A carga dos transtornos de ansiedade no Brasil pelo estudo Carga Global de Doenças, 2018-2021.

Abstract

Introduction: Anxiety disorders have an early onset, high prevalence, and a significant contribution to increased morbidity in the global population. In 2019, they affected 301 million people, 58 million of whom were children and adolescents. According to the Institute for Health Metrics and Evaluation (IHME), in 2020, 15% more people developed anxiety disorders as a result of the COVID-19 pandemic compared to 2019. The methodology used by the Global Burden of Disease (GBD) study aims to measure the health status of a population by considering both disability and mortality associated with a given disease. This study aimed to describe and analyze estimates of the burden of anxiety disorders in Brazil and its Federative Units, as well as in other South American countries and Mexico, in the pre-pandemic years (2018-2019) and during the COVID-19 pandemic (2020-2021). Methods: A descriptive study was conducted with data from the GBD 2021 study using the metric Healthy Life Years Lost (DALY), calculated as the sum of years of life lost due to premature death (YLL) and years lived with disability (YLD). Since anxiety disorders are not a cause of death, YLL is not considered for anxiety disorders; DALY is equal to YLD. To calculate YLD, the prevalence of anxiety disorders was multiplied by their disability weight. Statistical models were used in the GBD 2021 study to produce the estimates. Results: The COVID-19 pandemic period (2020 - 2021) represented a period of increases in both absolute prevalence, age-standardized prevalence rate, and age-standardized DALY rate. In 2021, Brazil had 21,248,815 (95% UI: 18,160,824 - 24,695,181) prevalent cases of anxiety disorders, compared to 2018 when the number of cases was 16,883,600 (95% UI: 14,552,196 - 19,427,966) cases, there was an increase in the prevalence of cases of 25.8%. During the pandemic, the number of prevalent cases increased by 18.2% in the first year (2020) and by 5.2% in the second year (2021). The age-standardized prevalence increased by 22.9% between 2018 and 2021, with an increase of 17.6% in the first year of the pandemic (2020) and 4.4% in the second year (2021). The increase in the age-standardized DALY rate between 2018 and 2021 was 22.7%. The DALY rate in the first year of the pandemic (2020) increased by 17.6% and, in the second year (2021), by 4.3%. In the first year of the pandemic (2020), all subnational units showed increases. In the second year (2021), the states that showed the largest increases were: Minas Gerais (8.0%), Goiás (8.4%), Rondônia (9.8%), and Paraná (10.1%). Regarding age and sex, in 2021, the DALY rate for anxiety disorders began in childhood with increasing values up to the age group of 35 to 39 years in women and 40 to 44 years in men. Women had higher rates than men; however, it was possible to observe that the increases were proportional in both sexes. In Brazil in 2021, anxiety disorders ranked first and seventh as the leading causes of YLDs and DALYs, respectively. Globally, they rank 23rd in DALYs and fifth in YLDs. In South America and Mexico, DALYs range from sixth in Peru to eighteenth in Guyana, and YLDs range from first in Bolivia, Ecuador, Paraguay, and Peru to sixth in Mexico and Venezuela. Final considerations: The COVID-19 pandemic has led to an increase in anxiety disorders in Brazil and worldwide. Women, children, and adolescents were the groups most vulnerable to anxiety disorders. Therefore, we believe that using the results of the GBD study can contribute to effective care for people with anxiety disorders and better targeting of public policies.