Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016

Abstract

SummaryBackgroundPolitical, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses.MethodsWe analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries.FindingsNationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0–68·9) in 1990 to 75·2 years (74·7–75·7) in 2016, and HALE increased from 59·8 years (57·1–62·1) to 65·5 years (62·5–68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4–34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7–32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index.InterpretationHealth improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities.FundingBill & Melinda Gates Foundation and the Brazilian Ministry of Health.

Limited alignment of publicly competitive disease funding with disease burden in Japan

“…Using published studies and available data worldwide, the GBD's latest study (GBD2017) covered 195 countries and territories, and estimated DALYs and other health metrics for 359 diseases and injuries for each year from 1990 until 2017. The results of the GBD study have been widely used by researchers, policymakers, and several other stakeholders to argue for more strategic resource allocation [19][20][21][22][23][24][25][26].…”

Global, Regional, National, and Subnational Big Data to Inform Health Equity Research: Perspectives from the Global Burden of Disease Study 2017

“…Another finding of note is the sharp difference in DALYs due to mental disorders between the United States and its neighbors. [21][22][23][24][25][26] America, South Africa, Philippines, and Russia had more deaths from interpersonal violence than would be expected given their SDI. Conversely, countries in Africa with some notable exceptions (ie, South Africa, Namibia, and Lesotho) and parts of Asia had much lower deaths from violence than would be expected.…”

“…to examine disparities and empower health officials to address health equity. [21][22][23][24][25][26] GBD data could also be used to assess progress from 1990 and as prove the understanding of the issues impacting the burden of disease. For example, the Health Access and Quality of Care Index (HAQ) is based on 32 causes from which deaths should not occur in the presence of effective health care.…”

Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016

“…There is a growing prevalence of LBP in Brazil [16], resulting in an increase of 79% in the total number of years lived with disability between 1990 and 2016 [17]. Previous findings showed a LBP prevalence ranging from 10% to 50% in different populations, such as adolescents, adults, and elderly [18][19][20][21][22].…”