估算巴西城市社会经济不安全因素与绝望导致的死亡之间的关系。我们使用了5570个县的数据，根据社会经济发展情况创建了不同的类别，然后分析了每个类别的年龄调整死亡率（ASMR），并使用方差分析进行比较。聚类分析产生了两组巴西城市。在经历更多贫困的类别中，绝望导致的死亡率一直较高。然而，考虑到2010年至2019年之间的差异，贫困经历较少的类别中死亡率的上升幅度更大（48.82%对39.53%）。我们发现在2010年经济停滞开始之前，不同类别之间就存在差距。这两组之间的差距从2010年的20.58%（p<0.001）降至2019年的14.03%（p=0.034）。经济危机的形势在某些人群中造成了死亡率差异。此外，显著的不平等现象解释了绝望导致的死亡原因如何影响不同的亚人群体。我们的第一种方法评估了这一假设，并且我们能够在生态层面上检验这些差异。公共政策应专注于缩小社会经济较高和较低阶层之间因绝望导致的死亡率差异。
