Carga de doenças em agentes de combate às endemias no estado do Ceará

Abstract

This research was born from the needing to know the profile of illness in agents to fighting endemic diseases (AFE), a group of workers chronically exposed to insecticides used in public health campaigns. Objective: The main of this study has been measure the Global Burden of Disease (GBD) that affected these workers during their occupational trajectory. Methods: This is a retrospective cohort with agents to fighting endemic diseases, linked to the Ministry of Health in the state of Ceará. Information was collected through expert medical records, identifying diagnoses, periods of incapacity for work and deaths. Based on this information, the Global Burden of Disease indicators (DALY, YLL, YLD) were measured. In addition, we investigated the incidences of neoplasms and neuropsychiatric disorders. We performed survival analysis using the Kaplen-Meier method, and the Cox model, for neoplastic outcomes, and for mental disorders, we known the measures of association by logistic regression. Results: We observed changes in the GBD pattern over the second, third and fourth decades of job. Initially, there was a predominance of traumatic injuries, which were replaced by non- communicable chronic diseases. Neoplasms had a significant incidence during the last decade analyzed, with a predominance of prostate cancer (19%), neoplasms of uncertain behavior (13.8%), digestive organ neoplasms (10.3%) and skin neoplasms (10.3%). It using the Cox regression, we found that AFEs working in Fortaleza had a 69% higher risk of neoplasia when compared to workers from other cities (HR 1.69; CI 0.92-3.12). Mental and behavioral disorders had a great impact on GBD, with mood disorders having the highest DALY, the expence of YLD. Leaves due to mental and behavioral disorders (MBD) has been long and recurrent, those that generated more sick leave has been Stress-related disorders (37.6%), Mood disorders (33.5%) and disorders due to the use of psychoactive substances (22.8%). AFEs working in Fortaleza were more likely to have mental disorders than workers working in other cities (OR 2.26; 95%CI 1.46-3.5). Conclusion: These findings are relevant to public and worker health as they demonstrate a change in the burden of disease over decades of work. In addition, it revealed an increased incidence of neoplasms in workers exposed to insecticides, which is consistent with previously published studies. As for neuropsychiatric manifestations, mental disorders were important because they confer a high burden of disease, generating long periods of disability.