title: Chronic obstructive pulmonary disease in Brazil: mortality and hospitalization trends and rates, 1996-2008.
abstract: METHODS
  Chronic obstructive pulmonary disease (COPD) is the third leading cause of death among adults in Brazil.
  
  
  OBJECTIVE
  To evaluate the mortality and hospitalisation trends in Brazil caused by COPD during the period 1996-2008.
  
  
  METHODS
  We used the health official statistics system to obtain data about mortality (1996-2008) and morbidity (1998-2008) due to COPD and all respiratory diseases (tuberculosis: codes A15-16; lung cancer: code C34, and all diseases coded from J40 to 47 in the 10th Revision of the International Classification of Diseases) as the underlying cause, in persons aged 45-74 years. We used the Joinpoint Regression Program log-linear model using Poisson regression that creates a Monte Carlo permutation test to identify points where trend lines change significantly in magnitude/direction to verify peaks and trends.
  
  
  RESULTS
  The annual per cent change in age-adjusted death rates due to COPD declined by 2.7% in men (95%CI -3.6 to -1.8) and -2.0% (95%CI -2.9 to -1.0) in women; and due to all respiratory causes it declined by -1.7% (95%CI 2.4 to -1.0) in men and -1.1% (95%CI -1.8 to -0.3) in women. Although hospitalisation rates for COPD are declining, the hospital admission fatality rate increased in both sexes.
  
  
  CONCLUSIONS
  COPD is still a leading cause of mortality in Brazil despite the observed decline in the mortality/hospitalisation rates for both sexes.
authors.affiliation: School of Medicine, University of São Paulo, Sao Paulo, Sao Paulo, Brazil. isabensenor@hu.usp.br
authors.forename: I M
authors.initials: IM
authors.lastname: Benseñor
authors.forename: T G
authors.initials: TG
authors.lastname: Fernandes
authors.forename: P A
authors.initials: PA
authors.lastname: Lotufo
mesh_terms: D000368:Aged; D001938:Brazil / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D016012:Poisson Distribution; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality*; D012044:Regression Analysis; D012140:Respiratory Tract Diseases / Q000453:epidemiology* / Q000401:mortality; D012737:Sex Factors