Exposure to and Burden of Major Non-Communicable Disease Risk Factors in Brazil and its States, 1990-2019: The Global Burden of Disease Study

Abstract

INTRODUCTION: Non-Communicable Diseases (NCDs) have become the main cause of disease burden in Brazil. Our objective was to describe trends (1990 to 2019) in prevalence and attributable burden of five modifiable risk factors and related metabolic risk factors in Brazil and its states. METHODS: In Global Burden of Disease 2019 analyses, we described trends in prevalence of modifiable risk factors and their metabolic mediators as percentage change in Summary Exposure Value (SEV). We estimated deaths and disability-adjusted life years (DALYs) attributable to the risk factors. RESULTS: Age-adjusted exposures to alcohol [41.0%, Uncertainty Interval (UI): 24.2 - 63.4], red meat (61.2%, UI: 42.4-92.3), low physical activity (3.9%, UI: -5-17.5) and ambient particulate matter pollution (3.3%, UI: -48.9-128.0) have worsened. Those for smoking (-51.4%, UI: -54.7- - 47.8), diet low in fruits (-28.1%, UI: -39.1- -18.7) and vegetables (-19.6%, UI: -32.7 - -8.7), and household air pollution (-85.3%, UI: -92.9- -74.3) have improved. All mediating metabolic risk factors, except high blood pressure (0.7%, UI: -6.9-8.3), have worsened: BMI (110.2%, UI: 78.6-161.7), hyperglycemia (15.1%, UI: 9.3-21.2), kidney dysfunction (12.0%, UI: 8.4-17.2), and high LDL-c (11.8%, UI: 6.9-17.2). CONCLUSIONS: A variable pattern of progress and failure in controlling modifiable risk factors has been accompanied by major worsening in most metabolic risk factors. The mixed success in public health measures to control modifiable risk factors for NCDs, when gauged by the related trends in metabolic risk factors, alert to the need for stronger actions to control NCDs in the future.

Premature mortality due to four main non-communicable diseases and suicide in Brazil and its states from 1990 to 2019: A Global Burden of Disease Study

“…Declines in deaths due to diabetes have been stable. The mixed results of controlling lifestyle-determined risk factors such as dietary risks, physical inactivity, harmful alcohol consumption and smoking, coupled with major worsening in the prevalence of overweight and obesity, and with them worsening of hyperglycemia, hypertension and dyslipidemia, have undoubtedly contributed to this flattening 14 .…”

Mudanças nos comportamentos de saúde em idosos brasileiros: dados das Pesquisa Nacional de Saúde 2013 e 2019

“…A elevada carga de morbimortalidade por DCNT afeta a qualidade de vida dos indivíduos e a sustentabilidade dos sistemas de saúde [1][2][3] . Um pequeno conjunto de comportamentos relacionados aos fatores de risco como tabagismo, consumo abusivo de álcool, inatividade física e baixo consumo de dieta a base de frutas, verduras e legumes tem determinado e sustentado elevados níveis da presença dessas doenças de modo singular ou como multimorbidades 2,[4][5][6] .…”

“…A ocorrência das DCNT é atribuída a combinação de processos socioeconômicos, raciais, culturais e políticos que aumentaram adoção e manutenção de comportamentos e estilos de vida negativos à saúde associados a esses agravos 1,4 . Comportamentos relacionados aos fatores de risco ocorrem sobre complexa interdependência de relações e a extensão da exposição a eles se modifica ao longo do curso da vida 6 . Desiguais trajetórias de vida e saúde definem o acúmulo individual de benefícios ou déficits de comportamentos saudáveis de saúde que modelam a qualidade de cada ciclo vital [6][7][8] .…”

“…Comportamentos relacionados aos fatores de risco ocorrem sobre complexa interdependência de relações e a extensão da exposição a eles se modifica ao longo do curso da vida 6 . Desiguais trajetórias de vida e saúde definem o acúmulo individual de benefícios ou déficits de comportamentos saudáveis de saúde que modelam a qualidade de cada ciclo vital [6][7][8] .…”

Commentary on Education-Related Health Inequities in Noncommunicable Diseases: An Analysis of the Brazilian National Health Survey, 2013 and 2019

“…However, its control of other risk factors, including unhealthy eating and harmful use of alcohol, has been blocked by political resistance fueled by economic interests. A lack of such policies may explain why many metabolic risk factors in Brazil have worsened, including a 110% increase in adiposity over the last three decades 8 .…”