ABSTRACT

Objective:

To evaluate changes in selected laboratory tests in the population included in the Brumadinho Health Project, according to the exposure to the dam failure.

Methods:

Cross-sectional study carried out on representative sample of residents (≥12 years) in Brumadinho, Minas Gerais, including: 1) non-exposed; 2) directly affected by tailings sludge; 3) residents in mining area. The prevalence of abnormal results of blood count, total, HDL and LDL cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatinine, urea, estimate of glomerular filtration rate (eGFR) and high-sensitivity C-reactive protein (hs-CRP) were estimated. The Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI) of having an abnormal laboratory finding were estimated using Generalized Linear Models with Poisson probability distribution. Crude and adjusted models were estimated for age range, gender, diabetes, body mass index, smoking, hypertension.

Results:

After adjusting, there was no difference in PR between the three populations for most tests, with the exception of the population residing in an area with mining activity and not directly affected by the mud, with a lower chance of having altered total cholesterol (PR: 0.84; 95%CI 0.74–0.95) and a higher chance of having altered HDL cholesterol (PR: 1.26; 95%CI 1.07–1.50), hs-CRP (PR: 1.19; 95%CI 1.04–1.37), and eGFR <60mL/min/1,73 m² (PR: 1.51; 95%CI 1.05–2.19).

Conclusion:

No significant differences were found in the prevalence of biochemical and hematological alterations between the populations directly exposed and not exposed to tailings. Only the group residing in the mining area had a higher prevalence of alterations related dyslipidemia, renal disease, and inflammation.

Keywords:
Man-made disasters; Mining; Laboratory tests; Brazil

INTRODUCTION

Disasters caused by man, such as technological (chemical and radioactive) or natural disasters, like floods, droughts, and landslides, can generate human, environmental or material impacts in the short, medium or long term¹1 Freitas CM, Silva EL, Silva IVM, Mazoto ML, Silva MA, Alpino TMA, et al. Guia de preparação e respostas do setor saúde aos desastres. Rio de Janeiro: Fiocruz; 2018..

Disasters with mining dams have already been reported around the world²2 Tableau Public. Acidentes em barragens de mineradoras de 2000 a 2015. [Internet] 2015 [cited on Jun. 28, 2022]. Available at: https://public.tableau.com/profile/keucosta#!/vizhome/Acidentesemrepresasderejeito/Dashboard1
https://public.tableau.com/profile/keuco... , but in Brazil, specifically in the state of Minas Gerais, two major events of this type have recently occurred³3 Escola Superior Dom Helder Câmara. O rompimento de barragens no Brasil e no mundo: desastres mistos ou tecnológicos? [Internet] 2015 [cited on Jun. 28, 2022]. Available at: www.domhelder.edu.br/uploads/artigoHRA.pdf
www.domhelder.edu.br/uploads/artigoHRA.p... –⁵5 Freitas CM, Silva MA, Menezes FC. O desastre na barragem de mineração da Samarco: fratura exposta dos limites do Brasil na redução de risco de desastres. Cienc Cult 2016; 68(3): 25-30. http://dx.doi.org/10.21800/2317-66602016000300010
http://dx.doi.org/10.21800/2317-66602016... . A disaster of great magnitude occurred on January 25^th, 2019, with the rupture of the tailings dam at the Córrego do Feijão mine, owned by mining company Vale S.A., in Brumadinho, Minas Gerais, affecting a considerable territorial extension and causing dozens of deaths and disappearances. About 12 million m³3 Escola Superior Dom Helder Câmara. O rompimento de barragens no Brasil e no mundo: desastres mistos ou tecnológicos? [Internet] 2015 [cited on Jun. 28, 2022]. Available at: www.domhelder.edu.br/uploads/artigoHRA.pdf
www.domhelder.edu.br/uploads/artigoHRA.p... of wet iron ore tailings leaked and traveled along the Ribeirão Ferro-Carvão bed, reaching the Paraopeba River, heading toward São Francisco River⁶6 Romão A, Froes C, Barcellos C, Silva DX, Saldanha R, Gracie R, et al. Nota técnica: avaliação dos impactos sobre a saúde do desastre da mineração da Vale (Brumadinho, MG). Rio de Janeiro: Observatório de Clima e Saúde; 2019..

