title: Urbanization is associated with increased asthma morbidity and mortality in Brazil.
abstract: BACKGROUND
  Previous cross-sectional studies could establish an association between prevalence of self-reported wheeze and urban-rural environment, but the impact of urbanization on meaningful outcomes of asthma for public health is not established yet.
  
  
  OBJECTIVE
  Evaluate the effect of urbanization on asthma burden.
  
  
  METHODS
  A time series study of 5,505 Brazilian municipalities. The unit of analysis was the municipality. Two time frames were evaluated: from 1999 to 2001 and from 2009 to 2011. Trends from the first to the second time frame were evaluated. Governmental databases were the source of information. Multivariate binary logistic regression models were used.
  
  
  RESULTS
  In the age range from 5 to 24 years old, municipalities with increase in the proportion of individuals living in urban area had lower odds to reduce hospital admission rate from asthma (OR: .93) and lower odds to reduce death rate from asthma (OR: .88). In the age range from 25 to 39 years old, municipalities with increase in the proportion of individuals living in urban area had lower odds to reduce hospital admission rate from asthma (OR: .93) and lower odds to reduce death rate from asthma (OR: .82). Municipalities that increased access to physicians and that supplied inhaled corticosteroids free of charge for asthma since year 2003 had increased odds to reduce hospital admission and death rates from asthma.
  
  
  CONCLUSIONS
  Increase in urban population was associated with lower odds to reduce hospital admission and death rates from asthma in children and young adults living in a transition society.
authors.affiliation: Faculdade de Medicina de Jundiaí, Sao Paulo, Brazil.
authors.forename: Eduardo Vieira
authors.initials: EV
authors.lastname: Ponte
authors.affiliation: ProAR - Núcleo de Excelência em Asma, Universidade Federal da Bahia, Bahia, Brazil.
authors.forename: Alvaro A
authors.initials: AA
authors.lastname: Cruz
authors.affiliation: Pulmonary Divison-Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Athanazio
authors.affiliation: Pulmonary Divison-Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Regina
authors.initials: R
authors.lastname: Carvalho-Pinto
authors.affiliation: Pulmonary Divison-Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Frederico L A
authors.initials: FLA
authors.lastname: Fernandes
authors.affiliation: Instituto de Saúde Coletiva, UFBA.
authors.forename: Mauricio L
authors.initials: ML
authors.lastname: Barreto
authors.affiliation: Pulmonary Divison-Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Rafael
authors.initials: R
authors.lastname: Stelmach
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D006760:Hospitalization / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D009017:Morbidity / Q000639:trends; D009026:Mortality / Q000639:trends*; D015995:Prevalence; D012307:Risk Factors; D057566:Self Report; D014505:Urban Population / Q000706:statistics & numerical data / Q000639:trends*; D014507:Urbanization / Q000639:trends*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones
keywords: asthma; epidemiology; hospitalization; mortality; treatment; urbanization