Male homicide in the Metropolitan Region of São Paulo between 1979 and 1998: a pictorial approach

Homicide has become a major social problem in Brazil in the last two decades. In Greater Metropolitan S?o Paulo, Southeast Brazil, the proportional incidence of male homicides increased from 35 to 121 (x 10-5) from 1979 to 1998. This study presents the trend in this phenomenon using a set of three-dimensional figures. We show both the absolute number and proportional incidence of male deaths by homicide and the natural logarithm of the male/female relative risk of homicide for Greater Metropolitan S?o Paulo from 1979 to 1998. Seven 3D figures show the homicide trend by age, sex, and year. The figures show the main trends in homicide distribution in the male population during the study period: a clear predominance among adolescents and young adults, a systematic and sharp increase in that same age range, a systematic spread to the lower (below-18) and higher (above-30) age groups, and a non-negligible incidence above the age of 40.     

Social inequality and homicide rates in Sao Paulo City, Brazil

OBJECTIVE: The relation between income and mortality due to violence has been studied in recent years. The Synthesis of Social Indicators of 2002 [Sintese de Indicadores Sociais, 2002], published by The Brazilian Institute of Geography and Statistics (IBGE), states that one of the most outstanding characteristic of Brazilian society is inequality. The proposal of this ecological study was to test the association between homicide rates, and some health and socioeconomic indicators. METHODS: This is an ecological cross-sectional study. Data regarding Sao Paulo City, Brazil in the year 2000 was analyzed. The association between homicide coefficients and the following five indicators were tested: infant mortality rates, monthly average income of household heads, percentage of adolescents aged 15 to 17 years not attending school, proportion of pregnant adolescent women aged 14 to 17 years and demographic density. Pearson's correlation coefficient and a multiple linear regression model were utilized to test these associations. RESULTS: The municipal homicide rate was 57.3/100,000. The correlation between homicide rates and average monthly income was strong and negative (r=-0.65). Higher homicide rates were found in the districts whose inhabitants had lower incomes and lower rates were found in those districts whose inhabitants had higher incomes. The correlation between homicide rates and proportion of adolescents not attending school was positive and strong (r=0.68). The correlation between homicide rates and the proportion of pregnant adolescent women was positive and strong (r=0.67). The correlation between homicides and the rate of infant mortality was r=0.24 (for all: p<0.05). The correlation between demographic density and homicides was not significant. Although the univariate regression was positive for four indicators, the multivariate regression test was only significant for average monthly income (negative) and proportion of adolescents not attending school (positive) (for both indicators: p<0.01). CONCLUSIONS: The findings highlight the problem of homicides and socioeconomic disparities in S. Paulo City. Economic development and reducing socioeconomic inequality may have an impact on the rates of mortality due to violence.     

Characteristics of anticontraception methods used in São Paulo State,Brazil (correction)

OBJECTIVE: To analyze data on contraceptive use in the State of S?o Paulo, Brazil, collected by the Demographic and Health Survey (DHS) conducted in 1996. METHODS: The study data were compared to 1986 DHS and 1996 data on the Brazilian population. Contraceptive use among married or cohabiting women was evaluated focusing on age, number of children, schooling, and age and timing of female sterilization. Statistical analysis was performed using Student t-test and Kendall's non-parametric test. RESULTS: Unlike data on the Brazilian population, female sterilization rates were steady in the State of S?o Paulo during the studied period. The same contraceptive pattern is seen in both Brazil and S?o Paulo: women aged up to 30 years use largely pills; female sterilization predominates in women over 30, increasing with the number of children and decreasing with years of schooling. Male methods have also increased in recent years, being greater in S?o Paulo than in Brazil. S?o Paulo also shows a greater variety of reversible contraceptive methods. CONCLUSIONS: Although there were some differences, the prevalence of only two contraceptive methods in both Brazil and S?o Paulo suggests a tendency regarding the contraceptive methods offered and in reproductive health in the view of new regulations on family planning.     

