Carga global de doença no Brasil: o papel de fatores de risco como o tabagismo e o excesso de peso

Overweight⁄obesity and tobacco smoking are considered as risk factors to the development of non-communicable chronic diseases. The present thesis had as objectives to quantify, analyze and discuss the impact of those factors on the Global burden disease in Brazil and was elaborated under four scientific articles. The first article, “Mortality Aspects Attributed to Tobacco: A systematic review”, presented and discussed the methods used to calculate the Tobacco Attributed Mortality (TAM). The studies showed evidences that, among the diseases tobaccorelated, Cancer of the Trachea/Bronchi/Lungs, Ischemic Heart Disease (IHD), Chronic Obstructive Pulmonary Disease (COPD) and Cerebrovascular Diseases (CD) were among those that mostly contributed to TAM. In spite of the different methodologies and parameters used, the estimates for the TAM showed high levels of accuracy in the studies that evaluated lung cancer and the COPD on male population aged 35 years or older. In the second article, “ The burden of disease associated to smoking in the state of Rio de Janeiro (RJ), 2000”, we calculated the population fraction attributed to tobacco, by means of parameters such as prevalence and death risk. Among the main results, it was observed that 10, 6% of total de DALY, in the population aged 30 years or older who live in the State of Rio de Janeiro, was among smokers. Besides, it was also observed that in COPD, IHD and CD were responsible for 61.1% of the total of DALY attributed to smokers in Rio de Janeiro who were 30 years old or older. The Third article, “Global burden disease attributed to mellitus diabetes (DM) in Brazil” presented the results of the study on Global burden disease carried out in 1998, emphasizing DM and its complications. The mortality information were from the Sistema de Informacao de Mortalidade (SIM) while that on morbidities (YLD - Years Lived with Disability), were obtained, mainly through extensive review of literature. It showed that 66.3% of the total burden of disease estimated in Brazil (DALY - disability adjusted life of years) was related to the group II (Non-communicable chronic diseases); having DM, as a worsening factor within the large II group, to be the first cause of loss of years by premature death and disability (DALY) for both sexes in 1998 and corresponded to 5.1% of the total DALY estimated for Brazil. It is expected that by 2013, DM will become the first cause of Daly’s loss, that is a 29.5% increase. Finally, in the fourth article, “The Global burden of mellitus diabetes attributed to the overweight and obesity in Brazil”, we estimated the DM burden that can be attributed to the overweight⁄obesity, in 2002-2003. Parameters such as prevalence of overweight and risk for the development of DM were used, for calculating the population attributable fraction. It appeared that in Brazil 61.8% and 45.4% of DM, among females, were attributed to overweight and obesity respectively. As for men, these percentages were 52.8% and 32.7%. It was observed that the highest values were found in the South, Southeast and Central-west regions of the country. It is the population group aged between 35 to 44 years old in which the highest fraction attributed for both sexes were observed. From those ages on, the values tended to decrease.