In Brazil, cardiovascular diseases account for 33% of deaths and the prevalence of hypertension is of approximately 22%. The Santos and São Vicente Estuarine System is the most important example of environmental degradation by chemicals from industrial sources. The aim of the present study was to evaluate the prevalence of hypertension and its associated factors in the population of this estuary in the period 2006-2009. A cross-sectional study was conducted to assess the aforementioned prevalence of hypertension in the evaluated areas, as well as risk factors for this disease in four contaminated areas located in the Estuary, and one area outside Estuary, the city of Bertioga. Associations between categorical variables were tested using Pearson's chi-square test incorporating Yates' correction, or Fisher's exact test. Single and multiple logistic regression models were applied to evaluate the risk factors for hypertension. The highest prevalence of hypertension was found in Continental São Vicente (28.4%). The risk factors for hypertension were the following: living in Center of Cubatão (OR: 1.3; IC95%: 1.0 - 1.6) and Continental São Vicente (OR: 1.4; IC95%: 1.1 - 1.8); illiterate (OR: 1.9; IC95%: 1.1 - 3.2); living in the area for more than 20 years (OR: 1.2; IC95%: 1.0 - 1.5); group of people aged 36-60 years (OR: 3.9; IC95%: 3.3 - 4.6) and who have had past occupational exposure (OR: 1.3; IC95%: 1.1 - 1.6). Results indicate that living in contaminated areas, especially for a longer time, is a risk factor for hypertension.

This study aims to compare pregnancy outcomes in four contaminated areas to those observed in a non-contaminated area of similar socioeconomic status. A cross-sectional study was carried out. A structured and pre-tested questionnaire was administered to population-based samples of 788-920 families in each of the five studied areas. The exposure assessment used was an ecological measure. Using logistic regression, odds of several pregnancies outcomes (pregnancy occurrence, miscarriage, stillbirth, prematurity, low birth weight, congenital malformation, and multiple births) were estimated after adjustment for potential confounders such as socioeconomic, demographic, and substance abuse factors. We adopted a statistical significance level of 5 %. In three of the four exposed areas, pregnancy occurrence was reduced in comparison to the control area (Area 2, odds ratio (OR) = 0.68, 95 % CI = 0.54-0.86; Area 3, OR = 0.76, 95 % CI = 0.60-0.97; Area 4, OR = 0.71, 95 % CI = 0.56-0.90). Also, a significantly increased odds of miscarriage for living in Area 3 (OR = 1.83, 95 % CI = 1.07-3.12) was found. The other pregnancy outcomes were not significantly elevated in the exposed areas. In conclusion, this study shows evidence of reduced pregnancy occurrence and increased miscarriage occurrence in some of the contaminated areas, compared to the control area.

The Santos and São Vicente Estuary has suffered extensively over the years from irregular industrial deposits. The present study aimed to evaluate liver disease prevalence and potential associated risk factors in four of the Estuary's areas (Pilões and Água-Fria, Cubatão Center, Continental São Vicente, and Guarujá) and a reference area (Bertioga). This study consisted of a cross-sectional study design, in which a questionnaire was used to collect information in 820 households at each of the study areas. The proportion of total liver diseases, hepatitis, cirrhosis, and cancer (liver, biliary tract, and pancreas) per area were estimated. Pearson's chi-square test and two proportion differences test were applied in order to evaluate associations between disease occurrence and areas and to test differences between two proportions, respectively. Single and multiple logistic regression models were applied to assess associations between disease prevalence and the different study areas. Liver disease prevalence was 1.5 % among all inhabitants and 1.4 % among those without any type of exposure. Among those who reported the presence of liver disease, a higher percentage of the participants that reported hepatitis (27.7 %) or other liver disease (48.7 %) did not report occupational or alcohol exposures. Hepatitis (77.8 %) was the most reported disease, and a statistical association between living in Pilões and Água-Fria and the occurrence of hepatitis was observed (Pearson's χ (2): z = 18.1; p = 0.001). The consumption of locally-produced groceries (2.88; CI: 1.24-6.70) and water (5.88; CI: 2.24-15.45) were shown to be risk factors for the occurrence of liver disease. Thus, environmental exposure is still a public health problem present in the estuary region.

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