Non-communicable diseases in Brazil: a flood of data is coming!

Doenças não-transmissíveis: uma inundação de dados está chegando!

FIRST DATA-GENERATION PERIOD

Over the last two or three decades, academic researchers within health sciences frequently complained about the "drought" of information concerning chronic diseases in Brazil. This comment, by qualified physicians and scientists, was made much more frequently than would be justified by the reality of epidemiological production relating to non-communicable diseases, albeit restricted to mortality data and surveys. Even though both mortality data and surveys present relatively limited scope for reaching conclusions, the data produced were enough to understand some aspects of the epidemiological profile of chronic diseases in Brazil.

The mortality data was sufficiently accurate to show that a decline in cardiovascular diseases was occurring in Brazil, in contrast with other countries with the same level of economic development.1 In addition, survey data made it possible to ascertain the following points: (1) premature heart disease rates in Brazil were higher than in affluent countries;2 (2) cancer mortality among Japanese descendants in São Paulo showed differences according to the generation of migration, compared with individuals living in Japan;3 (3) Brazil had the highest death rate due to stroke in the Western world;4 (4) the burden of cardiovascular diseases was inversely associated with formal education levels among Brazilian municipalities;5 (5) the decline in the risk of death due to heart disease was not taking place uniformly, such that the pace was slower among people living in the poorest neighborhoods, compared with the wealthiest ones in São Paulo;6 and (6) the impact of the smoking habit on all causes of death in Brazil.7

Likewise, surveys addressing diabetes have been extremely useful for planning diabetes control programs over the whole country, among adults, pregnant women and the indigenous population.8 10 Every year since 2006, VIGITEL (Surveillance System of Risk and Protective Factors for Chronic Non-Communicable Diseases through Telephone Interviews), which is a telephone-based behavioral survey conducted among the 27 state capitals of Brazil, has been providing data on dietary habits, obesity, alcohol intake, physical activity and smoking habit.11 However, the most important effort by the Ministry of Health and the academic community has been the National Health Survey ("Pesquisa Nacional de Saúde").12 The concept, design and preliminary results of this survey are presented in this issue of the Journal.

SECOND DATA-GENERATION PERIOD

Since the beginning of this century, the academic and government sectors have been making joint efforts to provide better information through new studies: longitudinal studies, hospital registry studies and randomized trials. The stage of maturation of these studies is not uniform, but they are leading to increased levels of publication, at a fast rate. Table 1summarizes some observational studies addressing non-communicable diseases that were designed and funded in Brazil.13 20

Indeed, these new studies with much more data will open up a new window with impacts on National Health System policies, professional activity, the industry and science on the bench. Over the next issues of the Journal, each of these studies will be presented in greater detail.

Table 1
Observational studies in Brazil addressing the epidemiology of chronic diseases

Concluding, the drought of epidemiological information has come to an end in Brazil. Now, we will need to prepare ourselves so that we do not drown in the flood of data that is coming.

REFERENCES

• Lolio CA, Souza JMP, Laurenti R. Decline in cardiovascular disease mortality in the city of São Paulo, Brazil, 1970 to 1983. Rev Saude Publica. 1986;20(6):454-64.
• Lotufo PA. Mortalidade precoce por doenças do coração no Brasil. Comparação com outros países [Premature mortality from heart diseases in Brazil. An international comparison]. Arq Bras Cardiol. 1998;70(5):321-5.
• Tsugane S, Gotlieb SL, Laurenti R, Souza JM, Watanabe S. Mortality and cause of death among first-generation Japanese in São Paulo, Brazil. Int J Epidemiol. 1989;18(3):647-51.
• Lotufo PA. Stroke in Brazil: a neglected disease. Sao Paulo Med J. 2005;123(1):3-4.
• Ishitani LH, Franco GC, Perpétuo IHO, França E. Desigualdade social e mortalidade precoce por doenças cardiovasculares no Brasil [Socioeconomic inequalities and premature mortality due to cardiovascular diseases in Brazil].. Rev Saude Publica 2006;40(4):684-91.
• Lotufo PA, Fernandes TG, Bando DH, Alencar AP, Benseñor IM. Income and heart disease mortality trends in Sao Paulo, Brazil, 1996 to 2010. Int J Cardiol. 2013;167(6):2820-3.
• Corrêa PC, Barreto SM, Passos VM. Smoking-attributable mortality and years of potential life lost in 16 Brazilian capitals, 2003: a prevalencebased study. BMC Public Health. 2009;9:206.
• Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30-69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence. Diabetes Care. 1992;15(11):1509-16.
• Reichelt AJ, Spichler ER, Branchtein L, et al. Fasting plasma glucose is a useful test for the detection of gestational diabetes. Brazilian Study of Gestational Diabetes (EBDG) Working Group.. Diabetes Care 1998;21(8):1246-9.
• Dal Fabbro AL, Franco LJ, da Silva AS, et al. High prevalence of type 2 diabetes mellitus in Xavante Indians from Mato Grosso, Brazil. Ethn Dis. 2014;24(1):35-40.
• Moura EC, Malta DC, Morais Neto OL, Monteiro CA. Prevalence and social distribution of risk factors for chronic noncommunicable diseases in Brazil [Prevalencia y distribución social de los factores de riesgo de enfermedades crónicas no transmisibles en Brasil]. Rev Panam Salud Publica. 2009;26(1):17-22.
• Malta DC, Szwarcwald CL. Lifestyles and chronic non-transmissible diseases of the Brazilian population according to the National Health Survey: balance of the main results. Sao Paulo Med J. 2015;133(4):286-9.
• Schmidt MI, Duncan BB, Mill JG, et al. Cohort Profile: Longitudinal Study of Adult Health (ELSA-Brasil).. Int J Epidemiol 2015;44(1):68-75.
• Andrade FC, Guevara PE, Lebrão ML, Duarte YA. Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke.. BMC Public Health 2012;12:361.
• Scazufca M, Menezes PR, Araya R, et al. Risk factors across the life course and dementia in a Brazilian population: results from the Sao Paulo Ageing & Health Study (SPAH).. Int J Epidemiol 2008;37(4):879-90.
• Lima-Costa MF, Firmo JO, Uchôa E. Estudo de coorte de idosos de Bambuí: metodologia e perfil de saúde dos participantes [The Bambuí Cohort Study of Aging: methodology and health profile of participants at baseline]. Cad Saude Publica. 2011;27(Supl. 3):s327-s335.
• Santos IS, Goulart AC, Brandão RM, et al. One-year Mortality after an Acute Coronary Event and its Clinical Predictors: The ERICO Study.. Arq Bras Cardiol 2015;105(1):53-64.
• Goulart AC, Fernandes TG, Santos IS, et al. Predictors of long-term survival among first-ever ischemic and hemorrhagic stroke in a Brazilian stroke cohort. BMC Neurol. 2013;13:51.
• Guimarães JM, Werneck GL, Faerstein E, Lopes CS, Chor D. Early socioeconomic position and self-rated health among civil servants in Brazil: a cross-sectional analysis from the Pró-Saúde cohort study. BMJ Open. 2014;4(11):e005321.
• Vasconcellos MT, Silva PL, Szklo M, et al. Sampling design for the Study of Cardiovascular Risks in Adolescents (ERICA).. Cad Saude Publica 2015;31(5):921-30.

Publication Dates

• Publication in this collection
  July-Aug 2015