Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016

Fatima Marinho(University of Washington), Valéria Maria de Azeredo Passos, Déborah Carvalho Malta(University of Washington), Elizabeth Barboza França(University of Washington), Daisy Maria Xavier de Abreu(University of Washington), Valdelaine Etelvina Miranda de Araújo(University of Washington), Maria Teresa Bustamante-Teixeira(University of Washington), Paulo Augusto Moreira Camargos(University of Washington), Carolina Cândida da Cunha(University of Washington), Bruce Bartholow Duncan(University of Washington), Mariana Santos Felisbino-Mendes(University of Washington), Maximiliano Ribeiro Guerra(University of Washington), Mark Drew Crosland Guimarães(University of Washington), Paulo A. Lotufo(University of Washington), Wagner Marcenes(University of Washington), Patrícia Pereira Vasconcelos de Oliveira(University of Washington), Marcel de Moares Pedroso(University of Washington), Antônio Luiz Pinho Ribeiro(University of Washington), María Inês Schmidt(University of Washington), Renato Azeredo Teixeira(University of Washington), Ana Maria Nogales Vasconcelos(University of Washington), Maurício L. Barreto(University of Washington), Isabela M. Benseñor(University of Washington), Luísa Campos Caldeira Brant(University of Washington), Rafael Moreira Claro(University of Washington), Alexandre C. Pereira(University of Washington), Ewerton Cousin(University of Washington), María Paula Curado(University of Washington), Kadine Priscila Bender dos Santos, André Faro(University of Washington), Cleusa P. Ferri(University of Washington), João M. Furtado(University of Washington), Julia Gall(University of Washington), Scott Glenn(University of Washington), Alessandra C. Goulart, Lenice Harumi Ishitani(University of Washington), Christian Kieling(University of Washington), Roberto Marini Ladeira(University of Washington), Ísis Eloah Machado(University of Washington), Sheila Cristina Ouriques Martins(University of Washington), Francisco Rogerlândio Martins‐Melo(University of Washington), Ana Paula Souto Melo(University of Washington), Molly K. Miller-Petrie(University of Washington), Meghan Mooney(University of Washington), Bruno Pereira Nunes(University of Washington), Marcos Roberto Tovani Palone(University of Washington), Cláudia Cristina Aguiar Pereira(University of Washington), Davide Rasella(University of Washington), Sarah E. Ray(University of Washington), Leonardo Roever(University of Washington), Raphael de Freitas Saldanha(University of Washington), Itamar S Santos(University of Washington), Ione Jayce Ceola Schneider(University of Washington), Diego Augusto Santos Silva(University of Washington), Dayane Gabriele Alves Silveira(University of Washington), Adauto Martins Soares Filho, Tatiane Moraes de Sousa, Célia Landmann Szwarcwald(University of Washington), Jefferson Traebert(University of Washington), Gustavo Velásquez-Meléndez(University of Washington), Yuan‐Pang Wang(University of Washington), Rafael Lozano(University of Washington), Christopher J L Murray(University of Washington), Mohsen Naghavi(University of Washington)
The Lancet
July 20, 2018
10.1016/s0140-6736(18)31221-2
Cited by 460Open Access
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Abstract

BACKGROUND: Political, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses. METHODS: We analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries. FINDINGS: Nationally, LE increased from 68·4 years (95% uncertainty interval [UI] 68·0-68·9) in 1990 to 75·2 years (74·7-75·7) in 2016, and HALE increased from 59·8 years (57·1-62·1) to 65·5 years (62·5-68·0). All-cause age-standardised mortality rates decreased by 34·0% (33·4-34·5), while all-cause age-standardised DALY rates decreased by 30·2% (27·7-32·8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index. INTERPRETATION: Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities. FUNDING: Bill & Melinda Gates Foundation and the Brazilian Ministry of Health.

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