Revista brasileira de epidemiologia = Brazilian journal of epidemiology最新文献

Objective: To investigate individual and contextual factors associated with seeking and access to oral health services among Brazilian adolescents and young adults.

Methods: This cross-sectional study was based on data from the 2023 Brazilian National Oral Health Survey (SB Brasil 2023). The sample comprised 12-year-old adolescents and young adults aged 15 to 19 years (n=14,757). Four outcomes structured into two stages (seeking and access) were assessed, subdivided into general oral health services and public services specifically. Binary logistic regression models were fitted to estimate odds ratios (ORs), and a 5% significance level was adopted (p<0.05).

Results: All associations were statistically significant (p<0.001). Black race/skin color and income below the poverty line reduced the odds of seeking general oral health services (OR=0.86 and OR=0.84, respectively). For general access, socioracial inequities were more pronounced, intensifying the barrier for Black individuals (OR=0.79). Conversely, in the context of public services, the most vulnerable groups had the highest odds of both seeking and effectively accessing services, particularly Black individuals (ORseeking=2.72; ORaccess=2.57) and those with low income (ORseeking=2.31; ORaccess=2.38).

Conclusions: Seeking and access to oral health services are influenced by socioeconomic and racial inequities. The public system acts as a compensatory resource for vulnerable groups but remains insufficient to overcome access barriers.

Objective: To analyze the temporal evolution of epidemiological indicators related to HIV/AIDS in the state of Tocantins between 2015 and 2023 and to assess potential changes associated with the COVID-19 pandemic.

Methods: An ecological time-series study was conducted using secondary data from national health information systems. Annual rates per 100,000 inhabitants were calculated. Trends were estimated using Prais-Winsten regression, and pandemic-associated changes were assessed using interrupted time-series analysis.

Results: Between 2015 and 2023, 1,854 HIV cases, 2,026 AIDS cases, and 511 AIDS-related deaths were recorded in Tocantins. The mean annual rates were 13.09 HIV cases, 14.32 AIDS cases, and 3.61 AIDS-related deaths per 100,000 inhabitants. Prais-Winsten analysis indicated stationary trends for HIV detection, AIDS detection, and AIDS mortality rates. In the interrupted time-series analysis, no significant immediate changes were observed after 2020. A significant increase was observed only in the trend of the AIDS detection rate during the post-interruption period (β = 2.67; 95%CI 0.26; 5.09; p=0.036), whereas HIV detection and AIDS mortality rates remained stable.

Conclusion: Trends in HIV detection, AIDS detection, and AIDS mortality rates remained stable in Tocantins between 2015 and 2023. However, an increase in the trend of the AIDS detection rate was observed after the onset of the COVID-19 pandemic, suggesting potential repercussions of this period on the dynamics of disease diagnosis and reporting.

Objective: This study aimed to estimate the prevalence of indicators related to experimentation and use of tobacco products among Brazilian students aged 13-17 years in 2024 and to compare them with values observed in 2015 and 2019 in the country.

Methods: A cross-sectional study was conducted, with prevalence estimates according to sociodemographic variables and temporal analysis of the indicators.

Results: An increase was observed in lifetime experimentation (from 16.8 to 29.6%) and electronic cigarette use in the past 30 days (from 2.8 to 8.7%). Conversely, a reduction was observed in cigarette, hookah, and overall tobacco product use in the past 30 days.

Conclusion: The increase in electronic cigarette use among students highlights the need to maintain their prohibition, expand educational actions, and strengthen surveillance and enforcement measures.

Objective: To estimate daily maximum temperature markers for defining heat wave alert levels in Belo Horizonte, Minas Gerais, Brazil.

Methods: the association between daily maximum temperature and mortality was estimated using quasi-Poisson regression with distributed lag non-linear models, considering lags from 0 to 21 days and adjustment for temporal trend, seasonality, and day of the week. The minimum mortality temperature was used as the reference for estimating relative risks, and high percentiles supported the definition of operational thresholds.

Results: The minimum mortality temperature was 29.3°C. Mortality risk increased at higher percentiles, with relative risks of 1.04 at the 90th percentile; 1.09 at the 95th percentile; 1.17 at the 98th percentile; and 1.26 at the 99th percentile. Four levels based on maximum temperature and thermal persistence were proposed: Alert 1, mild heat wave (32.0-33.1°C/3 days); Alert 2, moderate heat wave (33.2-34.6°C/3 days); Alert 3, intense heat wave (34.7-35.8°C/3 days); and Alert 4, extreme heat wave (>35.8°C/2 days). A higher frequency of heat waves was observed in years associated with El Niño.

