RESUMO
Heart failure (HF) is a significant clinical problem and an important public health issue due to the morbidity and mortality that it causes, especially in a population that is aging and affected by social stressors such as armed conflict. We aim to describe the inequalities and trends of HF mortality by educational level in Colombia between 1999 and 2017 compared with the cycles of the internal armed conflict during the same period. An observational study of ecological data panels, with aggregates at the national level, was conducted. Information from death certificates with HF as the basic cause of death (COD) was used. Variables of the year of death, sex, age, department of residence, and educational level were considered. Mortality rates adjusted for age were calculated. A joinpoint regression was used to model the trend of rates by educational level. We found that both men and women with primary education had the highest adjusted mortality rates: among men, RR_primary = 19.06 deaths/100,000 inhabitants, SE = 0.13 vs. RR_tertiary = 4.85, SE = 0.17, and similar differences among women. Mortality rates tended to decrease at all educational levels, with a greater reduction in people with higher educational levels. In both sexes, the behavior of the relative index of inequality showed significant inequality, albeit with a strong reduction during the last decade. Mortality due to HF in Colombia shows inequalities by educational level. In the prevention of HF, education should be considered a structural social determinant. In addition, we analyzed the potential role of the Colombian long-term armed conflict in the observed trends. We highlighted the role of the health sector, together with other sectors (education, work, and housing), in developing intersectoral public policies that contribute to the reduction of cardiovascular mortality disparities.
RESUMO
OBJECTIVE: This research aims to describe trends in inequalities in suicide mortality by educational level in Colombia between 1998 and 2015. METHOD: Standardized suicide mortality rates (SMR) were calculated by educational level, sex, and age in adult men and women over 25 years of age. Poisson regression models were used to calculate the RR (rate ratio) with those highly educated as a reference, and the RII (relative index of inequality). RESULTS: The number of reported deaths by suicide between 1998 and 2015 was 24,654, of which 84.7% were men. By age-group, 48.5% of suicides were among young adult men and women (25-44). Men had higher suicide rates than women (SMR men = 10.44/100,000; SMR women = 1.72/100,000). The age-standardized mortality rates (SMR) were higher in the groups with the lowest educational level in both sexes and all age-groups, except for senior adult women (65+). Broadly, while SMR reduced throughout most of the period, inequalities grew. CONCLUSIONS: We found that the educational inequities associated with suicide in Colombia grew slightly. This suggests the need to work on suicide prevention strategies that go beyond the individual risk factors. Socioeconomic issues need to be considered as a key tool to prevent suicide by improving peoples' quality of life and their mental health.
Assuntos
Saúde Mental , Suicídio , Adulto , Escolaridade , Feminino , Humanos , Masculino , Qualidade de Vida , Fatores SocioeconômicosRESUMO
Objetivo: Identificar las principales características epidemiológicas y sociodemográficas de los suicidas adultos mayores de 60 años, en Bogotá, en el periodo comprendido entre 2003 y 2007. Metodología: Estudio descriptivo-retrospectivo, cuya información primaria se obtuvo de los informes periciales de necropsia (n = 98), teniendo en cuenta las variables seleccionadas. Los datos se sistematizaron a través del programa Epi-Info 6.04 y fueron analizados mediante tablas de contingencia. Resultados: Los suicidas de este grupo poblacional son mayoritariamente hombres, que presentan una de las mayores tasas respecto al grueso de la población. Entre las principales motivaciones para el suicidio en este género se reportó el padecimiento de enfermedades crónicas y discapacitantes, mientras que para las mujeres, algún trastorno mental y/o la pérdida de un ser querido. Estar casado y tener una familia no se evidenció como un factor protector. La localidad que presentó la mayor tasa de suicidios fue Los Mártires, y no se encontró una relación directa entre los índices de pobreza por localidad, ni el aseguramiento en salud con el hecho. Conclusiones: Aunque desde el 2003 se ha evidenciado una disminución en las tasas de suicidio para la población mayor de 60 años, el suicidio en el adulto mayor continúa siendo un fenómeno predominantemente masculino y un problema importante de salud pública, cuya complejidad en términos de multicausalidad y multidimensionalidad hace que lo que se denominan factores de riesgo y factores protectores sean solo aspectos a tener en cuenta en términos de comprensión del fenómeno y su prevención.
Objective: To identify the major epidemiological and sociodemographic characteristics of suicidal adults over 60 years old in Bogotá between the years 2003 and 2007. Methodology: A descriptive-retrospective study was performed, mainly using information obtained from necropsy reports (n = 98), taking into account selected epidemiological variables. The data were systematized using Epi-Info 6.04 software, and were analyzed using contingency tables. Results: Suicide victims of this population group are primarily male, having one of the highest suicide rates with respect to the whole population. The presence of chronic and disabling diseases was reported among the main motivations for suicide in males, while for women it was the presence of a mental disorder and/or loss of a loved one. Having family support did not affect suicide rates. The locality that had the highest suicide rates was the district of Los Mártires, and there was no direct relationship between poverty rates or health insurance and the presence of the phenomenon. Conclusions: Although there has been a decrease in suicide rates for the population over 60 years old since 2003, suicide in elderly people remains a predominantly male phenomenon and an important public health problem. Due to its complexity in terms of multiple causes and multidimensionality, the protective and risk factors are just aspects to consider in terms of understanding the phenomenon and its prevention.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Suicídio , Classe Social , Condições Sociais , Violência , Epidemiologia , Colômbia , AdultoRESUMO
OBJECTIVE: To identify the major epidemiological and sociodemographic characteristics of suicidal adults over 60 years old in Bogotá between the years 2003 and 2007. METHODOLOGY: A descriptive-retrospective study was performed, mainly using information obtained from necropsy reports (n=98), taking into account selected epidemiological variables. The data were systematized using Epi-Info 6.04 software, and were analyzed using contingency tables. RESULTS: Suicide victims of this population group are primarily male, having one of the highest suicide rates with respect to the whole population. The presence of chronic and disabling diseases was reported among the main motivations for suicide in males, while for women it was the presence of a mental disorder and/or loss of a loved one. Having family support did not affect suicide rates. The locality that had the highest suicide rates was the district of Los Mártires, and there was no direct relationship between poverty rates or health insurance and the presence of the phenomenon. CONCLUSIONS: Although there has been a decrease in suicide rates for the population over 60 years old since 2003, suicide in elderly people remains a predominantly male phenomenon and an important public health problem. Due to its complexity in terms of multiple causes and multidimensionality, the protective and risk factors are just aspects to consider in terms of understanding the phenomenon and its prevention.