Mortality and cause of death among first-generation Japanese in S?o Paulo, Brazil

The death certificates of first-generation Japanese in the city of S?o Paulo, Brazil, were analysed for underlying causes of death, and standardized mortality ratio (SMR) values were calculated using the age-specific mortality rates for Japan and S?o Paulo. Mortality rates for all causes were lower than those of the general population in S?o Paulo for all age groups and both sexes, and were almost equal to those in Japan. Compared with the mortality in Japan, significantly higher SMR values were obtained for diabetes mellitus, ischaemic heart disease, respiratory diseases (females), motor vehicle accidents, and homicide (males), whereas SMR values were low for all causes (males), other heart diseases, cerebrovascular disease, chronic liver diseases (males), suicide, and malignant neoplasms (males). On the other hand, compared with the mortality for S?o Paulo, SMR values were significantly low for most causes of death. The potential cultural and social factors contributing to these changes in mortality pattern are discussed.     

Mapping of homicide risk with binomial cokriging and simulation: a case study in São Paulo, Brazil

The impact of violence on the population's health profile in large Brazilian cities is a real concern and has been incorporated into the country's public health agenda. Although violent crimes affect the entire population, they are distributed unequally in the city. In this context, analytical tools to evaluate the risk and spatial distribution of homicide are important for surveillance and prevention. The current article is a contribution in this direction. A geostatistical methodology is used to estimate and map homicide risk, and a new semivariogram estimator is presented and its application is evaluated in the city of S?o Paulo, Brazil, for the period 2002 to 2004. Homicide risk scenarios are generated using binomial cokriging and stochastic simulation procedures, allowing the demarcation of areas with greater or lesser risk that can be used to study spatial determinants of violence and improve the understanding of problems through analysis of differences across urban territories.     

Correlation between homicide rates and economic indicators in S?o Paulo, Brazil, 1996]

Around 30% of the deaths due to violent causes in Brazil result from homicides. Violence has traditionally been related to larger social problems, such as poverty. Recently, however, a positive correlation has been observed between higher incomes and an increase in the homicide rate, so that some researchers have begun to consider inequality, rather than poverty, as an explanation for the epidemic of violence. The objective of this study was to investigate the correlation between urbanization, poverty, and economic inequality and homicide rates in the state of S?o Paulo, Brazil, in 1996. Information regarding population size, average monthly income of household heads, income distribution, and Gini index was obtained for each municipality, based on the demographic census. Homicide rates were calculated based on official data. Data were analyzed in terms of correlation and relative risk with 95% confidence intervals. Homicide rates rose in direct proportion to city population and ranged from 6.96 (per 100,000 inhabitants) in municipalities with a population smaller than 10,000 inhabitants, to 55.54 in municipalities with more than 1 million inhabitants. Relative risk ranged from 1.35 to 7.98. A significant correlation with population size was found only for incomes above 3.11 times the minimum wage and a Gini index greater than 0.50. There was a strong, direct, and significant correlation between homicide rates and the income ratio between the ninetieth and the twentieth percentiles of the population. It is necessary to probe more deeply into the macrosocial determinants of homicide rates in order to identify indicators of inequality that can generate meaningful data for developing public health strategies.     

Time trends in death rates from homicides in the city of Sao Paulo, Brazil, 1979-1994

To study homicide trends by gender and age, 1979-1994, S?o Paulo, Brazil, cubic polynomials were used to determine the best model for adjusting to time trends in homicide mortality rates by age and gender in the city of S?o Paulo, Brazil, 1979-1994. The model best adjusted to each group was selected considering the regression coefficient (Beta) , R2 value, residual analysis, and model's simplicity. The results show linear growth for total rates and rates by gender due to behavior of rates in the 20-29 and 30-39 year age groups. The reciprocal model adjusted best to rates for the 40-49 and 50-59 year age groups, while rates for adolescents followed the multiplicative model. There was no significant relationship between homicide rates and time for the remaining groups (under 10 and over 59 years). Rates for males were considerably higher in all age groups. The remarkably steady growth in homicide rates among adolescents and young adults is consistent with trends observed in other urban areas in developing and developed countries and denotes deteriorating living conditions and increased poverty.     

