Mortalidade por diabetes mellitus no Brasil: associações com fatores sociodemográficos

Abstract

In recent decades, Brazil has faced changes in its sociodemographic, epidemiological and nutritional profile. Changes in the epidemiological and demographic profile were concomitant. Type 2 non-insulin dependent diabetes mellitus (DM) stands out as a disease that has progressed significantly as a cause of mortality. It should be pointed out that variables such as age, sex, schooling and income may have a relevant explanatory power for mortality from this disease. Thus, the general objective of this work is to analyze and describe the behavior of mortality rates due to Type 2 DM (TMDM) in the Brazilian population, in terms of large regions and UF, investigating its association with selected sociodemographic factors, taking as a reference the period 2000-2015. The Mortality Information System (SIM) and the Human Development Atlas of Brazil (Atlas BR-2013) of the UNDP were used as data sources. It is a descriptive and multivariate study, focusing on non-insulin dependent TMDM, which were standardized by the population of Brazil, where Brazilian UF were taken as basic units of analysis, which also characterizes it as an ecological study. Descriptive analyzes were performed, observing the three-year behavior of the rates. A multi-regression model (MRLM) was used, weighted by population size, using TMDM (average rate logito of the last four years, 2012-15) as a response variable and indicators of education, income and poverty, as explanatory variables. A non-parametric statistical analysis, using the Mann-Whitney Test was used to measure the significance of TMDM differences and sociodemographic indicators between two groups of UF, one represented by the North and Northeast regions and another by UF of the South, Southeast and Central West. In all analyzes the level of significance was taken as 5%. The results pointed to statistically significant associations between TMDM and the sociodemographic indicators analyzed (indicators of poverty, education and income inequality). In the adjustment of MRLM, the only statistically significant variable, to explain the variation of TMDM, was the poverty indicator (proportion of people living with less than 1/2 sm), (p-value = 0.027), indicating that the poorer and less developed the UF, the higher are their DM mortality rates (r = 0.43). The Mann-Whitney Test showed statistically significant differences for all sociodemographic variables and TMDM, between the two groups considered. Finally, it is possible to emphasize that, despite the socioeconomic advances, all the regions of the country presented growth in their TMDM, especially in those with less favored social and educational conditions. The need for more efficient and more effective public policies is an urgent premise, regarding an improvement in this health-space relationship in Brazil.