Poluição do ar e mortalidade cardiovascular, estimativa da carga da doença e perdas econômicas em Cuiabá, MT
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Data
2021-09-01
Autores
Machin, Adrian Blanco [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A poluição do ar é uma das principais causas de internação e óbito por doenças cardiovasculares. O objetivo desse estudo consiste em quantificar os anos potenciais de vida perdidos associados à exposição ao material particulado fino (PM2,5) e o custo financeiro dessas mortes em residentes de Cuiabá, MT, com 40 anos ou mais entre 2012 e 2014. Foi desenvolvido um estudo ecológico de séries temporais com dados relativos a internações e óbitos por algumas doenças cardiovasculares. A variável dependente considerada foi o número de internações e óbitos concernentes às doenças correspondentes aos códigos: (I10 - I15), (I20 - I25), (I50) e (I60 - I64), que representam em torno de 77% do total das doenças cardiovasculares (I00.0 – I99.9) da CID-10. Esses dados foram obtidos do DATASUS. As variáveis independentes consideradas foram as concentrações diárias de PM2,5 estimadas pelo modelo matemático CCATT-BRAMS, dados de temperatura mínima e umidade relativa do ar. A abordagem estatística utilizou o modelo linear generalizado da regressão de Poisson com defasagens de 0 a 7 dias. Foram estimados custos financeiros e aumentos no número de internações e óbitos decorrentes de aumentos na concentração de PM2,5 no ar. Foram estimados os anos de vida perdidos (YLL) por meio do método dos anos de vida ajustados por incapacidade (DALY) para estimar a carga de doenças devido à exposição ao PM2,5. O valor de um ano de vida (VOLY) foi então aplicado para converter o componente YLL em perda econômica. Foram 7351 internações segundo diagnóstico I00 - I99 no período e faixa etária estudados, sendo 5655 (76,9%) por doenças específicas e 809 (14,3%) resultaram em óbitos. A exposição ao PM2,5 constitui fator de risco de internação no Lag 5 RR=1,01 (IC95% 1,00 - 1,02) e Lag 6 RR=1,01 (IC95% 1,00 – 1,02) para ambos os sexos, e no Lag 2 RR=1,01 (IC95% 1,00 - 1,02), Lag 5 RR=1,01 (IC95% 1,00 – 1,03), Lag 6 RR=1,02 (IC95% 1,01 - 1,03) e Lag 7 RR=1,02 (IC95% 1,00 – 1,03) para o sexo masculino. Aumento de 5 µg/m3 na concentração de PM2,5 implicou aumentos de até 310 internações e custos na ordem de R$ 1,0 milhão para o Sistema de Saúde Pública. A associação significativa entre exposição ao PM2,5 e mortalidade cardiovascular mostrou-se no Lag 6 RR=1,12 (IC95% 1,03 – 1,21) para o sexo feminino, totalizando o YLL de 2171,9 anos, o que significa uma perda econômica da ordem dos US $ 123 milhões no período em estudo. O conhecimento dos custos das mortes prematuras pode ser utilizado para aprimorar as políticas públicas e facilitar a tomada de decisões no contexto econômico atual.
