부산대학교 도서관

To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1016/S0140-6736(18)31221-2 Byline: Fatima Marinho, Valeria Maria de Azeredo Passos, Deborah Carvalho Malta, Elizabeth Barboza Franca, Daisy M X Abreu, Valdelaine E M Araujo, Maria Teresa Bustamante-Teixeira, Paulo A M Camargos, Carolina Candida da Cunha, Bruce Bartholow Duncan, Mariana Santos Felisbino-Mendes, Maximiliano Ribeiro Guerra, Mark D C Guimaraes, Paulo A Lotufo, Wagner Marcenes, Patricia Pereira Vasconcelos Oliveira, Marcel de Moares Pedroso, Antonio L Ribeiro, Maria InA*s Schmidt, Renato Azeredo Teixeira, Ana Maria Nogales Vasconcelos, Mauricio L Barreto, Isabela M Bensenor, Luisa C C Brant, Rafael M Claro, Alexandre Costa Pereira, Ewerton Cousin, Maria Paula Curado, Kadine Priscila Bender dos Santos, Andre Faro, Cleusa P Ferri, Joao M Furtado, Julia Gall, Scott D Glenn, Alessandra Carvalho Goulart, Lenice Harumi Ishitani, Christian Kieling, Roberto Marini Ladeira, Isis Eloah Machado, Sheila Cristina Ouriques Martins, Francisco Rogerlandio Martins-Melo, Ana Paula Souto Melo, Molly K Miller-Petrie, Meghan D Mooney, Bruno P Nunes, Marcos Roberto Tovani Palone, Claudia C Pereira, Davide Rasella, Sarah E Ray, Leonardo Roever, Raphael de Freitas Saldanha, Itamar S Santos, Ione J C Schneider, Diego Augusto Santos Silva, Dayane Gabriele Alves Silveira, Adauto Martins Soares Filho, Tatiane Cristina Moraes Sousa, Celia L Szwarcwald, Jefferson Traebert, Gustavo Velasquez-Melendez, Yuan-Pang Wang, Rafael Lozano, Christopher J L Murray, Mohsen Naghavi Summary Background Political, economic, and epidemiological changes in Brazil have affected health and the health system. We used the Global Burden of Disease Study 2016 (GBD 2016) results to understand changing health patterns and inform policy responses. Methods We analysed GBD 2016 estimates for life expectancy at birth (LE), healthy life expectancy (HALE), all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and risk factors for Brazil, its 26 states, and the Federal District from 1990 to 2016, and compared these with national estimates for ten comparator countries. Findings Nationally, LE increased from 68*4 years (95% uncertainty interval [UI] 68*0--68*9) in 1990 to 75*2 years (74*7--75*7) in 2016, and HALE increased from 59*8 years (57*1--62*1) to 65*5 years (62*5--68*0). All-cause age-standardised mortality rates decreased by 34*0% (33*4--34*5), while all-cause age-standardised DALY rates decreased by 30*2% (27*7--32*8); the magnitude of declines varied among states. In 2016, ischaemic heart disease was the leading cause of age-standardised YLLs, followed by interpersonal violence. Low back and neck pain, sense organ diseases, and skin diseases were the main causes of YLDs in 1990 and 2016. Leading risk factors contributing to DALYs in 2016 were alcohol and drug use, high blood pressure, and high body-mass index. Interpretation Health improved from 1990 to 2016, but improvements and disease burden varied between states. An epidemiological transition towards non-communicable diseases and related risks occurred nationally, but later in some states, while interpersonal violence grew as a health concern. Policy makers can use these results to address health disparities. Funding Bill & Melinda Gates Foundation and the Brazilian Ministry of Health. (footnote)[Dagger] Collaborators listed at the end of the Article