Household Survey on Non Communicable Diseases Risk Factors and SelfReported Morbidity Brazil, 7 Capi

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Household Survey on Non Communicable Diseases
Risk Factors and Self-Reported MorbidityBrazil,
7 Capital Cities, 2002

• III Global Forum on Integrated NCD Prevention and
  Control

Secretaria de Vigilância à saúde

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Proportional distribution of the main causes of
deathBrazil - 1930 to 2000
Source Ministry of Health
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• The key to control of the global epidemic of NCDs
  is primary prevention. The aim must be to avert
  this epidemic wherever possible and to revert it
  as quickly as possible where it has already
  begun. Surveillance of risk factors for NCDs is
  an essential element in planning and evaluating
  programs that contribute to achievement of this
  aim. In a world of finite resources, priority
  should go to ensuring collection of at least the
  minimum data necessary for informing these
  programs and monitoring their impact.

WHO, 2002
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The stepwise approach to NCD risk factor
surveillance
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• Objective
• To estimate the prevalence of behavioral risk
  factors, self-reported morbidity and health
  assessment for selected non-communicable
  diseases.

• Target population
• 15 years and older, 18 Brazilian capitals

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Data consolidated
Data collected but not consolidated
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Methodology

• Cross-Sectional Survey
• Two-stage cluster random sampling.
• (1) Census tracts
• (2) Households
• Self-weighted sample by household
• Subjects 15 y.o. or older in each selected
  household

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Sample Size
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Methodology

• Data Collection
• Questionnaires
• Waist circumference
• Questionnaire Development
• Workshops with 33 Brazilian experts in the field
• National Cancer Institute work groups
• Pre-test
• Final version

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Quality control

• Careful training of personnel
• Re-interviews 15-20 of all households
• Periodic reviews of procedures and subjects
  responses

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Preliminary Results

• 7 Brazilian Capitals

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Study Population
Households selected 6.599
HH Inexistent 162 (2.45)
HH Occupied 5.840 (88.50)
HH Empty 597 (9.05)
HH Non response 502 (8.6)
HH Participants 5.338 (91.4)
Eligible Individuals 13.721
HH Refuse 289 (4.4)
Participating individuals 12.574 (91.6)
Non response 1.147 (8.36)
Refuse 437(3.18)
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Study population distribution according to gender
and household per capita income
US 1,00 R 2,86
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Population distribution by age, gender and State
capital
Censo - Homens
Censo - Mulheres
Amostra - Homens
Amostra - Mulheres
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Tobacco use

• Questionnaire
• Prevalence
• Third National Health and Nutrition Examination
  Survey, 1988-94 - NHANES III (CDC, 1994).
• Behavioral Risk Factor Surveillance (CDC, 2000)
• Guidelines for monitoring tobacco epidemic (WHO,
  1998)
• Opinion, knowledge and perception
• Experts professionals of Brazilian National
  Cancer Institute

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Prevalence of current smoking (smoking at least
100 cigarettes in life and smoking at the time of
the survey) and passive smoking (exposed to
tobacco smoke at home or workplace or
school)aged 15 years or older.Brazil, 2002,
selected State capitals
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Prevalence of current smoking by age and
genderBrazil, 2002, selected State capitals
?2 test with plt0.05
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Percent distribution of daily number of
cigarettes smokedBrazil, 2002, selected State
capitals.
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Percentage of ever smokers who are former smokers
(prevalence of cessation among ever smokers).
Total, males and females.Brazil, 2002, selected
State capitals
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Cigarette pack picture health warnings
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Percentage of smokers who answered Yes to the
question, In your opinion, does the warning
photos of the cigarette packs encourage people to
stop smoking? Brazil, 2002, selected State
capitals.
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Tobacco industry strategiesCommunication
descriptors in packs
Resolution of ANVISA n.º 46/01 Prohibit
cigarettes packs with descriptors light
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Percentage of smokers who think that The colors
(on the packs of cigarettes) differentiate light
and regular cigarettesBrazil, 2002, selected
State capitals
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Waist circumference, consumption of fruits and
vegetables and alcohol consumption

• Waist circumference
• MONICA protocol
• Consumption of fruits and vegetables
• Questions adapted from Gladys Block screening
  questionnaire
• Alcohol consumption
• Questionnaire from Behaivioral Risk Factor
  Surveillance System (CDC) and CARMEN

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Prevalence of waist circumference gt 102 cm for
men and gt 88 cm for women aged 18 years or older
by gender, Brazil, 2002, selected capitals
?2 test with plt0.05 for gender difference in
all capitals National Institutes of Health,
1998.
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Percentage of individuals aged 15 years or older
consuming fruits/fruit juice, greens and
vegetables less than once a day.Brazil, 2002,
selected State capitals
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Prevalence of alcohol consumption gt 2 drinks/day
for men and gt 1 drink/day for women in the last
30 days. Total, males, females aged 15 years or
older. Brazil, 2002, selected State capitals
?2 test with plt0.05 for gender difference in all
selected capitals
WCRF, 1997
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Prevalence of underage drinking in the last 30
days. Total, males and females, Brazil, 2002,
selected State capitals
?2 test with plt0.05 for gender difference in
Fortaleza and Manaus
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Physical Activity

• Questionnaire
• International Physical Activity Questionnaire
  (IPAQ) short version.

