Excesso de peso na população brasileira: prevalência, carga de doenças e custos para o SUS

Abstract

Introduction: Excess weight and high Body Mass Index (BMI) are related to the development of diseases that can lead to procedures and hospitalizations, increasing health costs. Objective: To analyze the prevalence, burden of disease and costs in the SUS of overweight in the Brazilian population. Methodology: Ecological study with two components, the time series of the prevalence of overweight and obesity, and the burden of diseases attributable to high BMI from 1990 to 2019 in Brazil; and the cross-sectional design to estimate the direct costs of hospitalizations and SUS procedures attributable to high BMI. Data from the 2019 Global Burden of Disease (GBD) study and the costs of hospital admissions and outpatient procedures for the year 2019 from the Department of Informatics of the Brazilian Unified Health System (DATASUS) were used. The prevalence estimated by the Surveillance of Risk and Protective Factors for Chronic Diseases by Telephone Survey (VIGITEL), Family Budget Survey (POF) and National Health Survey (PNS) and deaths, Years of Life Lost due to Premature Death (YLL), Years Lived with Disability (YLD) and Disability-Adjusted Life Years Lost (DALY) resulting from NCDs attributed to high BMI. To calculate the costs, the FAP was used referring to the YLD proportion of each risk-associated outcome. Results: All data sources analyzed showed a constant increase in the prevalence of overweight and obesity in Brazil in both sexes between 1990 and 2019, despite women having a higher prevalence of obesity. High BMI caused a loss of 5,817,938.71 DALYs, 1,592,243.31 YLDs and 177,939.70 deaths from Chronic Noncommunicable Diseases (NCDs) in Brazil in 2019. When stratifying the metrics by the main groups of CNCDs, it is observed a reduction in the rates of DALY, YLL, YLD and deaths from Cardiovascular Disease (CVD) attributed to high BMI and an increase in the rate of YLD from diabetes. With regard to costs, US$377,295,781.84 were spent on hospitalizations and high and medium complexity procedures in the treatment of NCDs attributed to high BMI. SUS expenditures were higher with hospital admissions, regardless of CNCD. The South and Southeast regions and Federative Units (UF), Paraná and Santa Catarina had the highest total cost per 10,000 inhabitants. CVD and chronic kidney disease (CKD) have a higher cost due to hospital admissions and neoplasms and CVD have higher costs due to outpatient procedures. Conclusion: This study advances by showing that high BMI is a growing risk factor in the country, with a relevant volume of disease burden and financial costs attributed to it. Despite the reduction in mortality from CVD in Brazil, these diseases have the highest cost with hospitalizations and procedures, attributed to the high BMI risk factor. In addition, it quantified the savings in public spending that could be reallocated or avoided at the national, regional and local levels, if this risk factor were reduced. These findings highlight the need to renegotiate current public policies and apply effective intervention packages, with a focus on promoting healthier lifestyles, considering individual reality.