Conclusion: Markers based on high percentiles of maximum temperature produced levels consistent with the increased mortality risk, with potential application in public health surveillance and response.

Objetive: In this study, we aimed to perform the cross-cultural adaptation and psychometric evaluation of the Quality of Life Impact of Refractive Correction (QIRC) questionnaire for European Portuguese.

Methods: International guidelines for the adaptation of questionnaire-based assessment instruments were followed, and the study was conducted in two phases: 1) Cross-cultural adaptation, involving translation, back-translation, and pretesting for semantic equivalence; 2) Psychometric evaluation of the scale. A convenience sample was selected from secondary and higher education institutions. Reliability was assessed using Cronbach's alpha (α) and McDonald's omega (ω), while temporal stability was evaluated by the intraclass correlation coefficient (ICC). The evaluation of the instrument's dimensional structure was performed using exploratory factor analysis (EFA).

Results: The sample consisted of 373 students, aged between 16 and 35 years. Internal consistency was high (α=0.848 and ω=0.862) and temporal stability was considered excellent (ICC=0.951). We identified three factors (Difficulties and Concerns - 11 items; Comfort and Well-being - 7 items; and Function and Symptoms - 2 items), according to the EFA, which explained 66.82% of the total variance. Internal consistency was excellent for Difficulties and Concerns (α=0.970), good for Comfort and Well-being (α=0.830); and low for Function and Symptoms (α=0.253), the latter being composed of only two items.

Conclusion: The results support the evaluation of the instrument's dimensional structure and reliability of the Portuguese version of the QIRC, adapted for European Portuguese. It is a suitable tool for assessing the impact of refractive correction on the quality of life among young populations in Portugal.

Objective: To analyze spatiotemporal trends in hospital morbidity indicators for road traffic injuries in the state of Piauí, Brazil, from 2010 to 2023.

Methods: This is an ecological, time-series and spatial analysis using data from the Hospital Information System of the Brazilian Unified Health System. Trends in hospitalization rates, according to health regions and sociodemographic characteristics, were analyzed using annual percent change (APC) and 95% confidence intervals (95%CI), estimated by Prais-Winsten regression. Spatial clusters were identified at the municipality level using Local Indicators of Spatial Association (LISA) maps.

Results: A total of 80,251 hospitalizations due to road traffic injuries were recorded. The mean hospitalization rate was 176.1/100 thousand inhabitants, showing an increasing trend (APC 5.72; 95%CI 1.04; 10.61), while case fatality (2.3%) remained stable (APC -2.42; 95%CI -5.07; 0.30). The mean hospitalization cost per admission (BRL 1,123.92) showed a decreasing trend (APC -3.17; 95%CI -5.57; -0.71), whereas the mean length of hospital stay (4.9 days) remained stable (APC -1.07; 95%CI -2.96; 0.86). High-high spatial clusters of hospitalization rates were observed in municipalities located in the Northern and Southern regions of the state.

Conclusion: Hospitalization rates for road traffic injuries increased in Piauí, followed by a reduction in mean cost and stability in case fatality and length of hospital stay. Higher morbidity was concentrated in the Northern and Southern regions, suggesting a geographic shift of hospital morbidity toward inland areas.

Objective: To describe the literature on the methodological characteristics and use of record linkage techniques applied to tuberculosis surveillance in Brazil.

Methods: A systematic methodological review (PROSPERO: CRD42024623969) was conducted following the 2020 guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Searches were performed on the following databases: PubMed, Embase, Scopus, Virtual Health Library (VHL), Scientific Electronic Library Online (Scielo), and Latin American and Caribbean Literature on Health Sciences (LILACS) on February 5, 2025. Scientific articles produced in Brazil and whose authors applied record linkage between health information systems for epidemiological surveillance purposes were included. Grey literature, studies without a focus on tuberculosis, studies without application of linkage, and studies conducted outside Brazil were excluded. Descriptive synthesis was used, reporting frequencies, proportions, and measures of central tendency. Risk of bias or methodological quality were not assessed due to the heterogeneity of study designs and objectives, and because this review aimed to describe the methodological characteristics of the studies rather than synthesize effect estimates or epidemiological associations.

Results: The search retrieved 1,549 records; 49 studies were included. Most studies used the tuberculosis module of the Notifiable Diseases Information System (SINAN-TB, 98.0%) and the Mortality Information System (SIM, 67.3%); the most frequently used software was OpenRecLink (57.1%). The most common key variables were "name," "date of birth," and "mother's name." The linkage percentage ranged from 0.1 to 97.3%. The most frequent objectives were the description of epidemiological scenarios (24.5%), analysis of associated factors (20.4%), and investigation of underreporting (16.3%). Cohort (49.0%) and descriptive (34.7%) study designs predominated.