Various consequences are associated with disasters, such as increased incidence of cardiovascular, respiratory, and obesity diseases, in addition to mental disorders, increased consumption of alcohol, tobacco, and other drugs⁷7 Geng F, Zhou Y, Liang Y, Fan F. A longitudinal study of recurrent experience of earthquake and mental health problems among chinese adolescents. Front Psychol 2018; 9: 1259. https://doi.org/10.3389/fpsyg.2018.01259
https://doi.org/10.3389/fpsyg.2018.01259... –⁹9 Kukihara H, Yamawaki N, Uchiyama K, Arai S, Horikawa E. Trauma, depression, and resilience of earthquake/tsunami/nuclear disaster survivors of Hirono, Fukushima, Japan. Psychiatry Clin Neurosci 2014; 68(7): 524-33. https://doi.org/10.1111/pcn.12159
https://doi.org/10.1111/pcn.12159... .

Identifying and evaluating the impacts on the health of the population surrounding these disasters is important and include, in addition to environmental contamination, unfavorable outcomes for physical and mental health, as well as possible economic destabilization¹⁰10 Pereira LF, Cruz GB, Guimarães RMF. Impactos do rompimento da barragem de rejeitos de Brumadinho, Brasil: uma análise baseada nas mudanças de cobertura da terra. Journal of Environmental Analysis and Progress 2019; 4(2): 122-9. https://doi.org/10.24221/JEAP.4.2.2019.2373.122-129
https://doi.org/10.24221/JEAP.4.2.2019.2... . Producing this knowledge is essential for the planning of preventive actions and for facing possible new events, reducing the impact on the affected populations¹¹11 Freitas CM, Silva DRX, Sena ARM, Silva EL, Sales LBF, Carvalho ML, et al. Desastres naturais e saúde: uma análise da situação do Brasil. Ciênc Saúde Coletiva 2014; 19(9): 3645-56. https://doi.org/10.1590/1413-81232014199.00732014
https://doi.org/10.1590/1413-81232014199... . Assessing selected laboratory parameters can contribute to the identification of early or late changes in health and produce important evidence on the impacts on the health conditions of these populations.

The present study aimed to evaluate the existence of hematological changes, renal function, liver function, carbohydrate metabolism, lipid profile, and inflammation through laboratory tests carried out in three different groups of Brumadinho residents in relation to exposure:

Unexposed population, considered not directly affected by the dam failure or not residing in an area with active mining;

• Population directly affected by the tailings sludge;

• Population residing in an area with mining activity that was not directly affected by the mud.

METHODS

Population

The Brumadinho Health Project (Projeto Saúde Brumadinho) is a prospective cohort study started in 2021, coordinated by Fundação Oswaldo Cruz de Minas Gerais (Fiocruz Minas) in partnership with Universidade Federal do Rio de Janeiro (UFRJ), with the objective of evaluating the living conditions and health of residents in the city of Brumadinho.

The research sampling plan was designed to represent the population residing in the municipality of Brumadinho aged 12 years old and older, in three estimation domains, formed by different groups of residents in relation to exposure:

• Population not directly affected by the dam failure or not residing in an area with active mining, considered non-exposed or reference population (n=1,562);

• Population directly affected by the tailings mud or by the water from the Paraopeba River, contaminated by the mud, residing in the areas at the time of the survey or at the time of the dam failure — Córrego do Feijão/Parque da Cachoeira/Pires (n=981);

• Residents of the region with mining activity who were not directly affected by the mud — Tejuco (n=537).

This design involved a random sample of existing households in the region not directly affected, in addition to a census in the two other domains, allowing a representative sample of the municipality's population to be estimated. In the selected households, all residents in the age group considered were invited to participate in the survey, and 86.4% of the eligible ones participated in it.

The Brumadinho Health Project was approved by the Research Ethics Committee of Fiocruz Minas (20814719.5.0000.5091), and all participants agreed to provide information for the study by signing the informed consent (adults) or assent (adolescents).

Variables

The collection of biological material took place at the participants’ homes between 7 am and 3 pm, without the need for fasting, between September and November 2021. Two tubes of blood were collected from each participant, one containing separator gel and clot activator, without anticoagulant, with a capacity of 5 mL, and another, ethylenediamine tetraacetic acid dipotassium (EDTA K2) with a capacity of 4 mL, to obtain serum and whole blood, respectively. The samples were stored in thermal boxes with reusable ice and kept at a temperature of 4-8°C for a maximum period of 24 h until analyzed. Samples that remained outside the established temperature parameters were rejected. Some participants did not have all tests performed because of insufficient sample volume.

