A priority health index identifies the top six priority risk and related factors for non-communicable diseases in Brazilian cities

Abstract

Background: In Brazil, 72% of all deaths in 2007 were attributable to non-communicable diseases (NCD). We used a risk and related factor based index to prioritize NCD prevention programs in the combined 26 capital cities and the federal district (i.e., Brasilia) of Brazil. Methods: We used 2006-2011 data (adults) from census and Brazil's surveillance of 12 NCD risk factors and 74 disease group mortality. The risk and related factors were: smoking, physical inactivity, overweight-obesity, low fruits and vegetables intake, binge drinking, insufficient Pap smear screening (women aged 25 to 59 years), insufficient mammography screening (women aged 50 to 69 years), insufficient blood pressure screening, insufficient blood glucose screening, diagnosis of hypercholesterolemia, diagnosis of hypertension and diagnosis of diabetes. We generated six indicators: intervention reduction of the risk factor prevalence, intervention cost per person, prevalence of risk factor, deaths attributable to risk factor, risk factor prevalence trend and ratio of risk factor prevalence between people with and without a high school education. We transformed risk and related factor indicators into priority scores to compute a priority health index (PHI). We implemented sensitivity analysis of PHI by computing it with slightly altered formulas and altering values of indicators under the assumption of bias in their estimation. We ranked risk factors based on PHI values. Results: We found one intermediate (i.e., overweight-obesity) and six top risk and related factors priorities for NCD prevention in Brazil's large urban areas: diagnosed hypertension, physical inactivity, blood pressure screening, diagnosed hypercholesterolemia, smoking and binge drinking. Conclusion: Brazil has already prioritized the six top priorities (i.e., hypertension, physical inactivity, blood pressure screening, hypercholesterolemia, smoking and binge drinking) and one intermediate priority (i.e., overweight-obesity) for NCD prevention identified in this report. Because effective interventions to reduce disease burden associated with each of the six priority risk factors are available, strategies based on these interventions need to be sustained in order to reduce NCD burden in Brazil. PHI can be used to track NCD prevention and health promotion actions at the local and national level in Brazil and in countries with similar public health surveillance systems.

A pilot study of a Community Health Agent-led type 2 diabetes self-management program using Motivational Interviewing-based approaches in a public primary care center in São Paulo, Brazil

“…Simōes et al describe programs implemented by the Brazilian Ministry of Health to address this diabetes epidemic, but there is not yet evidence on the effectiveness of these interventions. Success will depend largely on the development of scalable interventions that enhance patients’ ability to effectively manage their diabetes and to make and sustain healthy behavior changes (“self-management”) [15]. …”

Effect of High Blood Pressure and Other Cardiovascular Risk Factors on All-causes Mortality in Elderly People: A Joined Survival Analysis from Brazil, Argentina and Italy

“…(20) Brazil and Argentina have an intermediate mortality rate for this cause and it has been shown an important reduction in life expectancy in persons aged ≥ 60 years old when two or three conditions are present simultaneously. (21) Moreover, a priority health index has recently identified the top priorities for NCCDs in Brazil (22) where HBP and unhealthy life-style were the largest contributors to cardiometabolic deaths. (23) The A Joined Survival Analysis from Brazil, Argentina and Italy scenario remains unchanged in Argentina (24) where HBP prevalence rate in people ≥65 years old reach 71%with a different risk behavior between ≤55 years old people and subjects older than 55.…”

Prevalência e fatores associados ao excesso de peso em uma população urbana do interior do Amazonas, Brasil

“…Segundo os resultados do presente estudo, a prevalência do sobrepeso se apresentou 1,58 vezes maior para aqueles com pressão arterial superior a 140/90mmHg. A frequência aumentada de hipertensos entre os indivíduos com sobrepeso sugere o risco de comorbidade e está em consonância com achados na literatura (6,13,21,22,29) . É fato que a obesidade e o sobrepeso são importantes indicadores de risco para doenças crônicas não transmissíveis, especialmente as doenças cardiovasculares (1) , mostrando a importância de se investir em ações de promoção de alimentação saudável e atividade física (4) .…”

“…Estudos populacionais de âmbito nacional indicam uma tendência de aumento no número de casos de sobrepeso e obesidade nas capitais da Região Amazônica (10) . Investigações recentes têm associado estes resultados às mudanças no estilo de vida em virtude de projetos de infraestrutura (11) , processos migratórios (12) e mudanças no comportamento alimentar (13) . Logo, os impactos socioambientais oriundos de tais fatores sobre o estilo de vida podem ser suficientemente importantes a ponto de alterar o perfil de morbimortalidade das populações residentes na Região Amazônica (11,12) .…”