. Trinta e nove por cento da amostra acumulavam dois ou mais desses cinco fatores de risco, somente 22% de homens e 21% de mulheres não apresentaram esses fatores de risco. As elevadas freqüências e concomitâncias desses fatores de risco alertam para sua importância em programas que visam a prevenção das doenças não-transmissíveis.

The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.

diseases associated with poor sanitation are still an important issue in the metropolitan region of Porto Alegre-RS, although this region presents good development indicators.

OBJETIVO: Descrever no âmbito nacional e por faixa etária, sexo e região as 327.800 hospitalizações por diabetes mellitus (DM) da rede pública do Brasil, entre 1999-2001. MÉTODOS: Foram utilizados dados do Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS) referentes ao DM (diagnóstico principal CID-10 E10-E14 combinado com procedimento realizado) e indicadores anuais de hospitalizações/10(4)hab. e óbitos hospitalares/10(6)hab. (ajustados pelo método direto por idade), letalidade, médias de permanência e gastos por internação e por 10(4)hab. em US$, e regressão logística múltipla para desfecho óbito. RESULTADOS: Houve mais hospitalizações anuais do sexo feminino (7,5/10(4)hab. [intervalo de confiança de 95%: 7,4-7,6] vs. masculino (5,2/10(4)hab. [5,2-5,3]), mais óbitos hospitalares anuais de mulheres (38,1/10(6)hab. [36,8-39,3] vs. 30,7 [29,5-32,0]), porém maior letalidade no sexo masculino (5,9 vs. 5,0%) em todas as regiões. Observou-se incremento das hospitalizações com a idade, mais acentuado para mulheres. Não houve diferença na permanência das internações com óbito (6,5 dias [6,3-6,6]) ou sem (6,4 [6,3-6,6]), apesar do gasto por internação superior (US$ 275,27 [268,37-282,16] vs. 143,45 [136,56-150,35]). O gasto anual/10(4)hab. equivaleu a US$ 969,09. A razão de chances de óbito hospitalar aumentou com a idade, foi maior para homens (1,21 [1,17-1,24]) e 2 vezes maior para habitantes das regiões Nordeste e Sudeste comparados aos da região Sul. Os gastos anuais/10(4)hab. foram 50-100% maiores nas regiões mais desenvolvidas. CONCLUSÕES: O volume e a desigualdade nos gastos enfatizam a necessidade de cobertura mais adequada da população, evitando as hospitalizações e suas complicações.

Objective: to estimate the number of hospitalizations attributable to diabetes mellitus (DM) and its complications within the public healthcare system in Brazil (SUS) and the mean cost paid per hospitalization. Methods: the official database from the Hospital Information System of the Unified Health System (SIH/SUS) was consulted from 2008 to 2010. The proportion of hospitalizations attributable to DM was estimated using attributable risk methodology. The mean cost per hospitalization corresponds to direct medical costs in nursing and intensive care, from the perspective of the SUS. Results: the proportion of hospitalizations attributable to DM accounted for 8.1% to 12.2% of total admissions in the period, varying according to use of maximum (self-reported with correction factor) or minimal (self-reported) DM prevalence. The hospitalization rate was 47 to 70.8 per 10.000 inhabitants per year. The mean cost per hospitalization varied from 1.302 Brazilian Reais (BRL) to 1,315 BRL. Assuming the maximum prevalence, hospitalizations were distributed as 10.3% as DM itself, 36.6% as chronic DM-associated complications and 53.1% as general medical conditions. Advancing age was accompanied by an increase in hospitalization rates and corresponding costs, and more pronounced in male patients. Conclusion: the results express the importance of DM in terms of the use of health care resources and demonstrate that studies of hospitalizations with DM as a primary diagnosis are not sufficient to assess the magnitude of the impact of this disease.

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BackgroundMortality from acute complications of diabetes, a predominantly preventable condition, although controlled in high income countries, remains a major challenge for low/middle income countries. The aim of this study is to describe trends in mortality from acute complications of diabetes between 1991 and 2010 in Brazil, a period during which a national health system was implemented offering broad access to diabetes treatment.MethodsWe obtained the number of deaths listed in the Brazilian Mortality Information System between 1991 and 2010 as due to acute complications of diabetes (ICD-9 250.1, .2, or .3 and ICD-10 E10–14.0 or 1), corrected this number for ill-defined causes of death and incompleteness in mortality reporting, and calculated mortality rates standardized to the world’s population. We describe mortality trends with Joinpoint regressions.ResultsOver this 20 year period, mortality due to the acute complications of diabetes fell 70.9 % (95 % CI 67.2 to 74.5 %), from 8.42 (95 % CI 8.27 to 8.57) deaths per 100000 inhabitants in 1991 to 2.45 (95 % CI 2.38 to 2.52) per 100000 in 2010. The reduction occurred in men and women, in all age groups, and in all regions of Brazil.ConclusionsMortality from acute complications of diabetes in Brazil has declined markedly in parallel with the implementation of a national health system providing access to insulin and organization of health care. Further decline is possible and necessary.

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