Laboratory tests were performed by the laboratory of Associação Fundo de Incentivo à Pesquisa (AFIP — Medicina Diagnóstica), using widely validated methods and included blood count, glycated hemoglobin (HbA_1c), total cholesterol (Total-C), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, urea and high-sensitivity C-reactive protein (hs-CRP). The glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2021 equation¹²12 Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New creatinine- and cystatin c-based equations to estimate GFR without race. N Engl J Med 2021; 385(19): 1737-49. https://doi.org/10.1056/NEJMoa2102953
https://doi.org/10.1056/NEJMoa2102953... . The laboratory has an accreditation certification with excellence III from the National Accreditation Organization (Organização Nacional de Acreditação – ONA)¹³13 Brasil. Ministério da Saúde. Secretaria de Assistência à Saúde. Manual brasileiro de acreditação hospitalar. 3ᵃ ed. rev. e atual. Brasília: Ministério da Saúde; 2002. [cited on Mar. 7, 2022]. Available at: https://bvsms.saude.gov.br/bvs/publicacoes/acreditacao_hospitalar.pdf
https://bvsms.saude.gov.br/bvs/publicaco... .

The tests had their precision monitored daily by the use of own controls and/or commercial controls, following the recommendations by the current legislation¹⁴14 Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. Diretoria Colegiada. Resolução RDC n° 504, de 27 de maio de 2021. Dispõe sobre as Boas Práticas para o transporte de material biológico humano. Diário Oficial da União. Publicado em 31/05/2021. Edição 101. Seção 1. pág. 126 [cited on Mar. 7, 2022]. Available at: https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-504-de-27-de-maio-de-2021-323008631
https://www.in.gov.br/en/web/dou/-/resol... . Reagent systems, methods, analytical coefficients of variation of controls, and reference values and ranges used are available in supplementary material (Tables S1 and S2). Results different from the intervals or reference values were considered altered, thus defining the outcomes of this analysis.

Participant information, including gender, age, weight, height, smoking, diabetes mellitus (DM) and hypertension, was obtained through the questionnaires.

DM was defined as a self-reported disease and/or HbA1c ≥6.5%, and hypertension, based on the report of a previous medical diagnosis for this condition. The body mass index (BMI) was calculated by dividing weight (kg) by height (meters) squared, based on self-reported measurements, and categorized as normal (≤25 kg/m²), overweight (>25 kg/m² and <30 kg/m²), and obesity (≥30 kg/m²). Smoking was categorized into never smoked, former smoker, and current smoker. Age was categorized into the following age groups: 12 to 17 years, 18 to 59 years, and ≥60 years.

Statistical analysis

At first, the sample was characterized according to sociodemographic and behavioral variables and the diagnosis of chronic diseases, and the differences were tested using the Rao-Scott test¹⁵15 Rao JNK, Scott AJ. On chi-squared tests for multiway contingency tables with cell proportions estimated from survey data. Ann Statist 1984; 12(1): 46-60. https://doi.org/10.1214/aos/1176346391
https://doi.org/10.1214/aos/1176346391... . Laboratory test results were described based on their continuous distributions, through summary measurements, median, and interquartile range (1^st–3^rd quartile), for population groups, and stratification by gender and age range. Differences between groups were tested using the Kruskal-Wallis test¹⁶16 Hollander M, Wolfe DA. Nonparametric statistical methods. New York: John Wiley & Sons; 1973..

The prevalence of abnormal tests was estimated according to the study region, gender and age range, and the differences were tested by Rao-Scott. Prevalence ratios (PR) and 95% confidence intervals (95%CI) of altered tests were also estimated, using generalized linear models with Poisson probability distribution¹⁷17 Barros AJD, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003; 3(1): 21. https://doi.org/10.1186/1471-2288-3-21
https://doi.org/10.1186/1471-2288-3-21... . As adjustment variables, age, gender, DM, BMI, smoking, and hypertension were used. For each test, the modeling strategy consisted initially of fitting univariate models (model 1=no fit) and, subsequently, of multiple models with chained input of fit variables, which are pre-analytical factors known to influence the results of the analyzed tests (model 2=model 1 adjusted by age range and gender; model 3=model 2+DM; model 4=model 3+BMI+smoking+hypertension).

