Exposição ambiental e risco à saúde - Brasil
Environmental exposure and health risks in Brazil
Marilyn Urrutia-Pereira; Raquel Prudente Baldaçara; Adelmir Souza Machado; Raphael Coelho Figueredo; Lucas Pitrez Mocelin; Paulo Oliveira Lima; Herberto Jose Chong-Neto; Dirceu Solé
Resumo
Objetivo: Identificar possíveis fatores sociodemográficos, econômicos, de saúde, ambientais e de hábitos de vida associados a efeitos adversos sobre a saúde de moradores em três cidades brasileiras. Método: Estudo transversal com abordagem quantitativa realizado nas cidades de Imperatriz (Maranhão), Palmas (Tocantins) e Salvador (Bahia). Participaram 975 pacientes (18 a 75 anos) atendidos em unidades básicas de saúde no período de junho de 2021 a junho de 2022. Esses indivíduos foram selecionados aleatoriamente (amostra de conveniência). Foi aplicado o questionário padronizado sobre fatores sociodemográficos e exposição a fatores ambientais, assim como o de hábitos de vida. Empregou-se a situação de saúde (excelente/boa x regular/ má/péssima) como desfecho, foi realizada análise multivariada seguida por regressão logística respeitando-se cada município individualmente e o seu coletivo. Os dados foram apresentados como odds ratio (OR) e intervalos de confiança de 95% (IC95%). Resultados: Em todas as cidades houve predomínio de pacientes do sexo feminino: 58,3% em Imperatriz, 67,5% em Tocantins e 65,4% em Salvador. A prevalência de tabagismo (presente e/ou passado) foi significantemente mais elevada em Salvador, assim como a de consumo de álcool. Houve maior referência de saúde regular/má/péssima entre os moradores de Imperatriz, apesar de em Salvador haver o maior relato de comorbidades. Os fatores ambientais associados à condição precária de saúde, em ambos os modelos de análise, foram: ter sido exposto durante a infância a fogão a lenha/carvão/querosene/outro; passar mais de duas horas na cozinha, com fogão em funcionamento; e residir próximo a uma fonte poluidora. Morar em Imperatriz revelou chance 1,8 vezes maior de ter saúde debilitada quando comparado aos moradores de Salvador, e de 1,7 vezes para os de Palmas. Conclusões: Profissionais de saúde deverão orientar a população quanto as questões socioambientais que interferem nos índices de saúde. Os dados demográficos, ambientais e econômicos podem interferir nas condições de saúde.
Palavras-chave
Abstract
Objective: To identify potential sociodemographic, socioeconomic, health, environmental, and lifestyle factors associated with adverse health effects in residents of 3 Brazilian cities. Methods: This cross-sectional study with a quantitative approach was conducted in the cities of Imperatriz (Maranhão), Palmas (Tocantins), and Salvador (Bahia). A total of 975 patients aged 18 to 75 years treated at primary health care units from June 2021 to June 2022 were selected via convenience sampling. A standardized questionnaire on sociodemographic characteristics, exposure to environmental factors, and lifestyle habits was administered. The outcome measured was health status (excellent/good vs fair/bad/very poor). Multivariate analysis was performed using logistic regression, respecting each municipality individually and collectively. Data were presented as odds ratios (OR) and 95%CIs. Results: Women predominated in all cities: 58.3% in Imperatriz, 67.5% in Tocantins, and 65.4% in Salvador. The prevalence of smoking (present and/or past) was significantly higher in Salvador, as was the prevalence of alcohol consumption. Despite Salvador having the highest rate of comorbidities, residents of Imperatriz reported more instances of fair/poor/very poor health. Environmental factors significantly associated with poor health conditions in both analysis models included exposure to wood/ coal/kerosene/other stoves during childhood, spending more than 2 hours in the kitchen with a working stove, and living close to a pollution source. Residents of Imperatriz were 1.8 times and 1.7 times more likely to have poor health compared with residents of Salvador (a more developed center with more health resources) and Palmas, respectively. Conclusions: Health professionals should guide the population regarding socio-environmental issues affecting health indices. Demographic, environmental, and economic data can impact health conditions
Keywords
Referências
1. Burbank AJ, Hernandez ML, Jefferson A, Perry TT, Phipatanakul W, Poole J, et al. Environmental justice and allergic disease: A Work Group Report of the AAAAI Environmental Exposure and Respiratory Health Committee and the Diversity, Equity and Inclusion Committee. J Allergy Clin Immunol. 2023;151(3):656-70.
2. Bazyar J, Pourvakhshoori N, Khankeh H, Farrokhi M, Delshad V, Rajabi E. A comprehensive evaluation of the association between ambient air pollution and adverse health outcomes of major organ systems: a systematic review with a worldwide approach. Environ Sci Pollut Res Int. 2019;26(13):12648-61.
3. Barbone F, Catelan D, Pistelli R, Accetta G, Grechi D, Rusconi F, et al. A Panel Study on Lung Function and Bronchial Inflammation among Children Exposed to Ambient SO from an Oil Refinery. Int J Environ Res Public Health. 2019;16(6):1057.
4. Amster E, Lew Levy C. Impact of Coal-fired Power Plant Emissions on Children's Health: A Systematic Review of the Epidemiological Literature. Int J Environ Res Public Health. 2019;16(11).
