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Eventos meteorológicos extremos e adversos: avaliação dos impactes nos indicadores de saúde nos Estados de Santa Catarina e Pernambuco - Brasil
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RESUMO - Nas últimas décadas muito se tem falado sobre as alterações climáticas e a ocorrência de eventos naturais extremos, sendo que seus impactes são analisados de forma preocupante, nomeadamente na saúde das populações.
A presente investigação pretende contribuir para a discussão acerca dos impactes dos Eventos Meteorológicos Extremos na saúde humana. Como tal, o objetivo primordial foi identificar e estimar quais são os impactes da ocorrência de Eventos Meteorológicos Extremos nos indicadores de saúde nos Estados de Santa Catarina e de Pernambuco/Brasil no período de 2005 a 2014. Para tanto, foram realizados dois estudos, um sobre os impactos dos eventos hidrológicos nas internações por leptospirose e o outro sobre a influência dos extremos de temperatura na mortalidade.
O primeiro estudo teve como objetivo identificar a associação entre as taxas de hospitalização por Leptospirose e a ocorrência de eventos hidrológicos extremos no Estado de Santa Catarina (Brasil) entre os anos de 2005 e 2014. A associação entre hospitalizações por Leptospirose e a ocorrência de alagamentos, inundações rápidas e eventos de inundação foram medidos pelo coeficiente de correlação bivariada de Spearman. As inundações repentinas corresponderam a 92,6% do total de eventos hidrológicos. As macrorregiões costeiras apresentaram maiores taxas de admissão hospitalar por Leptospirose do que as do interior. A taxa de internamento por Leptospirose apresentou um padrão sazonal, com picos nos meses de verão. Foram identificadas correlações positivas e significativas ao nível mensal e anual para algumas das macrorregiões analisadas, com maiores valores de correlação na região costeira. Os resultados obtidos sugerem a influência da ocorrência de eventos hidrometeorológicos extremos na variabilidade da taxa de hospitalizações por Leptospirose no Estado de Santa Catarina, com diferenças significativas encontradas para as regiões costeira e interior.
O segundo estudo teve como objetivo identificar se a temperatura do ar, e os extremos de frio e calor, tem impactes sobre a mortalidade e as morbidades, exacerbadas pela incapacidade dos serviços de saúde e das respostas de proteção, particularmente nos países subdesenvolvidos. No âmbito deste estudo foi analisado o efeito da temperatura do ar no risco de morte para todas as causas e causas específicas em duas regiões do Brasil (Florianópolis e Recife), entre 2005 e 2014. A associação entre temperatura e mortalidade foi realizada através da adaptação de um modelo distribuído de atraso não linear distrubuted-lag non linear model de quasi-Poisson. A associação entre temperatura do ar e mortalidade foi identificada em ambas as regiões. Os resultados mostraram que a temperatura exerce influência tanto nos indicadores gerais de mortalidade quanto nas causas específicas, com temperaturas quentes e frias trazendo impactes diferentes para as regiões estudadas. Os óbitos por doenças cerebrovasculares e cardiovasculares apresentam valores mais elevados no caso das temperaturas baixas tanto em Florianópolis como em Recife.
Com base na aplicação de uma metodologia inovadora e muito bem documentada, foi possível concluir no segundo estudo que existem evidências de que a temperatura extrema do ar influencia as mortes gerais e específicas, destacando a importância de consolidar evidências e pesquisas em países tropicais como o Brasil, como uma forma de entender as mudanças climáticas e seus impactes nos indicadores de saúde.
Os eventos meteorológicos extremos começam a ser percebidos como causas de potenciais distúrbios na saúde. A construção de indicadores que mostrem os impactes desses eventos sobre a saúde humana se torna necessários no planeamento em saúde, principalmente em países em desenvolvimento ou tropicais/subtropicais
No campo da promoção da saúde, esta investigação mostra que ações de mitigação destes impactes na saúde são necessárias, pois as mudanças climáticas e o aumento da ocorrência de eventos meteorológicos extremos expõem grupos populacionais vulneráveis. A construção de evidências pode subsidiar a elaboração de políticas públicas e contribuir para formulação de medidas de empoderamento individual e coletivas.
