TIOTREFIS GOMES FERNANDES
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conferenceObject Higher Stroke Prevalence Rates among Ribeirinhos Compared to Townsmen in the Brazilian Amazon.(2013) FERNANDES, Tiotrefis G.; BENSENOR, Isabela M.; LOTUFO, Paulo A.- Income and heart disease mortality trends in Sao Paulo, Brazil, 1996 to 2010(2013) LOTUFO, Paulo A.; FERNANDES, Tiotrefis G.; BANDO, Daniel H.; ALENCAR, Airlane P.; BENSENOR, Isabela M.Background: Reductions in heart disease mortality rates are variable according to socioeconomic status. Methods: We performed a time trend analysis of all heart diseases (all circulatory diseases, except rheumatic, cerebrovascular, and aortic diseases) comparing three different household income levels (high, middle, and low) in the city of Sao Paulo from 1996 to 2010. Results: A total of 197,770 deaths were attributed to heart diseases; 62% of them were due to coronary diseases. The rate of death due to heart diseases declined for the city as a whole. The annual percent change (APC) and 95% confidence intervals for men living in the high, middle and low income areas were -4.1 (-4.5 to -3.8), -3.0 (-3.5 to -2.6), and -2.5 (-2.8 to -2.1), respectively. The decline in death rate was greatest among men in the wealthiest area. The trend rates of women living in the high-income area had one joinpoint; APC was -4.4 (-4.8 to -3.9) from 1996-2005 and -2.6 (-3.8 to -1.4) from 2005-2010. Middle and low income areas had an APC of -3.6 (-4.1 to -3.1) and -3.0 (-3.2 to -2.7) from 1996-2010, respectively. During the last 5 years of observation, there was a gradient of the decline of the risk of death, faster for people living in the wealthiest area and slower for people living in the more deprived neighborhoods. Conclusion: Reduction in deaths due to heart diseases is greatest for men and women living in the wealthiest neighborhoods.
- A reappraisal of stroke mortality trends in Brazil (1979-2009)(2013) LOTUFO, Paulo A.; GOULART, Alessandra C.; FERNANDES, Tiotrefis G.; BENSENOR, Isabela M.Background Brazil has one of the highest cerebrovascular death rates in the Western Hemisphere. We investigated temporal trends according to gender and stroke subtypes. Methods We analyzed mortality rates between 1979 and 2009 for different stroke subtypes. Data were stratified by gender and age (3574years). The annual percent change and significant changes in the trends were identified with Poisson regression. Results After excluding deaths due to sequel from stroke for men, the annual percent changes (95% confidence intervals) were as follows: 19791984, 0 center dot 7 (0 center dot 8 to 2 center dot 1); 19841994, 1 center dot 8 (2 center dot 4 to 1 center dot 2); 19942007, 5 center dot 0 (5 center dot 4 to 4 center dot 7); and 20072009, 0 center dot 8 (7 center dot 0 to 5 center dot 8). For women, the annual percent changes were as follows: 19791994, 1 center dot 9 (2 center dot 2 to 1 center dot 6); 19941997, 7 center dot 5 (14 center dot 0 to 0 center dot 6); 19972007, 4 center dot 0 (4 center dot 6 to 3 center dot 3); and 20072009, 1 center dot 6 (5 center dot 5 to 9 center dot 2). For the 20062009 period, the average annual percent change (95% confidence interval) for all strokes was 3 center dot 1 (3 center dot 3 to 2 center dot 9) for men and 2 center dot 9 (3 center dot 1 to 2 center dot 8) for women. For the same period, the average annual percent change of death rates for stroke subtypes were, for men and women, respectively: intracerebral hemorrhage, 4 center dot 0 (4 center dot 9 to 3 center dot 1) and 2 center dot 9 (3 center dot 4 to 2 center dot 3); and ischemic stroke, 3 center dot 2 (3 center dot 3 to 3 center dot 0) and 1 center dot 4 (2 center dot 0 to 0 center dot 9). Conclusion Stroke mortality rates are declining in Brazil for all stroke subtypes.