Unequal trends in causes of death in Brazilian regions

OBJECTIVE: To determine changing patterns in the main causes of mortality Brazilian regions between 1980 and 2000 taking into consideration the inequalities among territories and epidemiological transition. MATERIAL AND METHODS: Data was gathered from the Information System of the state of S?o Paulo. Age-standardized mortality rates were calculated using the European population as reference. The average annual increase was calculated using linear regression models. RESULT: Mortality rates due to ill-defined causes of death, assaults and homicide, and HIV infection increased in men and women while mortality due to cardiovascular disease, pneumonia and influenza significantly decreased. CONCLUSION: The epidemiological transition in Brazil differs from that of developed countries and other Latin American countries, since causes of death connected with both developed and developing countries coexist.     

Homicides among children and young adults--Puerto Rico, 1999-2003

Interpersonal violence causes substantial morbidity and mortality worldwide and poses a considerable economic burden, equivalent to 4%-5% of the gross national product in certain countries. The Commonwealth of Puerto Rico is a U.S. territory with a 2004 population of approximately 3.9 million. In Puerto Rico, homicides were the 12th leading cause of death overall in 2003, ranking fifth among males and 15th among females. This report summarizes an analysis of death certificate data on violent deaths of children and young adults in Puerto Rico during 1999-2003, which determined that 93% of homicide victims aged <30 years were young males, the most common method of homicide was assault by firearm discharge, and the rate of homicide among males aged 25-29 years increased during the period. To address this problem, the Puerto Rican government has initiated a comprehensive strategy that includes enhancing an integrated surveillance system for fatal and nonfatal assault, supporting research on interpersonal violence, and establishing local prevention programs (e.g., violence prevention curricula in selected schools).     

Homicide mortality, socioeconomic development, and police violence in the city of S?o Paulo, Brazil]

OBJECTIVE: To analyze the association between police violence and homicide mortality rates taking into consideration the effect of contextual variables. METHODS: This was an environmental, cross-sectional study that included the 96 census districts in the City of S?o Paulo. The association between the variables was analyzed using Spearman's rank correlation and simple and multiple regression analysis. RESULTS: Univariate analysis revealed a strong and significant association between homicide mortality coefficients and all the indicators of socioeconomic development and police violence. After controlling for potential confounding factors, the association between police violence and homicide mortality coefficients remained strong and significant. This significance was lost only after control for the size of the resident population. CONCLUSION: The results indicate that police action that violates basic human rights is not the right answer to urban violence. The combination of homicides from interpersonal violence and deaths from police violence results in negative socialization and promotes further violence.     

Homicides between men aged 15 to 29 years and related factors in the State of Paraná, Brazil, 2002/2004

Homicides are the main cause of non-natural death in Brazil and studies about them may contribute to their control. The objective of this study was to verify mortality rates due to homicides and legal interventions among young men in the State of Paraná, Brazil, and to identify correlated municipal characteristics. An ecological study was conducted, having the municipalities of the State as units of analysis. Mortality rates of homicides and legal interventions among men from 15 to 29 years of age were calculated for the years 2002-2004 and demographic and social municipal indicators were obtained. Mortality rate in the State was 94.8 per one hundred thousand. The size of the population, the proportion of young people aged 15 to 24 years, the proportion of enrollments in universities and the Gini index were the main indicators correlated to homicide mortality (p<0.0001). Mortality rates were highest in municipalities of metropolitan regions, in those located at the border with Paraguay and in those located in the way between them and the Southeast Region of Brazil. Mortality rates and the proportion of deaths due to firearms increased with the size of the municipality. The greater number of youth and easier access to firearms and illicit drugs in such places may be influencing on these rates.     