ABSTRACT - In the last decades much has been said about climate change and the occurrence of extreme natural events, and it is impacts are analyzed in a worrying way, namely in the health of the populations. This research aims to contribute to the discussion about the impacts of Extreme Meteorological Events on human health. As such, the primary objective was to identify and estimate the impacts of extreme weather events on health indicators in the states of Santa Catarina and Pernambuco / Brazil from 2005 to 2014. To achieve this objective, two studies were carried out, one on the impacts of Hydrological events on hospitalizations for leptospirosis, and the other on the influence of temperature extremes on mortality. The first study aimed to identify and measure the association between hospitalization rates for Leptospirosis and the occurrence of extreme hydrological events in the state of Santa Catarina (Brazil) between 2005 and 2014. The association between hospitalizations for Leptospirosis and the occurrence floods, flash floods and flooding events were measured by the Spearman bivariate correlation coefficient. Flash floods accounted for 92.6% of total hydrological events. Coastal regions had higher admission rates than inland. Leptospirosis showed a seasonal pattern, peaking in the summer months. Positive and significant correlations for monthly and annual analyses were identified for some of the analysed macroregions, with higher correlation values in the coastal region. Current results suggest the influence of extreme hydrometeorological events on the variability of the rate of hospitalization for leptospirosis in the state of Santa Catarina, with significant differences found for coastal and inland regions. The main purpose of the second study was to identify whether cold or hot air temperatures have an impact on mortality and morbidity, which can be exacerbated by health services’ disability and protective responses, particularly in underdeveloped countries. This study proposes to analyse the effects of air temperature on the risk of death for all and specific causes in two regions of Brazil (Florianópolis and Recife), between 2005 and 2014. The association between temperature and mortality was performed by adapting a distributed-lag nonlinear quasi-Poisson delay model, leading to the identification of an association between air temperature and mortality in both regions. The results showed that temperature influences both general and specific causes of mortality indicators, with hot and cold temperatures bringing different impacts to the studied regions. Cerebrovascular and cardiovascular deaths presented higher values when low temperatures were present, both for Florianópolis and Recife. Based on the application of an innovative and well-documented methodology, it was possible to conclude from the second study that there is evidence that extreme air temperature influences general and specific deaths, highlighting the importance of consolidating evidence and research in tropical countries such as Brazil as a way of understanding climate change and its impacts on indicators of health indicators. Therefore, extreme weather events are beginning to be perceived as causes of potential health disorders. The construction of indicators that show the impact of these events on human health becomes necessary in health planning, especially in developing or tropical / subtropical countries. In the field of health promotion, this research shows that mitigating actions of these health impacts are necessary, as climate change and increased occurrence of extreme meteorological events expose vulnerable population groups. Evidence building can support the development of public policies and contribute to the formulation of individual and collective empowerment measures.
ABSTRACT - In the last decades much has been said about climate change and the occurrence of extreme natural events, and it is impacts are analyzed in a worrying way, namely in the health of the populations. This research aims to contribute to the discussion about the impacts of Extreme Meteorological Events on human health. As such, the primary objective was to identify and estimate the impacts of extreme weather events on health indicators in the states of Santa Catarina and Pernambuco / Brazil from 2005 to 2014. To achieve this objective, two studies were carried out, one on the impacts of Hydrological events on hospitalizations for leptospirosis, and the other on the influence of temperature extremes on mortality. The first study aimed to identify and measure the association between hospitalization rates for Leptospirosis and the occurrence of extreme hydrological events in the state of Santa Catarina (Brazil) between 2005 and 2014. The association between hospitalizations for Leptospirosis and the occurrence floods, flash floods and flooding events were measured by the Spearman bivariate correlation coefficient. Flash floods accounted for 92.6% of total hydrological events. Coastal regions had higher admission rates than inland. Leptospirosis showed a seasonal pattern, peaking in the summer months. Positive and significant correlations for monthly and annual analyses were identified for some of the analysed macroregions, with higher correlation values in the coastal region. Current results suggest the influence of extreme hydrometeorological events on the variability of the rate of hospitalization for leptospirosis in the state of Santa Catarina, with significant differences found for coastal and inland regions. The main purpose of the second study was to identify whether cold or hot air temperatures have an impact on mortality and morbidity, which can be exacerbated by health services’ disability and protective responses, particularly in underdeveloped countries. This study proposes to analyse the effects of air temperature on the risk of death for all and specific causes in two regions of Brazil (Florianópolis and Recife), between 2005 and 2014. The association between temperature and mortality was performed by adapting a distributed-lag nonlinear quasi-Poisson delay model, leading to the identification of an association between air temperature and mortality in both regions. The results showed that temperature influences both general and specific causes of mortality indicators, with hot and cold temperatures bringing different impacts to the studied regions. Cerebrovascular and cardiovascular deaths presented higher values when low temperatures were present, both for Florianópolis and Recife. Based on the application of an innovative and well-documented methodology, it was possible to conclude from the second study that there is evidence that extreme air temperature influences general and specific deaths, highlighting the importance of consolidating evidence and research in tropical countries such as Brazil as a way of understanding climate change and its impacts on indicators of health indicators. Therefore, extreme weather events are beginning to be perceived as causes of potential health disorders. The construction of indicators that show the impact of these events on human health becomes necessary in health planning, especially in developing or tropical / subtropical countries. In the field of health promotion, this research shows that mitigating actions of these health impacts are necessary, as climate change and increased occurrence of extreme meteorological events expose vulnerable population groups. Evidence building can support the development of public policies and contribute to the formulation of individual and collective empowerment measures.
Descrição
Palavras-chave
Saúde Pública Extremos Meteorológicos Leptospirose Extremos de Temperatura Indicadores de Saúde Mortalidade Promoção da Saúde Public Health Meteorological Extremes Leptospirosis Temperature Extremes Health Indicators Mortality Health Promotion