Abstract: Cardiovascular disease (CVD) and cancer are the first and second leading causes of death in Brazil and worldwide. However, an ongoing epidemiological transition in which cancer surpasses CVD has been observed in many high and middle-income countries. In this study, we provided a nationwide analysis of the transition towards cancer mortality predominance over CVD mortality in Brazil. We leveraged data from 5570 municipalities using the Mortality Information System and classified the causes of death using ICD-10 codes. Age-standardized CVD and cancer mortality rates were calculated annually between 2000 and 2019. Mortality rate ratios (MRRs = CVD rates divided by cancer rates) described the predominance of cancer or CVD mortality across municipalities and states. Choropleth maps displayed state-specific MRRs and the transition in the predominant cause of death over time. From 2000 to 2019, CVD mortality rates declined in 25 out of 27 states, whereas cancer mortality increased in 15 states, indicating a shift towards cancer predominance. While in 2000 cancer mortality was lower than CVD in all states and only exceeded the latter in 7% of the municipalities, by 2019 the gap narrowed considerably, with 13% of municipalities displaying higher cancer mortality rates vs CVD mortality rates. Additionally, higher household income correlated with higher mortality from cancer vs CVD. An ongoing epidemiological transition in which cancer mortality surpasses CVD mortality is occurring in Brazil, particularly in municipalities with higher household incomes. Our findings may provide important information for policymakers and public health practitioners in Brazil.

Abstract: This paper assesses the effects of adverse economic shocks on children’s mental health. We rely on the Brazilian High Risk Cohort Study for Mental Conditions, which provides an unprecedented array of data on psychopathology, life events, family medical history as well as parental behavior and polygenic scores for mental disorders over a 10-year period. Our empirical strategy exploits parental job loss events over time in a difference-in-differences framework. We document that parental job loss significantly worsens children’s mental health resulting in increased clinical diagnoses of mental disorders. These results are robust to several specifications and pre-trends. Heterogeneous results and mechanism analysis indicate that psychological distress in the household brought about by job loss events may be a key mechanism affecting children’s mental health.

Summary: We describe the progression of the Brazilian immunization program for COVID-19, and the association of socioeconomic development with vaccination rates, considering the potential protective effect of primary health care coverage. We performed an ecological analysis of COVID-19 immunization data from the Brazilian National Immunization Program from January 17 to August 31, 2021. We estimated the association of human development index (HDI) levels (low, medium, and high) with age-sex standardized first dose coverage using a multivariable negative binomial regression model and evaluated the interaction between HDI and primary health care coverage. In Brazil, socioeconomic disparities are negatively associated with first dose vaccination rate. Primary health care coverage mitigates these disparities, suggesting that primary health care coverage is associated with more equitable access to vaccines in vulnerable locations.

Summary: This study estimated the economic burden of NCDs attributable to overweight and obesity in the SUS (Brazilian Unified Health System), using data from the 2019 National Health Survey and the SUS Hospital and Outpatient Information Systems. The relative risks for NCDs were retrieved from the Global Burden of Disease study. In parallel with the increase in the prevalence of obesity in Brazil, an increase in direct health costs related to Chronic Noncommunicable Diseases (NCDs) is expected. Overweight and obesity account for US$654 million (22%) of the direct costs of NCDs annually. Effective policies to promote healthy body weight can have economic benefits.

Summary: Using daily data on reported cases and deaths, this study measured and compared the spatial-temporal pattern of distribution between municipalities. Indicators of clustering, trajectories, speed and intensity of COVID-19 movement towards inland regions, combined with response rates, showed that while no single narrative explains diversity in spread, a general failure to implement an immediate, coordinated and equitable response, in the context of strong local inequalities, fueled the spread of the disease. This resulted in high and uneven rates of infection and mortality.

Summary: This study analyzed the relationship between the level of preparedness of the health system, the response to COVID-19, and the pattern of the pandemic spread. A socioeconomic vulnerability index (SVI) was developed based on individual, household, and HDI characteristics. Descriptive statistics and correlations between state indicators were used to characterize the relationship between the availability of health resources and socioeconomic features, the spread of the pandemic, and the response of governments and the population in terms of new investments, legislation, and physical distancing. In Brazil, socioeconomic inequalities, rather than age, health status, and other risk factors for COVID-19, have affected the course of the pandemic, with a disproportionately adverse burden on the most vulnerable states and municipalities, where local government response and the behavior of the population helped to contain the effects of the epidemic.