All point and interval estimates, tests of differences in proportions, and regression models considered the sample weights and correction for design purposes, through the survey¹⁸18 Lumley T. Complex surveys: a guide to analysis using R 565. Hoboken: John Wiley; 2010. package of the statistical R software¹⁹19 Team R. The R project for statistical computing. R Foundation for Statistical Computing, Vienna, Austria [Internet]. 2013 [cited on Mar. 7, 2022]. Available at: https://www.r-project.org/
https://www.r-project.org/... .

RESULTS

Of the 3,080 subjects sampled in the study, 2,782 participants (90.3%) had results from at least one laboratory test. As shown in Table 1, the population studied was predominantly female (56.6%), aged 18–59 years (64.8%), who had never smoked (68%), and were overweight or obese (54.4%). The prevalence of alterations in the serum levels of Total-C, HDL-C, LDL-C, and TG was 54, 26.5, 30.6, and 39.3%, respectively. About a quarter of the total population had anemia, and a third had abnormal hs-CRP (Table 1).

In the evaluation of the distribution of laboratory tests, according to gender and different age groups — adolescent (12 to 17 years old), adult (18 to 59 years old), and aged (60 years old or more) — it was observed that, for most parameters analyzed, there is no difference between the three populations studied; differences occurred for lipid profile, eGFR and hs-CRP (Tables S4 and S5).

In assessing the prevalence of alterations in biochemical (Table S6) and hematological (Table S7) parameters, according to geographic stratum, age range, and gender, it was found that women aged between 18 and 59 years, from the population considered not directly affected by the dam failure, showed a higher prevalence of increased Total-C (57.9%) and LDL-C (33.7%) (Table S6). The prevalence of high hs-CRP was higher in the population of residents of the region located in an area with mining activity, aged 60 years old or older and of both genders (Table S6). There was no difference in the prevalence of hematological alterations among the three population strata, except for eosinophils in women aged 12 to 17 years (Table S7).

Tables 2 and 3 show the results of the raw and adjusted models for the association between the altered parameters and the region of residence. The estimated PR and 95%CI were verified for residents in regions directly affected by the mud and residents in communities with active mining activity, compared to the unexposed population. There was no difference between the PR adjusted for the results of the hematological tests among the three population strata (Table 2 and Table S8). According to Table 3, in the population of residents of the area with mining activity, the prevalence of altered Total-C was lower (PR=0.83; 95%CI 0.74–0.94), and of altered HDL-C (PR= 1.31; 95%CI 1.12–1.54), altered hs-CRP (PR=1.26; 95%CI 1.09–1.44), and eGFR <60 mL/min/1.73 m² (PR=1.50; 95%CI 1.04–2.16) was higher when adjusted for age, gender, and DM (model 3).

These findings persisted after additional adjustment for BMI, hypertension, and smoking (model 4) for variables Total-C and HDL-C, eGFR <60 mL/min/1.73 m², and hs-CRP (Table 3).

DISCUSSION

In this study, laboratory tests that assess renal function, liver function, carbohydrate metabolism, lipid profile, inflammation, and blood cell counts were measured in strata of the population of the Brumadinho region. The results showed that the population directly affected by the tailings mud or by the water from the Paraopeba River contaminated by the mud did not present a significant difference in the prevalence of altered laboratory test results, when compared to the unexposed population, regardless of the adjustments made. On the other hand, the population of residents of the region located in an area with mining activity had a higher prevalence of low HDL-C, high hs-CRP, and low eGFR (<60 mL/min/1.73 m²) when compared to the unexposed population.

The data analyzed in the present study do not allow us to conclude about this instigating finding; however, considering that this population was not directly affected by the dam failure, but lives in an area with active mining, it is possible to assume that the changes in the results of laboratory tests may have been observed due to prolonged contact with mining activity. Individuals who work for long periods in a mining environment are at greater risk of developing chronic diseases such as high blood pressure, overweight/obesity, dyslipidemia, and high blood glucose²⁰20 Rodriguez-Fernandez R, Rahajeng E, Viliani F, Kushadiwijaya H, Amiya RM, Bangs MJ. Non-communicable disease risk factor patterns among mining industry workers in Papua, Indonesia: longitudinal findings from the Cardiovascular Outcomes in a Papuan Population and Estimation of Risk (COPPER) Study. Occup Environ Med 2015; 72(10): 728-35. https://doi.org/10.1136/oemed-2014-102664
https://doi.org/10.1136/oemed-2014-10266... . Additionally, studies show that not only acute exposure, but also prolonged exposure to concentrations of some heavy and essential metals, can cause damage to various human organs and tissues²¹21 Vergilio CS, Lacerda D, Oliveira BCV, Sartori E, Campos GM, Pereira ALS, et al. Metal concentrations and biological effects from one of the largest mining disasters in the world (Brumadinho, Minas Gerais, Brazil). Sci Rep 2020; 10(1): 5936. https://doi.org/10.1038/s41598-020-62700-w
https://doi.org/10.1038/s41598-020-62700... ,²²22 Klaassen CD, Watkins III JB. Casarett & Doull's essentials of toxicology. 4th ed. Philadelphia: McGraw Hill; 2021..

