RESUMO
The road traffic crash burden is significant in Brazil; calculating years of life lost and life expectancy reduction quantifies the burden of road traffic deaths to enable prioritization of this issue. Years of life lost and reduction in life expectancy were calculated using 2008 population/crash data from Brazil's ministries of health and transport. The potential for reduction in crash mortality was calculated for hypothetical scenarios reducing death rates to those of the best-performing region and age category. In Brazil, road traffic deaths reduce the at-birth life expectancy by 0.8 years for males and by 0.2 years for females. Many years of life lost for men and woman could be averted-270,733 and 123,986, respectively-if all rates matched those of the lowest-risk region and age category. This study further characterizes the burden of motor vehicle deaths in Brazil and quantifies the potential health benefits of policies/interventions that reduce road traffic death rates to those of the best-performing subpopulations.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Expectativa de Vida , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Características de Residência/estatística & dados numéricos , Fatores Sexuais , Adulto JovemRESUMO
OBJECTIVE: To determine the incremental costs and effects of different HPV testing strategies, when compared to Papanicolau cytology (Pap), for cervical cancer screening in Mexico. METHODS: A cost-effectiveness analysis (CEA) examined the specific costs and health outcomes associated with (1) no screening; (2) only the Pap test; (3) only self-administered HPV; (4) only clinician administered HPV; and (5) clinician administered HPV plus the Pap test. The costs of self- and clinician-HPV testing, as well as with the Pap test, were identified and quantified. Costs were reported in 2008 US dollars. The health outcome associated with these screening strategies was defined as the number of high-grade cervical intraepithelial neoplasia or cervical cancer cases detected. This CEA was performed using the perspective of the Mexican Institute of Social Security (IMSS) in Morelos, Mexico. RESULTS: Screening women between the ages of 30-80 for cervical cancer using clinical-HPV testing or the combination of clinical-HPV testing, and the Pap is always more cost-effective than using the Pap test alone. CONCLUSIONS: This CEA indicates that HPV testing could be a cost-effective screening alternative for a large health delivery organization such as IMSS. These results may help policy-makers implement HPV testing as part of the IMSS cervical cancer screening program.
Assuntos
Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Displasia do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/diagnóstico , Esfregaço Vaginal/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Técnicas Citológicas/economia , Técnicas Citológicas/métodos , Feminino , Humanos , México , Pessoa de Meia-Idade , Papillomaviridae/fisiologia , Infecções por Papillomavirus/complicações , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/virologia , Esfregaço Vaginal/métodos , Adulto Jovem , Displasia do Colo do Útero/etiologia , Displasia do Colo do Útero/virologiaRESUMO
OBJECTIVE: To identify factors that are associated with an increased risk of developing high-grade cervical intraepithelial neoplasia (CIN) or cancer among human papillomavirus (HPV)-positive women in Mexico. MATERIAL AND METHODS: A case-control study design was used. A total of 94 cases and 501 controls who met the study inclusion criteria were selected from the 7 732 women who participated in the Morelos HPV Study from May 1999 to June 2000. Risk factor information was obtained from interviews and from HPV viral load results. Odds ratios and 95 percent confidence intervals were estimated using unconditional multivariate regression. RESULTS: Increasing age, high viral load, a young age at first sexual intercourse, and a low socio-economic status are associated with an increased risk of disease among HPV-positive women. CONCLUSIONS: These results could have important implications for future screening activities in Mexico and other low resource countries.
Assuntos
Papillomaviridae/isolamento & purificação , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , México , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
OBJECTIVE: To identify factors that are associated with an increased risk of developing high-grade cervical intraepithelial neoplasia (CIN) or cancer among human papillomavirus (HPV)-positive women in Mexico. MATERIAL AND METHODS: A case-control study design was used. A total of 94 cases and 501 controls who met the study inclusion criteria were selected from the 7 732 women who participated in the Morelos HPV Study from May 1999 to June 2000. Risk factor information was obtained from interviews and from HPV viral load results. Odds ratios and 95 percent confidence intervals were estimated using unconditional multivariate regression. RESULTS: Increasing age, high viral load, a young age at first sexual intercourse, and a low socio-economic status are associated with an increased risk of disease among HPV-positive women. CONCLUSIONS: These results could have important implications for future screening activities in Mexico and other low resource countries.
OBJETIVO: Identificar factores asociados con un mayor riesgo de desarrollar neoplasia intraepitelial cervical (NIC) de alto grado o cáncer en mujeres con virus de papiloma humano (VPH), en México. MATERIAL Y MÉTODOS: Se utilizó un diseño de casos y controles. Un total de 94 casos y 501 controles fueron seleccionados de las 7 732 mujeres que participaron en el Estudio de VPH en Morelos, de mayo de 1999 a junio de 2000. La información sobre factores de riesgo se obtuvo de entrevistas y de los resultados de carga virales de VPH. Se estimaron razones de momios e intervalos de confianza de 95 por ciento con modelos multivariados de regresión no condicionada. RESULTADOS: El incremento de edad, la carga viral elevada, la edad temprana al inicio de la vida sexual y el nivel socioeconómico bajo se asocian con un mayor riesgo de enfermedad en mujeres VPH positivas. CONCLUSIONES: Estos resultados podrían tener implicaciones importantes a futuro para las actividades de tamizaje en México y en otros países de bajos recursos.