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Prevalence of individuals sedentary or with low
physical activity. Total, males and females aged
15 years or older.Brazil, 2002, selected State
capitals
?2 test with plt0.05 for gender difference in all
selected capitals but Belém
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Papanicolaou test, breast clinical exam and
mammography

• Questionnaire
• Proportion of women tested
• Behavioral Risk Factor Surveillance (CDC, 2000)
• Third National Health and Nutrition Examination
  Survey, 1988-94 - NHANES III (CDC, 1994).
• Coverage of the exam
• Brazilian experts professionals of Brazilian
  National Cancer Institute.

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Proportion of women who had at least one
Papanicolaou test in the last 3 years before the
survey, by age.Brazil, 2002, selected capitals.
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Proportion of women who had at least one breast
clinical examination in the last 2 years before
the survey, by age.Brazil, 2002, selected State
capitals
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Proportion of women who had at least one
mammography in the last 2 years before the
survey, by age.Brazil, 2002, selected State
capitals
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Prevalence of drinking and driving in the last 30
days by gender.Brazil, 2002, selected State
capitals. Individuals aged 15 years or older
?2 test with plt0.05 for gender difference in
all capitals
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Prevalence of not using safety belt by vehicle
user categoryBrazil, 2002, selected State
capitals. Individuals aged 15 years or older
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Self-reported morbidity

• Questionnaire
• Behavioral Risk Factor Surveillance (CDC, 2000)
• Third National Health and Nutrition Examination
  Survey, 1988-94 - NHANES III (CDC, 1994).

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Self reported prevalence of cancer (all sites)
and estimative of total number of prevalent
cases. Individuals aged 15 years or older
Brazil, 2002, selected capitals
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Percent of individuals who reported having their
blood pressure measured and being diagnosed as
having hypertension by a health professional and
estimative of number of hypertension cases in the
target population. Brazil, 2002, selected State
capitals
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Percent of individuals who reported having tests
to measure glicemia and being diagnosed as
diabetic by a doctor and estimative number of
diabetics in the target population.Brazil, 2002,
selected State capitals.
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Conclusions

• The prevalence of major risk factors for chronic
  diseases (tobacco use, low consumption of fruits
  and vegetables, insufficient physical activity,
  high consumption of alcohol, risk behavior for
  motor vehicle accidents) is high for both sex and
  across geographic locations.

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Conclusions

• Tobacco use prevalence is high. However, a
  comparison between information from the 1989 -
  National Health and Nutrition Survey (NHNS) and
  more recent data, suggests a decrease in smoking
  prevalence. For the 7 cities presented, the
  proportion of people reporting smoking at the
  time of the interview was 31.5 in the 1989 NHNS
  and 20.3 in our survey.

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Conclusions

• According to the data presented, 85 to 90 of the
  targeted women had been screened for cervical and
  breast cancer in the last 3 years. Previous
  information on coverage for these screening
  tests, from different studies and using different
  methods is presented on the table below. The data
  suggest that the Health Ministrys efforts to
  improve coverage have been successfully.

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Conclusions

• Self-reported hypertension (17.9), diabetes
  (7.4) and cancers of all sites (1.6) have been
  found to be highly prevalent, notwithstanding the
  fact that, for diabetes, hypertension and cancer
  we had to rely on self-reports.
• Two Brazilian studies measuring blood pressure
  obtained higher prevalence estimates

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Conclusions

• Regarding prevalence of diabetes, our finding
  (7.4) is within the variation margin obtained
  from other Brazilian studies

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Conclusions

• The estimated total number of existing cases of
  these three diseases (cancer, hypertension and
  diabetes) in 7 Brazilian capitals is 1,143,102,
  underscoring the challenges facing medical
  professionals and the need to allocate vast
  resources to treat them.

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Conclusions

• We presented data from 7 State capitals
  therefore, the global results are for these
  cities only. These data may not be inferred for
  all other Capitals as well as to the whole
  country. Self-reported morbidity prevalence
  measures are affected by health care coverage and
  can be underestimated. However at the end of the
  study with data from all target capitals, it will
  be possible to identify the more exposed groups
  and to better understand the distribution of risk
  factors between capitals. If collected
  periodically, these findings can be very valuable
  and useful for planning and assessment of NCD
  preventive and control measures.

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Conclusions

• The effective primary and secondary preventive
  measures implemented by Ministry of Health for
  NCD, as illustrated by the many tobacco
  prevention and cessation strategies, allow us to
  shift some of the resources spent in tertiary
  care to expand our already substantial prevention
  efforts.