Recent studies suggest that the increasing supply of college-educated workers in Latin American countries has negatively impacted returns to skill over the last two decades, as evidenced by the decreasing college premium. In this paper, we show that changes in the college premium do not accurately represent shifts in returns to skill, particularly in the context of a significant expansion in the number of college graduates and institutions. Using novel data with approximately one million college graduates from 20 different cohorts in Brazil, we find that returns to skill have not decreased; in fact, they increased by 24% over 16 years. The supply of college-educated workers has grown, primarily from newer, lower-ranked, and lower-wage-premium universities. Changes in the composition of college workers seem to have driven a decrease in the college premium, even though returns to skill are increasing. Using a simple supply and demand framework (Katz and Murphy, 1992) we show that skill-biased technical change (SBTC) increased by 3% per year over a 12-year period, in contrast to the apparent -0.1% yearly decrease indicated by the unadjusted data.

Abstract: Regionalization has been an organizing principle of the Unified Health System (SUS) since the Federal Constitution of 1988. Regionalization consists of organizing health services in groups of neighboring municipalities called health regions so that their residents can access services from a range of complexities in a hierarchical manner. After several federal regulatory attempts to enact this principle into practice, we analyzed data on healthcare services, hospital resources, and inter-municipal admission flows between 1998 and 2019 in order to assess whether there was a reorganization toward a more regional design. We estimated a simple gravitational model to better understand the dynamics of hospital flows in the country. Three sets of results seem consistent with an advance in regionalization in the first two decades of SUS: (i) greater availability of services, measured by the reduction of distances, signaling a redistribution of services over the territory; (ii) An increase in the inequality of ICU beds between municipalities in the same region, indicating greater specialization within health regions; (iii) A reallocation of hospital flows out of the municipality of residence and towards "hub" municipalities. However, it is not clear whether these patterns derive from the federal regulations or whether they may have arisen from other phenomena, such as economic growth and the dynamics of regional development experienced in the period.

* In Portuguese only
2022

• A Regionalização da Saúde no Brasil. (With Rocha, R., and Nunes, L.) [link] [YouTube]

• Doenças Crônicas e Seus Fatores de Risco e Proteção: Tendências Recentes no Vigitel. (With Aguillar, A., Rocha, R., Cabrera, P., Tao, L., and F. M. Rezende, L.) [link] [Estadão] [TV Cultura]

2021

• Considerações sobre a Reforma da Lei dos Planos de Saúde e seus Possíveis Impactos sobre o SUS. (With Rocha, R., Salmen, M. C., Lima, T., Miessi, F., Moreno-Serra, R., Mrejen, M., Soares, R. R., and M. Viegas) [link]

• Pressões Orçamentárias da Saúde para 2021 e Além. (With Nunes, L., Freitas, R., Aguillar, A., Bigoni, A., Tasca, R., Malik, A.M., Cupertino, F., Frutuoso, J., and A. Massuda) [link]

• COVID-19 e Saúde Mental: Uma Análise de Tendências Recentes no Brasil. (With Mrejen, M. and L. Nunes) [link]

• Quantas Vidas Cabem em um Voto? (With Lago, M., Falbel, F., and R. Rocha) [link] [Folha de São Paulo]

• Aceleração de Óbitos por COVID-19 nas Capitais e Estados em 2021. (With Marcia Castro) [link] [Estadão]

2020

• Caracterização da Oferta e Vulnerabilidade da População no Estado do Rio de Janeiro frente à Propagação da COVID-19. (With Nunes, L.; Aguillar, A.; Thami, H.; Sena, M.; Tepedino, P.; Lago, M. and Rocha, R.) [link]

• Para Além do Custeio: Necessidades de Investimento em Leitos de UTI no SUS sob Diferentes Cenários da COVID-19. (With Rocha, R.; Nunes, L.; Spinola, P. and Massuda, A.) [link]

• Como Conter a Curva no Brasil? Onde a Epidemiologia e a Economia se Encontram. (With Nunes, L.; Rocha, R.; Lago, M. and Fraga, A.) [link]

• Necessidades de Infraestrutura do SUS em Preparo à COVID-19: Leitos de UTI, Respiradores e Ocupação Hospitalar. (With Rocha, R.; Nunes, L.; Spinola, P.; Malik, A. M. and Massuda, A.) [link] [Valor Econômico]

• Estimação de Custos de Hospitalizações em UTI por COVID-19 no SUS: Limite Inferior por Cenários Populacionais de Infecção. (With Rocha, R.; Nunes, L.; and Massuda, A.) [link]

• Evolução Recente e Perfil Atual da Mortalidade no Brasil: Uma Análise da Heterogeneidade entre Municípios. (With Nunes, L. and Rocha, R.) [link]