Ischemic heart disease: mortality in natives and migrants, São Paulo, Brazil, 1979-1998

OBJECTIVE: The State of S o Paulo has been a major center of attraction for foreign and Brazilian migrants since the 19th century. The pattern of mortality due to ischemic heart disease according to place of birth is, however, unknown. Thus, the objective of the study was to identify differences in mortality due to ischemic heart disease among residents of the State of S o Paulo according to their place of birth. METHODS: Analytical time series study based on secondary data. Rates were not calculated due to lack of denominators. Instead, non-census indicators (proportional mortality and standardized mortality ratio weighted for years of potential life lost before the age of 100 years) and medians were utilized. Temporal trends were analyzed by means of simple linear regression. RESULTS: In the State of S o Paulo, about 40% of deaths due to ischemic heart disease occurred among migrants. The trend was negative for foreigners and positive for Brazilian migrants. Those born in northeastern Brazil, who presented the highest percentage of deaths in hospitals, had the worst performance: their proportional mortality due to ischemic heart disease remained unchanged throughout the study period (while this clearly declined for all other groups) and they died at younger ages. CONCLUSIONS: Migrants' share of total deaths due to ischemic heart disease in the State of S o Paulo is very high. While there is a declining trend for foreigners, it is growing among Brazilian migrants. Among the compared groups, mortality due to ischemic heart disease in the State of S o Paulo is most prominent for those born in northeastern Brazil.     

Discrepancies among ecological, household, and individual data on fruits and vegetables consumption in Brazil

Information on fruits and vegetables consumption in Brazil in the three levels of dietary data was analyzed and compared. Data about national supply came from Food Balance Sheets compiled by the FAO; household availability information was obtained from the Brazilian National Household Budget Survey (HBS); and actual intake information came from a large individual dietary intake survey that was representative of the adult population of S?o Paulo city. All sources of information were collected between 2002 and 2003. A subset of the HBS, representative of S?o Paulo city, was used in our analysis in order to improve the quality of the comparison with actual intake data. The ratio of national supply to household availability of fruits and vegetables was 2.6 while the ratio of national supply to actual intake was 4.0. The discrepancy ratio in the comparison between household availability and actual intake was smaller, 1.6. While the use of supply and availability data has advantages, as lower cost, must be taken into account that these sources tend to overestimate actual intake of fruits and vegetables.     

Work, violence and death in Campinas, São Paulo, Brazil

In this epidemiological study, deaths resulting from external causes in 1999 and 2000 among males (age 15-64 years) in Campinas, S?o Paulo State were analyzed through interviews with their relatives. We attempted to correlate this incidence with individual occupational history, allowing the characterization of these events as work-related injuries. The proportional death rate due to work-related injuries was estimated at 27% in this group. None of the death certificates we analyzed had "yes" specified in the appropriate work-related injury field. Based on these results, official data from the Brazilian Ministry of Labor on the number of deaths resulting from work-related injuries in this period in the State of S?o Paulo is underestimated by 83.4%. The vast majority of fatal work-related injuries were homicides and traffic accidents, reflecting an increase in violence in this Brazilian city.     

Characterization of the receptor population as listed and those who were submitted to pancreas and pancreas-kidney transplantation

About 1 million cases of transplantation were registered around the world. The first Pancreas transplantation in Brazil was in 1996, proceeded by a medical team of S?o Paulo. The objetctive of this study was to characterize the socio- demographic and epidemiological profile of the receivers in list and those submitted to this procedure. It is an inter-relational retrospective study considereing the period from 1996 to 2004. Results demonstrated the predominance of women, from white race, and, with an average of 35 years. The origin of the patients was the states of S?o Paulo and Minas Gerais.     

Linking of information from health and security databases on homicides

OBJECTIVE: Increased homicide rates in the city of Sao Paulo, Brazil, in the last two decades points out to the need for better understanding this subject. The purpose of the present study was to link information about homicide from different sources of data. METHODS: Homicide data from death certificates, medical examiners and police records of residents in the city of Sao Paulo was linked for the second semester of 2001. Variables about victims, risk factors and homicide circumstances were analyzed using absolute numbers, proportions and coefficients. Statistical differences were tested using Pearson's Chi-square test. RESULTS: Homicide crude rate was 57.2/100,000. Higher rates were observed among men aged 15 to 29 years (56.0% of all cases). The proportion of firearm-related homicides was 88.6%, higher among men than women. Most injuries were to the head (68.9%). Among the victims who underwent to drug screening, 42.5% had high blood alcohol concentrations (44.0% for men and 24.0% for women). Most events occurred at night during weekends and it was found a high correlation (74.6%) between the victim's place of residence and event location. CONCLUSIONS: The study findings highlight that linking information provides better quality of data and allows for better understanding of homicides.     