When analyzing the results of laboratory tests from the population of Brumadinho, there was a higher prevalence of abnormal results for some laboratory tests compared to other populations, indicating a higher prevalence of anemia, dyslipidemia, renal dysfunction, and inflammation. The prevalence of high Total-C (>200 mg/dL) and hypertriglyceridemia (TG >175 mg/dL) was 53.9 (95%CI 50.8–57) and 39.3% (95%CI 36.1–43), respectively. These values are higher than those found in studies in the Brazilian adult population, whose prevalence of high Total-C is 32.7% and of hypertriglyceridemia, 21%²³23 Faludi AA, Izar MCO, Saraiva JFK, Chacra APM, Bianco HT, Afiune Neto A, et al. Atualização da diretriz brasileira de dislipidemias e prevenção da aterosclerose - 2017. Arq Bras Cardiol 2017; 109(2Supl. 1): 1-76.–²⁵25 Moraes SA, Checchio MV, Freitas ICM. Dislipidemia e fatores associados em adultos residentes em Ribeirão Preto, SP: resultados do Projeto EPIDCV. Arq Bras Endocrinol Metab 2013; 57(9): 691-701. https://doi.org/10.1590/S0004-27302013000900004
https://doi.org/10.1590/S0004-2730201300... .

The prevalence of elevated creatinine (>1.3 mg/dL among men and >1.02 mg/dL among women) in the total population analyzed was 8.1% (95%CI 6.6–10), being higher than the values indicated in population surveys in two Brazilian cities, with prevalences varying between 3.13 and 3.46%²⁶26 Marinho AWGB, Penha AP, Silva MT, Galvão TF. Prevalence of chronic renal disease among Brazilian adults: a systematic review. Cad Saúde Colet 2017; 25(3): 379-88. https://doi.org/10.1590/1414-462X201700030134
https://doi.org/10.1590/1414-462X2017000... . The prevalence of anemia (hemoglobin <13.5 g/dL among men and <12 g/dL among women) was 25.1% (95%CI 22.4–28) in the total population of Brumadinho and is higher than the prevalence of 9.9% observed in Brazilians aged over 18 years old²⁷27 Machado ÍE, Malta DC, Bacal NS, Rosenfeld LGM. Prevalência de anemia em adultos e idosos brasileiros. Rev Bras Epidemiol 2019; 22(Suppl 2): E190008. https://doi.org/10.1590/1980-549720190008.supl.2
https://doi.org/10.1590/1980-54972019000... . Finally, the prevalence of high hs-CRP (≥0.3 mg/dL) was 33.75% (95%CI 30.9–37). Hs-CRP is a marker of inflammation, and is remarkably increased in diseases such as DM, obesity, metabolic syndrome, atherosclerosis in addition to being associated with a higher risk of cardiovascular disease and death²⁸28 Libby P, Loscalzo J, Ridker PM, Farkouh ME, Hsue PY, Fuster V, et al. Inflammation, immunity, and infection in atherothrombosis: JACC review topic of the week. J Am Coll Cardiol 2018; 72(17): 2071-81 https://doi.org/10.1016/j.jacc.2018.08.1043
https://doi.org/10.1016/j.jacc.2018.08.1... ,²⁹29 Maluf CB, Barreto SM, Giatti L, Ribeiro AL, Vidigal PG, Azevedo DRM, et al. Association between C reactive protein and all-cause mortality in the ELSA-Brasil cohort. J Epidemiol Community Health 2020; 74(5): 421-7. https://doi.org/10.1136/jech-2019-213289
https://doi.org/10.1136/jech-2019-213289... .