Conclusion: Record linkage integrates complementary databases and may strengthen tuberculosis surveillance. The findings suggest the potential usefulness of record linkage to support epidemiological analyses, improve records, and inform surveillance actions.

Objective: This study analyzed trends in tooth loss and caries severity among adults and older adults from 2003 to 2023.

Methods: An ecological study using secondary data from the three national oral health Surveys (SB Brasil 2003, 2010, and 2023) in 43 municipalities that participated in all editions. The analysis of trends in caries severity and tooth loss among adults (35-44 years) and older adults (65-74 years) was performed using structural equation modeling.

Results: Among adults, a significant association was observed between higher illiteracy rates and increased the decayed, missing, and filled teeth index (DMFT) (β=+0.309; p<0.001). On the other hand, greater coverage by oral health teams and private dental plans were associated with a reduction in these outcomes (β=-0.040 p<0.001 and β=-5.527 p<0.001, respectively). The associations were less evident but pointed in the same direction among older adults regarding illiteracy rates and private dental plan coverage, where the estimated coefficients showed lower magnitude and significance, indicating moderation of contextual effects and stability of the indicators over time.

Conclusion: The study confirmed a downward trend in tooth loss and DMFT between 2003 and 2023, pronounced in adults and to a lesser extent in older adults in Brazil. The latter are particularly vulnerable to rapid deterioration in oral health, requiring individualized analyses in future studies and the targeting of efforts by policymakers and implementers.

Objective: The study evaluated the association between COVID-19 vaccination and in-hospital mortality among immunocompromised older adults hospitalized for COVID-19 in Brazil during the 2024 epidemiologic year.

Methods: This retrospective hospital-based surveillance study used data from the Brazilian SIVEP-Gripe database. All hospitalized cases of COVID-19-related severe acute respiratory syndrome in immunocompromised individuals aged ≥60 years reported during epidemiological weeks 1-52 of 2024 were included. Multivariable logistic regression was used to estimate odds ratio (OR) and 95% confidence interval (95%CI) for the association between COVID-19 vaccination (number of doses) and in-hospital mortality, adjusting for clinical and sociodemographic covariates.

Results: Among 474 patients, in-hospital mortality was 36% (171/474). Only 56 (12%) were unvaccinated. Compared with unvaccinated individuals, adjusted ORs for mortality were 0.67 (95%CI 0.32-1.39) for 1-2 doses, 0.67 (95%CI 0.31-1.42) for 3 doses, 0.54 (95%CI 0.26-1.15) for 4 doses, and 0.56 (95%CI 0.26-1.17) for 5-6 doses. Mechanical ventilation (OR 12.55; 95%CI 6.39-26.33) and lower educational attainment (elementary education: OR 2.94; 95%CI 1.39-6.44) were independent predictors of death. COVID-19 vaccination was not significantly associated with reduced in-hospital mortality among immunocompromised older adults hospitalized for the disease in Brazil in 2024. However, all adjusted ORs were below unity, suggesting a trend toward protection with increasing doses.

Conclusions: The strong association of mortality with mechanical ventilation and social determinants highlights the need for timely boosters and comprehensive preventive strategies for this vulnerable population.

Objective: The burden of disease due to diabetes mellitus has shown an increasing trend worldwide. Given the potential of physical structures to create opportunities for the adoption of individual behaviors, this study aimed to analyze the relationship between neighborhood food environments and green spaces and the prevalence of diabetes mellitus in the Mar del Plata-Batán urban agglomeration in Argentina, while also considering individual characteristics, from 2013 to 2018.

Methods: A cross-sectional design with a multilevel approach was used. Individual data from the National Risk Factor Survey were linked to data on food environments and green spaces aggregated at the census tract level. Multilevel logistic regression models were used, with individuals nested within census tracts; odds ratios were estimated for independent variables with 95% confidence intervals.

Results: A total of 946 observations distributed across 81 census tracts were analyzed. After adjustment for individual variables, living in census tracts with a high density of healthy food outlets was associated with a 43% reduction in the odds of having diabetes [OR 0.57 (0.35-0.93)]. Public green space area per inhabitant in the neighborhood was not significantly associated with the odds of diabetes. The proportion of variability attributable to the contextual level ranged from 2.35 to 1.20%.

Conclusions: The neighborhood food environment was associated with diabetes mellitus in the studied agglomeration. These results may encourage the development of longitudinal studies with greater power to demonstrate the causal role of the food environment in the occurrence of diabetes.