Trends in oral cancer mortality in the city of São Paulo, Brazil, 1980-2002

The current study assessed trends in oral cancer mortality in the city of S?o Paulo, Brazil, from 1980 to 2002. The official mortality information system supplied data on deaths whose underlying cause was classified as oral cancer, stratified by sex, age, and anatomic site. Death rates were estimated and adjusted by the direct method, using population data supplied by national censuses from 1980, 1991, and 2000 and a population count performed in 1996. There was an upward trend in overall cancer mortality, at a yearly rate of 0.72%. Accounting for more than one third of these deaths, tongue cancer was the main mortality category. Labial, gengival, and retromolar cancer showed a downward trend, while oropharyngeal cancer and cancer in unspecified parts of the mouth and oropharynx showed increasing mortality. Monitoring the magnitude and trends in cancer mortality can assist the planning of health initiatives aimed at reducing the disease burden from oral cancer in Brazil.     

The relative contribution of income inequality and imprisonment to the variation in homicide rates among Developed (OECD), South and Central American countries

Homicide rates vary widely across and within different continents. In order to address the problem of violence in the world, it seems important to clarify the sources of this variability. Despite the fact that income inequality and imprisonment seem to be two of the most important determinants of the variation in homicide rates over space and time, the concomitant effect of income inequality and imprisonment on homicide has not been examined. The objective of this cross-sectional ecological study was to investigate the association of income inequality and imprisonment with homicide rates among Developed (OECD), South and Central American countries. A novel index was developed to indicate imprisonment: the Impunity Index (the total number of homicides in the preceding decade divided by the number of persons in prison at a single slice in time). Negative binomial models were used to estimate rate ratios of homicides for young males and for the total population in relation to Gini Index and Impunity Index, controlling for infant mortality (as a proxy for poverty levels), Gross Domestic Product per-capita, education, percentage of young males in the population and urbanization. Both low income inequality and low impunity (high imprisonment of criminals) were related to low homicide rates. In addition, we found that countries with lower income inequality, lower infant mortality (less poverty), higher average income (GDP per-capita) and higher levels of education had low impunity. Our results are compatible with the hypothesis that both low income inequality and imprisonment of criminals, independent of each other and of other social-structural circumstances, may greatly contribute to the reduction in homicide rates in South and Central American countries, and to the maintenance of low levels of homicides in OECD countries. The Impunity Index reveals that countries that show greater commitment to education and to distribution of income also show greater commitment to punish serious criminal behavior.     

Increases in age-group-specific injury mortality--United States, 1999-2004

From 1979 to 1999, total injury mortality rates declined overall in the United States, despite increases in suicide rates in the late 1980s and in homicide rates in the early 1990s (CDC, unpublished data, 2007). From 1999 to 2004, however, total injury mortality rates increased 5.5%, from 53.3 to 56.2 per 100,000 population, the first sustained increase in 25 years. To assess this increase, CDC analyzed the most recent data from the National Vital Statistics System (NVSS). This report summarizes the results of that analysis, which determined that U.S. mortality rates increased from 1999 to 2004 for unintentional injuries, suicides, and injuries of undetermined intent; homicide rates were stable. Among persons aged 45-54 years, the total injury mortality rate increased 24.5%, including an 87.0% increase in the mortality rate from unintentional poisoning (most commonly drug poisoning) and a 48.0% increase in suicide by hanging/suffocation. Among persons aged 20-29 years, the total injury mortality rate increased 7.7%, including a 92.5% increase in the death rate from unintentional poisoning and a 31.7% increase in suicide by hanging/suffocation. Parallel increases in multiple categories and mechanisms of injuries within these two age groups suggest an increase in one or more shared risk factors (e.g., drug abuse); prevention programs that focus on shared risk factors might help reduce deaths from injuries.