Taken together, these findings may be related to mining activity, which is intense throughout the municipality of Brumadinho, since acute or chronic exposure to concentrations of some heavy and essential metals, present in mining activity, can cause damage to various human organs and tissues, such as anemia, leukopenia, liver and kidney damage, endothelial dysfunction, among others²²22 Klaassen CD, Watkins III JB. Casarett & Doull's essentials of toxicology. 4th ed. Philadelphia: McGraw Hill; 2021.,²³23 Faludi AA, Izar MCO, Saraiva JFK, Chacra APM, Bianco HT, Afiune Neto A, et al. Atualização da diretriz brasileira de dislipidemias e prevenção da aterosclerose - 2017. Arq Bras Cardiol 2017; 109(2Supl. 1): 1-76..

On the other hand, disasters are known to have a direct impact on health, including imbalance of the autonomic system, hemodynamic disorders, activation of the sympathetic system and renin angiotensin, oxidative stress, as well as inflammation and atherosclerosis, which can be explained, at least partly, by exposure to particulate matter and harmful substances. After natural disasters, increased frequencies of post-traumatic stress disorder, depression, and other mental disorders have been reported⁸8 Hikichi H, Aida J, Kondo K, Tsuboya T, Kawachi I. Residential relocation and obesity after a natural disaster: a natural experiment from the 2011 Japan Earthquake and Tsunami. Sci Rep 2019; 9: 374. https://doi.org/10.1038/s41598-018-36906-y
https://doi.org/10.1038/s41598-018-36906... –¹⁰10 Pereira LF, Cruz GB, Guimarães RMF. Impactos do rompimento da barragem de rejeitos de Brumadinho, Brasil: uma análise baseada nas mudanças de cobertura da terra. Journal of Environmental Analysis and Progress 2019; 4(2): 122-9. https://doi.org/10.24221/JEAP.4.2.2019.2373.122-129
https://doi.org/10.24221/JEAP.4.2.2019.2... . Disasters are also related to increased hypertension, increased BMI, smoking, alcohol abuse, high blood glucose, high-sodium diets, and worsening socioeconomic status⁷7 Geng F, Zhou Y, Liang Y, Fan F. A longitudinal study of recurrent experience of earthquake and mental health problems among chinese adolescents. Front Psychol 2018; 9: 1259. https://doi.org/10.3389/fpsyg.2018.01259
https://doi.org/10.3389/fpsyg.2018.01259... –⁹9 Kukihara H, Yamawaki N, Uchiyama K, Arai S, Horikawa E. Trauma, depression, and resilience of earthquake/tsunami/nuclear disaster survivors of Hirono, Fukushima, Japan. Psychiatry Clin Neurosci 2014; 68(7): 524-33. https://doi.org/10.1111/pcn.12159
https://doi.org/10.1111/pcn.12159... . In addition, infrastructure is compromised and access to public health services is reduced, which can contribute to worsening of health conditions of the affected population¹¹11 Freitas CM, Silva DRX, Sena ARM, Silva EL, Sales LBF, Carvalho ML, et al. Desastres naturais e saúde: uma análise da situação do Brasil. Ciênc Saúde Coletiva 2014; 19(9): 3645-56. https://doi.org/10.1590/1413-81232014199.00732014
https://doi.org/10.1590/1413-81232014199... .

In any case, the data analyzed in the present study do not allow us to state the cause of the higher prevalence of laboratory alterations, since anemia, dyslipidemia, renal dysfunction, and inflammation can occur in different conditions. Longitudinal follow-up of this population may provide more accurate information to justify this finding.

Among the limitations of the present study, its sectional nature is highlighted, which does not allow establishing temporal relationships between the variables investigated. Tests were performed on 90.3% of study participants. In addition, due to the absence of information prior to the disaster, it is not possible to understand the impact of this event for the values described here. Finally, the exams were carried out two and a half years after the dam rupture, and the time required for this exposure to have an impact in these parameters is still unknow.

On the other hand, this is the first population-based study conducted in a region that suffered a disaster of this magnitude, which will constitute the baseline of a cohort. The identification of risk factors associated with the development of anemia, dyslipidemia, subclinical inflammation, and decreased eGFR, especially in individuals from areas with mining activity, can provide subsidies for the early identification of diseases and increased risk of illness, and the proposition of public health measures aimed at mitigating these risk factors should be considered. The results of the present study will serve as a reference for the longitudinal assessment of the health condition of the inhabitants of the different geographic strata of Brumadinho, more specifically the development of diseases that may be related to mining activities, exposure to mining mud tailings or the disaster per se.

REFERENCES

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History