5. Yu S, Park S, Park CS, Kim S. Association between the Ratio of FEV(1) to FVC and the Exposure Level to Air Pollution in Neversmoking Adult Refractory Asthmatics Using Data Clustered by Patient in the Soonchunhyang Asthma Cohort Database. Int J Environ Res Public Health. 2018;15(11).
6. Gehring U, Gruzieva O, Agius RM, Beelen R, Custovic A, Cyrys J, et al. Air pollution exposure and lung function in children: the ESCAPE project. Environ Health Perspect. 2013;121(11-12):1357-64.
7. Health Effects Institute - HEI. Traffic-Related Air Pollution: A Critical Review of the Literature on Emissions, Exposure, and Health Effects [Internet]. Disponível em: https://www.healtheffects.org/publication/traffic-related-air-pollution-critical-review-literature-emissions-exposure-and-health.
8. Kravitz-Wirtz N, Teixeira S, Hajat A, Woo B, Crowder K, Takeuchi D. Early-Life Air Pollution Exposure, Neighborhood Poverty, and Childhood Asthma in the United States, 1990-2014. Int J Environ Res Public Health. 2018;15(6):1114.
9. Hughes HK, Matsui EC, Tschudy MM, Pollack CE, Keet CA. Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey. Acad Pediatr. 2017;17(2):127-34.
10. Bryant-Stephens TC, Strane D, Robinson EK, Bhambhani S, Kenyon CC. Housing and asthma disparities. J Allergy Clin Immunol. 2021;148(5):1121-9.
11. Krieger J, Higgins DL. Housing and health: time again for public health action. Am J Public Health. 2002;92(5):758-68.
12. Hadley MB, Baumgartner J, Vedanthan R. Developing a Clinical Approach to Air Pollution and Cardiovascular Health. Circulation 2018;137(7):725-42.
13. Brasil. D.O.U. Lei Nº 14.358, de 1º de junho de 2022. Dispõe sobre o valor do salário-mínimo a vigorar a partir de 1º de janeiro de 2022. Disponível em: https://in.gov.br/en/web/dou/-/lei-n-14.358-de-1-de-junho-de-2022-404843135.
14. Exchange. Exchange - cotação do dólar americano [Site na Internet]. Disponível em: https://exchangenow.net/servicos/remessas-internacionais?gclid=CjwKCAjwp9qZBhBkEiwAsYFsb-phpRt4TknwrbIHmGS2xmLJWkJvVxgbKicU-R3ytiuxOKtc09YOLxoCsD0QAvD_BwE.
15. Brasil. Instituto Brasileiro de Geografia e Estatística - IBGE. ISM - Indicadores Sociais Mínimos [Internet]. Disponível em: https://www.ibge.gov.br/estatisticas/sociais/educacao/17374-indicadores-sociais-minimos.html?=&t=resultados.
16. Brasil. Instituto Brasileiro de Geografia e Estatística - IBGE. IBGE cidades [Internet]. Disponível em: https://cidades.ibge.gov.br/brasil/panorama.
17. Manisalidis I, Stavropoulou E, Stavropoulos A, Bezirtzoglou E. Environmental and Health Impacts of Air Pollution: A Review. Front Public Health. 2020 Feb 20;8:14.
18. Landrigan PJ, Fuller R, Acosta NJR, Adeyi O, Arnold R, Basu NN, et al. The Lancet Commission on pollution and health. Lancet. 2018;391(10119):462-512.
19. Fuller R, Rahona E, Fisher S, Caravanos J, Webb D, Kass D, et al. Pollution and non-communicable disease: time to end the neglect. Lancet Planet Health. 2018 Mar;2(3):e96-e98.
20. Batista KC, Leal PB, Cardoso PCOF, Araújo BP, Silva CMM, Pacheco GQ, et al. Há relação entre internações hospitalares por doenças respiratórias, mudanças climáticas e focos de queimadas numa população pediátrica? Pediatr Mod. 2014;50(9):415.
21. Lazzarini GMJ, Ferreira LCC, Felicíssimo MFG, Lira RG, Justino AG, Gomes CS, et al. Análise da distribuição de focos de calor no Tocantins entre 2002 e 2011. Revista Interface (Porto Nacional). 2012;5(5):24-35. Disponível em: https://sistemas.uft.edu.br/periodicos/index.php/interface/article/view/362.
22. Williams AM, Sahel JA. Addressing Social Determinants of Vision Health. Ophthalmol Ther. 2022;11(4):1371-82.
23. Rahi JS, Cumberland PM, Peckham CS. Visual function in working-age adults: early life influences and associations with health and social outcomes. Ophthalmology. 2009;116(10):1866-71.
24. Zhou P, Sun S, Chen T, Pan Y, Xu W, Zhang H. Impacts of Social Inequality, Air Pollution, Rural-Urban Divides, and Insufficient Green Space on Residents' Health in China: Insight from Chinese General Social Survey Data Analysis. Int J Environ Res Public Health. 2022;19(21):14225.
25. Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira - Inep. Índice de Desenvolvimento da Educação Básica (Ideb) [Internet]. Disponível em: https://www.gov.br/inep/pt-br/areas-de-atuacao/pesquisas-estatisticas-e-indicadores/ideb.
Submetido em:
27/11/2023
Aceito em:
14/12/2023
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