Air pollution is one of the main causes of hospitalization and death from cardiovascular diseases. The objective of this study is to quantify the potential years of life loss associated with exposure to fine particulate matter (PM2,5) and the financial cost of these deaths in residents of Cuiabá, MT, over 40 years of age between 2012 and 2014. A time-series ecological study was developed, using data related to hospitalizations and deaths due to cardiovascular diseases. The dependent variable considered was the number of hospitalizations and deaths concerning the diseases corresponding to the codes: (I10 - I15), (I20 - I25), (I50), and (I60 - I64), which represent around 77% of the total cardiovascular diseases (I00.0 – I99.9) of the ICD-10. These data were obtained from DATASUS. The independent variables considered were the daily concentrations of PM2,5 estimated by the CCATT-BRAMS mathematical model, minimum temperature, and relative humidity data. The statistical approach used the generalized linear regression model of Poisson with lags of 0 to 7 days. Financial costs and increases in the number of hospitalizations and deaths resulting from increases in the concentration of PM2,5 in the air were estimated. Years of life lost (YLL) were estimated through the disability-adjusted life years (DALY) method to estimate disease burden due to exposure to PM2,5. The value of a life year (VOLY) was then applied to convert the YLL component into the economic loss. There were 7351 admissions according to diagnosis I00 - I99 in the period and age group studied, 5655 (76.9%) due to specific diseases, and 809 (14.3%) resulted in deaths. Exposure to PM2,5 is a risk factor for hospitalization in Lag 5 RR=1.01 (95%CI 1.00 - 1.02) and Lag 6 RR=1.01 (95%CI 1.00 - 1.02) for both sexes, and in Lag 2 RR=1.01 (95%CI 1.00 - 1.02), Lag 5 RR=1.01 (95%CI 1.00 - 1.03), Lag 6 RR=1 .02 (95%CI 1.01 - 1.03) and Lag 7 RR=1.02 (95%CI 1.00 - 1.03) for males. An increase of 5 µg/m3 in the concentration of PM2,5 implied increases of up to 310 hospitalizations and economic loss of more than R$ 1.0 million for the Public Health System. The significant association between exposure to PM2,5 and cardiovascular mortality was shown in Lag 6 RR=1.12 (95%CI 1.03 – 1.21) for females, totaling the YLL of 2171.9 years, which means an economic loss of more than US$ 123 million in the period under study. Knowledge of the costs of premature death can be used to improve public policies and facilitate decision-making in the current economic context.
Air pollution is one of the main causes of hospitalization and death from cardiovascular diseases. The objective of this study is to quantify the potential years of life loss associated with exposure to fine particulate matter (PM2,5) and the financial cost of these deaths in residents of Cuiabá, MT, over 40 years of age between 2012 and 2014. A time-series ecological study was developed, using data related to hospitalizations and deaths due to cardiovascular diseases. The dependent variable considered was the number of hospitalizations and deaths concerning the diseases corresponding to the codes: (I10 - I15), (I20 - I25), (I50), and (I60 - I64), which represent around 77% of the total cardiovascular diseases (I00.0 – I99.9) of the ICD-10. These data were obtained from DATASUS. The independent variables considered were the daily concentrations of PM2,5 estimated by the CCATT-BRAMS mathematical model, minimum temperature, and relative humidity data. The statistical approach used the generalized linear regression model of Poisson with lags of 0 to 7 days. Financial costs and increases in the number of hospitalizations and deaths resulting from increases in the concentration of PM2,5 in the air were estimated. Years of life lost (YLL) were estimated through the disability-adjusted life years (DALY) method to estimate disease burden due to exposure to PM2,5. The value of a life year (VOLY) was then applied to convert the YLL component into the economic loss. There were 7351 admissions according to diagnosis I00 - I99 in the period and age group studied, 5655 (76.9%) due to specific diseases, and 809 (14.3%) resulted in deaths. Exposure to PM2,5 is a risk factor for hospitalization in Lag 5 RR=1.01 (95%CI 1.00 - 1.02) and Lag 6 RR=1.01 (95%CI 1.00 - 1.02) for both sexes, and in Lag 2 RR=1.01 (95%CI 1.00 - 1.02), Lag 5 RR=1.01 (95%CI 1.00 - 1.03), Lag 6 RR=1 .02 (95%CI 1.01 - 1.03) and Lag 7 RR=1.02 (95%CI 1.00 - 1.03) for males. An increase of 5 µg/m3 in the concentration of PM2,5 implied increases of up to 310 hospitalizations and economic loss of more than R$ 1.0 million for the Public Health System. The significant association between exposure to PM2,5 and cardiovascular mortality was shown in Lag 6 RR=1.12 (95%CI 1.03 – 1.21) for females, totaling the YLL of 2171.9 years, which means an economic loss of more than US$ 123 million in the period under study. Knowledge of the costs of premature death can be used to improve public policies and facilitate decision-making in the current economic context.
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Palavras-chave
Poluição do ar, Material particulado, Doenças cardiovasculares, Avaliação econômica, Coração - Doenças, Air pollution, Particulate matter, Cardiovascular diseases, Economic evaluation