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      Mortality patterns in municipalities of a mining region before the Brumadinho dam failure, state of Minas Gerais, Brazil Translated title: Padrões de mortalidade em municípios de uma região mineradora antes do rompimento da barragem de Brumadinho, Minas Gerais, Brasil

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          ABSTRACT

          Objective:

          To describe the patterns of overall mortality and mortality from external causes and the temporal evolution in the municipalities of the Paraopeba River Basin, before the socio-environmental disaster of the Brumadinho dam and, additionally, to investigate the correlation between mortality and socioeconomic deprivation in these municipalities.

          Methods:

          Global Burden of Disease Study mortality estimates for 26 municipalities in the state of Minas Gerais, Brazil, were analyzed. Rates of overall mortality and mortality from external causes were estimated in the triennia (T) T1 (2000 to 2002), T2 (2009 to 2011), and T3 (2016 to 2018). Pearson’s correlation coefficient measured the association between mortality rates and socioeconomic deprivation, according to the Brazilian Deprivation Index (IBP).

          Results:

          There was a decrease in overall mortality in the Paraopeba River Basin from 717.7/100 thousand to 572.6/100 thousand inhabitants, and in most municipalities between T1-T3. Mortality from external causes increased from 73.3/100 thousand to 82.1/100 thousand, and it was higher in these municipalities compared with the mean for Brazil and Minas Gerais. Deaths from suicide and interpersonal violence increased from 29.6/100 thousand to 43.2/100 thousand in most of the 26 municipalities. Death rates due to unintentional injuries decreased during the period, and those due to transport injuries, increased. There was a positive correlation between socioeconomic deprivation and the percent change in mortality rates.

          Conclusion:

          Despite the strong presence of mining activity in the region, such did not reflect in the improvement of the sanitary situation. Death rates due to external causes increased in the period, associated with inequalities, which must be considered in the planning for the recovery of the disaster areas.

          RESUMO:

          Objetivo:

          Descrever os padrões de mortalidade geral e por causas externas e a evolução temporal nos municípios da Bacia Hidrográfica do Rio Paraopeba previamente ao desastre socioambiental de Brumadinho e, adicionalmente, investigar a correlação entre a mortalidade e a privação socioeconômica nesses municípios.

          Métodos:

          Foram analisadas estimativas de mortalidade do Estudo Carga Global de Doenças referentes a 26 municípios de Minas Gerais. Calcularam-se taxas de mortalidade geral e por causas externas nos triênios (T) T1 (2000 a 2002), T2 (2009 a 2011) e T3 (2016 a 2018). O coeficiente de correlação de Pearson mediu associação entre as taxas de mortalidade e a privação socioeconômica, segundo Índice Brasileiro de Privação.

          Resultados:

          Houve declínio da mortalidade geral na Bacia Hidrográfica do Rio Paraopeba de 717,7/100.000 para 572,6/100.000 hab. e na maioria dos municípios entre T1-T3. A mortalidade por causas externas aumentou de 73,3/100.000 para 82,1/100.000 e foi mais elevada nesses municípios comparando-se com a média do Brasil e de Minas Gerais. As mortes por suicídio e violência interpessoal aumentaram de 29,6/100.000 para 43,2/100.000 na maioria dos 26 municípios. Os acidentes não intencionais reduziram-se no período, e as taxas por acidente de transporte aumentaram. Houve correlação positiva entre a privação socioeconômica e a variação percentual das taxas de mortalidade.

          Conclusão:

          Apesar da forte presença da atividade mineradora na região, isso não refletiu na melhoria do quadro sanitário, as causas externas aumentaram no período, associadas às desigualdades, o que deve ser considerado no planejamento para a recuperação das áreas do desastre.

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          Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

          Summary Background In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding Bill & Melinda Gates Foundation.
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            Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

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              Cancer Incidence in Atomic Bomb Survivors. Part III: Leukemia, Lymphoma and Multiple Myeloma, 1950-1987

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: Data curationRole: SoftwareRole: VisualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: MethodologyRole: Data curationRole: SoftwareRole: Project administrationRole: ResourcesRole: VisualizationRole: Writing – review & editing
                Role: MethodologyRole: Data curationRole: SoftwareRole: Project administrationRole: ResourcesRole: VisualizationRole: Writing – review & editing
                Journal
                Rev Bras Epidemiol
                Rev Bras Epidemiol
                rbepid
                Revista Brasileira de Epidemiologia (Brazilian Journal of Epidemiology)
                Associação Brasileira de Saúde Coletiva
                1415-790X
                1980-5497
                21 April 2023
                2023
                : 26
                : Suppl 1
                : e230010
                Affiliations
                [I ]Universidade Federal de Minas Gerais, Department of Maternal and Child Nursing and Public Health – Belo Horizonte (MG), Brazil.
                [II ]Universidade Federal de Minas Gerais, School of Nursing, Graduate Program in Nursing – Belo Horizonte (MG), Brazil.
                [III ]Universidade Federal Fluminense, Institute of Mathematics and Statistics, Department of Statistics — Niterói (RJ), Brazil.
                [IV ]Universidade Nova de Lisboa, Institute of Hygiene and Tropical Medicine — Lisbon, Portugal.
                [V ]University of Washington, Institute for Health Metrics and Evaluation – Seattle (WA), United States of America.
                [VI ]University of Washington, Institute for Health Metrics and Evaluation, Department of Global Health – Seattle (WA), United States of America.
                Author notes
                Corresponding author: Deborah Carvalho Malta. Avenida Alfredo Balena, 190, Escola de Enfermagem, 5º andar, Santa Efigênia, CEP: 30130-100, Belo Horizonte (MG), Brazil. E-mail: dcmalta@ 123456uol.com.br

                Conflict of interests: nothing to declare

                Author information
                http://orcid.org/0000-0002-8214-5734
                http://orcid.org/0000-0002-4580-8228
                http://orcid.org/0000-0002-5348-3793
                http://orcid.org/0000-0002-1114-5470
                http://orcid.org/0000-0001-9780-9428
                http://orcid.org/0000-0002-7382-5260
                http://orcid.org/0000-0003-3691-1458
                Article
                00408
                10.1590/1980-549720230010.supl.1
                10176738
                9cd960e7-c621-45ff-959b-7ab78685c651

                All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License

                History
                : 01 September 2022
                : 08 October 2022
                : 27 October 2022
                Page count
                Figures: 8, Tables: 2, Equations: 0, References: 43
                Categories
                Original Article

                dam failure,mining,ecological studies,mortality,external causes,diagnosis of health situation,rompimento de barragens,mineração,estudos ecológicos,mortalidade,causas externas,diagnóstico da situação de saúde

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