Health inequalities and well-being in times of financial and political crisis in Brazil, a case study

Sousa, Luna Rezende Machado de; Ville, Arlette Saint; Segall-Corrêa, Ana Maria; Melgar‐Quiñonez, Hugo

doi:10.1080/17441692.2019.1616800

Cited by 6 publications

(3 citation statements)

References 53 publications

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“…Third, low income and living outside the large Metropolitan area of São Paulo (the largest city in the Southern hemisphere with an estimated 12 million inhabitants), poses a major hurdle for people living with HTLV-1, and HAM/TSP patients in particular, to comply with yearly visits and hence may influence our results through increased loss of follow-up. The profound economic crisis in Brazil over the last five years might have aggravated this [38], for example, the unemployment rate rose from 7% in 2014 to 13% of the working population in 2017 [39]. Fourth, we do not have data on adherence to antiretroviral therapy (ART) among HIV-coinfected individuals in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

et al. 2019

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Background: Despite its relatively low incidence of associated diseases, Human T-cell Leukemia Virus-1 (HTLV-1) infection was reported to carry a significant risk of mortality in several endemic areas. HTLV-1-associated diseases, adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraperesis (HAM/TSP), as well as frequent coinfections with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and Strongyloides stercoralis were associated to increased morbidity and mortality of HTLV-1 infection. Objective: To determine the mortality rate and its associated variables from an open cohort started in July 1997 at the HTLV Clinic, Emilio Ribas Institute (IIER), a major infectious disease hospital in São Paulo, Brazil. Methods: Since inception up to September 2018, we admitted 727 HTLV-1-infected individuals, with a rate of 30–50 new admissions per year. All patient data, including clinical and laboratory data, were regularly updated throughout the 21-year period, using a dedicated REDCap database. The Ethical Board of IIER approved the protocol. Results: During 21 years of clinical care to people living with HTLV-1 in the São Paulo region, we recruited 479 asymptomatic HTLV-1-infected individuals and 248 HAM/TSP patients, of which 632 remained under active follow-up. During a total of 3800 person-years of follow-up (maximum follow-up 21.5 years, mean follow-up 6.0 years), 27 individuals died (median age of 51.5 years), of which 12 were asymptomatic, one ATLL patient and 14 HAM/TSP patients. HAM/TSP diagnosis (but neither age nor gender) was a significant predictor of increased mortality by univariate and multivariate (hazard ratio (HR) 5.03, 95% CI [1.96–12.91], p = 0.001) Cox regression models. Coinfection with HIV/HCV was an independent predictor of increased mortality (HR 15.08; 95% CI [5.50–41.32]; p < 0.001), with AIDS-related infections as a more frequent cause of death in asymptomatics (6/13; p = 0.033). HIV/HCV-negative fatal HAM/TSP cases were all female, with urinary tract infection and decubitus ulcer-associated sepsis as the main cause of death (8/14, p = 0.002). Conclusions: All-cause mortality among people living with HTLV-1 in São Paulo differs between asymptomatic (2.9%) and HAM/TSP patients (7.3%), independent of age and gender. We observe a dichotomy in fatal cases, with HAM/TSP and HIV/HCV coinfection as independent risk factors for death. Our findings reveal an urgent need for public health actions, as the major causes of death, infections secondary to decubitus ulcers, and immune deficiency syndrome (AIDS)-related infections, can be targeted by preventive measures.

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Section: Discussionmentioning

confidence: 99%

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

et al. 2019

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“…Third, low income and living outside the large Metropolitan area of São Paulo (the largest city in the Southern hemisphere with an estimated 12 million inhabitants), poses a major hurdle for people living with HTLV-1, and HAM/TSP patients in particular, to comply with yearly visits and hence may influence our results through increased loss of followup. The profound economic crisis in Brazil over the last five years might have aggravated this [42], for example, the unemployment rate rose from seven percent in 2014 to 13% of the working population in 2017 [43]. Fourth, we do not have data on adherence to antiretroviral therapy (ART) among HIV-co-infected individuals in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

