RESUMO
Objective: Despite significant advancements in understanding risk factors and treatment strategies, ischemic heart disease (IHD) remains the leading cause of mortality worldwide, particularly within specific regions in Brazil, where the disease is a burden. Therefore, the aim of this study was to estimate the risk of hospitalization and mortality from IHD in the state of Paraná (Brazil), using spatial analysis to identify areas with higher risk based on socioeconomic, demographic and health variables. Methods: This is an ecological study based on secondary and retrospective IHD hospitalization and mortality data obtained from the Brazilian Hospitalization and Mortality Information Systems during the 2010-2021 period. Data were analyzed for 399 municipalities and 22 health regions in the state of Paraná. To assess the spatial patterns of the disease and identify relative risk (RR) areas, we constructed a risk model by Bayesian inference using the R-INLA and SpatialEpi packages in R software. Results: A total of 333,229 hospitalizations and 73,221 deaths occurred in the analyzed period, and elevated RR of hospitalization (RR = 27.412, CI 21.801; 34.466) and mortality (RR = 15.673, CI 2.148; 114.319) from IHD occurred in small-sized municipalities. In addition, medium-sized municipalities also presented elevated RR of hospitalization (RR = 6.533, CI 1.748; 2.006) and mortality (RR = 6.092, CI 1.451; 2.163) from IHD. Hospitalization and mortality rates were higher in white men aged 40-59 years. A negative association was found between Municipal Performance Index (IPDM) and IHD hospitalization and mortality. Conclusion: Areas with increased risk of hospitalization and mortality from IHD were found in small and medium-sized municipalities in the state of Paraná, Brazil. These results suggest a deficit in health care attention for IHD cases in these areas, potentially due to a low distribution of health care resources.
Assuntos
Teorema de Bayes , Hospitalização , Isquemia Miocárdica , Humanos , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/epidemiologia , Hospitalização/estatística & dados numéricos , Brasil/epidemiologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Fatores de Risco , Adulto , Idoso , Medição de Risco/métodos , Taxa de Sobrevida/tendênciasRESUMO
INTRODUCTION: Abdominal aortic aneurysm (AAA) is a growing public health problem, and not all patients have access to surgery when needed. This study aimed to analyze spatiotemporal variations in AAA mortality and surgical procedures in Brazilian intermediate geographic regions and explore the impact of different surgical techniques on operative mortality. METHODS: A retrospective longitudinal study was conducted to evaluate AAA mortality from 2008 to 2020 using space-time cube (STC) analysis and the emerging hot spot analysis tool through the Getis-Ord Gi* method. RESULTS: There were 34,255 deaths due to AAA, 13,075 surgeries to repair AAA, and a surgical mortality of 14.92%. STC analysis revealed an increase in AAA mortality rates (trend statistic = +1.7693, p = 0.0769) and a significant reduction in AAA surgery rates (trend statistic = -3.8436, p = 0.0001). Analysis of emerging hotspots revealed high AAA mortality rates in the South, Southeast, and Central-West, with a reduction in procedures in São Paulo and Minas Gerais States (Southeast). In the Northeast, there were extensive areas of increasing mortality rates and decreasing procedure rates (cold spots). CONCLUSION: AAA mortality increased in several regions of the country while surgery rates decreased, demonstrating the need for implementing public health policies to increase the availability of surgical procedures, particularly in less developed regions with limited access to services.
Assuntos
Aneurisma da Aorta Abdominal , Acessibilidade aos Serviços de Saúde , Disparidades em Assistência à Saúde , Procedimentos Cirúrgicos Vasculares , Humanos , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/mortalidade , Brasil/epidemiologia , Estudos Retrospectivos , Estudos Longitudinais , Masculino , Fatores de Tempo , Feminino , Idoso , Fatores de Risco , Procedimentos Cirúrgicos Vasculares/mortalidade , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Resultado do Tratamento , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Medição de Risco , Análise Espaço-TemporalRESUMO
Pensar o cenário de ruínas e a possibilidade de criar outras paisagens para a vida diante da insuspeita normalidade tóxica que agride nossa imaginação, liberdade e desejos é a intenção deste ensaio. Abrimos o debate sobre população em situação de rua e saúde descendo ao abismo da realidade contemporânea para interrogar o pessimismo distópico, baseado em posturas impiedosas que fazem a noção de bem comum desintegrar. Cabe olharmos em outra direção que nos empurra para a possibilidade de sermos outros, diferentes do que somos, reforçando toda luta a partir das forças insurgentes, criadoras do presente em busca de novas perspectivas societárias. As relações entre os seres humanos e não humanos podem ser outras, os dualismos não mais nos servem, os horrores da vida civilizada na atualidade nos entristece, inibe e destrói.