Marcusso¹,

Weyenbergh²,

Moura³

et al. 2019

Preprint

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BACKGROUND: During the natural history, the incidence HTLV-1 related diseases were 0.5% until 10% after decades of infection. Despite relative low lethality, previous study observed that HTLV-1 infection is associated with significantly increased mortality. For example, the incidence of ATLL and HAM/TSP, co-infections with HIV and HCV, parasitic co-infection with Strongyloides stercoralis may increase morbidity and mortality. OBJECTIVE: Determine the mortality rate and its major variables as possible risk factors, analyzing the HTLV Clinic at Emilio Ribas Institute, a continuous open cohort of HTLV patients since 1997. METHODS: This cohort open cohort possesses new patients added at a rate of approximately 50 patients/year. There were 1100 HTLV-infected subjects identified by September 30th 2018. All clinical data including clinical and laboratory data, which have been updated on a regular basis over the last 22 years, were entered into a specific REDCap database. The Ethical Board of the IIER approved the protocol. RESULTS: Along 22 years of clinical care in the HTLV-out clinic, 727 HTLV-1-infected subjects and 248 HAM/TSP cases. Four-hundred sixty-eight patients of whom remaining under active follow up. The mean follow-up time of the cohort was 12 years. Twenty-seven patients died (median age of 51,5 years old). From this total, 13 was asymptomatic carriers and 14 HAM/TSP subjects, 12 of asymptomatic and seven HAM/TSP possess co-infected with HIV or/and HCV. Other seven presented HAM/TSP without co-infection, and all was female, and sepsis was the majority cases the majority of cases of sepsis were related to infection of the urinary tract (p=0.058) and to ulcers of decubitus (p=0.021), and it was associated with risk factors for mortality. CONCLUSIONS: Overall, the mortality rate for HAM-TSP patients was six percent. The mean life expectancy in Brazil is about 78 years in 2018, twenty-two years higher than HAM/TSP patients without any other coinfection. This study highlights the possibility of higher death risk among HTLV-1-infected patients and HAM/TSP subjects in Brazil, and identified some risk factors for this outcome. Also, these patients may possess higher risk for morbidity, usually urinary tract infections and decubitus scars, which could increase risk for death.

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“…Os dados da última POF (2017-2018) e outras publicações mostraram piora nas condições de SAN da população brasileira, tanto em função das crises política e econômica iniciadas em 2015 e agravadas a partir daí 34,65,66 , quanto em decorrência da crise sanitária da COVID-19. Por essa razão cresce a percepção e o receio de que o Brasil volte a figurar no "Mapa da Fome".…”

Section: Comentários Finaisunclassified

(In)segurança alimentar no Brasil no pré e pós pandemia da COVID-19: reflexões e perspectivas

Souza¹,

Bernardes²,

Vieira³

et al. 2021

IAJMH

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A alimentação e a nutrição adequadas são fundamentais para a promoção e a proteção da saúde, podendo determinar as condições de saúde de indivíduos e coletividades de diversos modos. A despeito dos avanços conquistados no Brasil - no que tange à realização do direito humano à alimentação adequada (DHAA) e à concretização da segurança alimentar e nutricional (SAN) - vêm-se observando, desde 2016, o enfraquecimento e o desmonte das políticas públicas de garantia de direitos e fortalecimento de sistemas alimentares sustentáveis. Tal cenário contribui para o aumento da pobreza e a piora das condições de vida de consideráveis parcelas da população. Os dados da última Pesquisa de Orçamentos Familiares (POF 2017-2018) mostram que a prevalência de insegurança alimentar no país aumentou para 36,1% (era 22,9% em 2013), sendo que 3,1 milhões de famílias vivenciaram a experiência da fome no período analisado. Essa situação se agrava em função da crise política e da crise sanitária causada pela pandemia da COVID-19. Nesse contexto, torna-se premente a reflexão sobre quais são as perspectivas no país em relação à garantia do DHAA e da SAN, especialmente para os grupos mais vulneráveis, considerando dimensões como acesso à alimentação, renda básica, programas de transferência de renda, sistemas e ambientes alimentares e mecanismos de participação e controle social.

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Health inequalities and well-being in times of financial and political crisis in Brazil, a case study

Cited by 6 publications

References 53 publications

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

(In)segurança alimentar no Brasil no pré e pós pandemia da COVID-19: reflexões e perspectivas

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Health inequalities and well-being in times of financial and political crisis in Brazil, a case study

Cited by 6 publications

References 53 publications

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil

Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in S&atilde;o Paulo, Brazil

(In)segurança alimentar no Brasil no pré e pós pandemia da COVID-19: reflexões e perspectivas

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Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil