ABSTRACT

Objective:

To analyze the temporal trends of prevalence of morbidities, risk and protection factors for noncommunicable diseases in elderly residents in Brazilian capitals between 2006 and 2021.

Methods:

A time series study with data from the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Inquiry. The variables analyzed were: high blood pressure, diabetes, smoking, overweight, obesity, consumption of alcoholic beverages, soft drinks, fruits and vegetables, and the practice of physical activity. Prais-Winsten regression and Interrupted Time Series from 2006 to 2014 and 2015 to 2021 were used.

Results:

From 2006 to 2021, for the total elderly population, there was an increase in diabetes (19.2 to 28.4%), alcohol consumption (2.5 to 3.2%), overweight (52.4 to 60.7%) and obesity (16.8 to 21.8%), and a reduction in the prevalence of smokers (9.4 to 7.4%) and in soft drink consumption (17 to 8.7%). By the interrupted series, between 2015 and 2021, there was stability in the prevalence of diabetes, female smokers, overweight among men, obesity in the total and male population, and soft drink consumption.

Conclusion:

Over the years, there have been changes and worsening in the indicators analyzed, such as an increase in diabetes, alcohol consumption, overweight, and obesity, which reinforces the importance of continuous monitoring and sustainability programs to promote the health, especially in the context of economic crisis, austerity, and COVID-19 pandemic.

Keywords:
Health of the elderly; Noncommunicable diseases; Risk factors; Protective factors

INTRODUCTION

Brazil is in a process of demographic and epidemiological transition due to the decrease in fertility and birth rates, as well as the increase in life expectancy, the reduction of infectious diseases and the growth of noncommunicable chronic diseases (NCDs).¹1 Barreto ML, Carmo EH. Padrões de adoecimento e de morte da população brasileira: os renovados desafios para o Sistema Único de Saúde. Ciênc Saúde Coletiva 2007; 12(suppl): 1179-90. https://doi.org/10.1590/S1413-81232007000700003
https://doi.org/10.1590/S1413-8123200700... .

Population aging is considered one of society's main gains, as it reflects social, technological, and health advances²2 Miranda GMD, Mendes ACG, Silva ALA. Population aging in Brazil: current and future social challenges and consequences. Rev Bras Geriatr Gerontol 2016; 19(3): 507-19. https://doi.org/10.1590/1809-98232016019.150140
https://doi.org/10.1590/1809-98232016019... . The United Nations Organization estimated that the global population aged 65 years old or older is expected to increase from 10% in 2022 to 16% in 2050³3 United Nations. Department of Economic and Social Affairs. World population prospects 2022. Summary of results. [Internet]. 2022 [cited on Aug. 29, 2022]. Available at: https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf
https://www.un.org/development/desa/pd/s... . In Brazil, projections by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística – IBGE) show that the aged population will correspond to 18.6% in 2030 and 33.7% in 2060⁴4 Instituto Brasileiro de Geografia e Estatística. Síntese de indicadores sociais: uma análise das condições de vida da população brasileira [Internet]. 2015 [cited on Aug. 29, 2022]. Available at: https://biblioteca.ibge.gov.br/visualizacao/livros/liv95011.pdf
https://biblioteca.ibge.gov.br/visualiza... .

NCDs are the most frequent among the aged population and the main causes of death and disability⁵5 Passos VMA, Champs APS, Teixeira R, Lima-Costa MFF, Kirkwood R, Veras R, et al. The burden of disease among Brazilian older adults and the challenge for health policies: results of the Global Burden of Disease Study 2017. Popul Health Metr 2020; 18(Suppl 1):14. https://doi.org/10.1186/s12963-020-00206-3
https://doi.org/10.1186/s12963-020-00206... . The four main groups of NCDs (cardiovascular, cancer, chronic respiratory diseasesand diabetes) have modifiable and common risk factors, such as smoking, alcohol abuse, physical inactivity and inadequate diet, which entail numerous social and economic consequences for individuals, families, and society⁶6 Malta DC, Morais Neto OL, Silva Junior JB. Apresentação do plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis no Brasil, 2011 a 2022. Epidemiol Serv Saúde 2011; 20(4): 425-38. http://dx.doi.org/10.5123/S1679-49742011000400002
http://dx.doi.org/10.5123/S1679-49742011... . On the other hand, the adoption of healthy habits, such as the practice of physical activity and the consumption of fruits and vegetables, can reduce the risk of developing these diseases, in addition to helping to control weight and improve quality of life and mental health⁷7 Malta DC, Iser BPM, Claro RM, Moura L, Bernal RTI, Nascimento AF, et al. Prevalência de fatores de risco e proteção para doenças crônicas não transmissíveis em adultos: estudo transversal, Brasil, 2011. Epidemiol Serv Saúde 2013; 22(3): 423-34. http://dx.doi.org/10.5123/S1679-49742013000300007
http://dx.doi.org/10.5123/S1679-49742013... .

Due to the severity of NCDs and their impact on Public Health, national efforts have been made to implement policies, programs and actions for the prevention and control of these diseases and their risk factors, in addition to comprehensive care and treatment⁶6 Malta DC, Morais Neto OL, Silva Junior JB. Apresentação do plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis no Brasil, 2011 a 2022. Epidemiol Serv Saúde 2011; 20(4): 425-38. http://dx.doi.org/10.5123/S1679-49742011000400002
http://dx.doi.org/10.5123/S1679-49742011... ,⁷7 Malta DC, Iser BPM, Claro RM, Moura L, Bernal RTI, Nascimento AF, et al. Prevalência de fatores de risco e proteção para doenças crônicas não transmissíveis em adultos: estudo transversal, Brasil, 2011. Epidemiol Serv Saúde 2013; 22(3): 423-34. http://dx.doi.org/10.5123/S1679-49742013000300007
http://dx.doi.org/10.5123/S1679-49742013... . There are also policies and guidelines that propose actions, services, and programs aimed at comprehensive health care for the aged⁸8 Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria no 2.528 de 19 de outubro de 2006. Aprova a Política Nacional de Saúde da Pessoa Idosa [Internet]. 2006 [cited on Aug. 29, 2022]. Available at: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2006/prt2528_19_10_2006.html
https://bvsms.saude.gov.br/bvs/saudelegi... ,⁹9 Brasil. Ministério da Saúde. Diretrizes para o cuidado das pessoas idosas no SUS: Proposta de modelo de atenção integral. XXX Congresso Nacional de Secretarias Municipais de Saúde [Internet]. 2014 [cited on Aug. 29, 2022]. Available at: https://bvsms.saude.gov.br/bvs/publicacoes/diretrizes_cuidado_pessoa_idosa_sus.pdf
https://bvsms.saude.gov.br/bvs/publicaco... . However, from mid-2014, economic and governmental crises occurred in Brazil, with the implementation of austerity policies that contributed to generate unemployment, increase inequalities, and negatively affect the health and social protection system¹⁰10 Malta DC, Duncan BB, Barros MBA, Katikireddi SV, Souza FM, Silva AG, et al. Medidas de austeridade fiscal comprometem metas de controle de doenças não transmissíveis no Brasil. Ciênc Saúde Colet 2018; 23(10): 3115-22. https://doi.org/10.1590/1413-812320182310.25222018
https://doi.org/10.1590/1413-81232018231... ,¹¹11 Silva AG, Teixeira RA, Prates EJS, Malta DC. Monitoramento e projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras. Ciênc Saúde Coletiva 2021; 26(4): 1193-206. https://doi.org/10.1590/1413-81232021264.42322020
https://doi.org/10.1590/1413-81232021264... . Added to this is the COVID-19 pandemic, which contributed to reduced access to health services and worsened living conditions, especially among aged people with NCDs¹²12 Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41(2): 145-51. https://doi.org/10.3760/cma.j.issn.0254-6450.2020.02.003
https://doi.org/10.3760/cma.j.issn.0254-... ,¹³13 Estrela FM, Cruz MA, Gomes NP, Oliveira MAS, Santos RS, Magalhães JRF, et al. COVID-19 e doenças crônicas: impactos e desdobramentos frente à pandemia. Rev Baiana Enferm 2020; 34: e36559. https://doi.org/10.18471/rbe.v34.36559
https://doi.org/10.18471/rbe.v34.36559... .

In the national context of population aging and increased NCDs cases, accompanied by the crisis, austerity and COVID-19 pandemic scenario, few Brazilian studies have been carried out, especially with analyses of historical series. In addition, it is important to monitor the health indicators of the aged population, in order to verify the changes that have occurred over the years and to know the reality in which they are inserted and their life habits. Thus, it is expected to contribute to the surveillance, control, and prevention of NCDs, so that Brazilian aged people can achieve longevity with quality of life.

This article aimed to analyze the temporal trends in the prevalence of morbidities and risk and protective factors for NCDs in elderly residents in Brazilian capitals between 2006 and 2021.

METHODS

Study design and data source

This is a time series study, from 2006 to 2021, with data from the Surveillance System of Risk and Protective Factors for Chronic Diseases by Telephone Survey (Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico – Vigitel).

Vigitel is a population-based telephone survey that annually monitors, since 2006, the frequency and distribution of the main risk and protective factors for NCDs¹⁴14 Bernal RTI, Iser BPM, Malta DC, Claro RM. Sistema de vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico (Vigitel): mudança na metodologia de ponderação. Epidemiol Serv Saúde 2017; 26(4): 701-12. https://doi.org/10.5123/S1679-49742017000400003
https://doi.org/10.5123/S1679-4974201700... . The sampling procedures employed aim to obtain representativeness of the capitals of the 26 Brazilian states and the Federal District, through probabilistic samples of the population of adults (≥18 years old) residing in households with at least one telephone landline¹⁴14 Bernal RTI, Iser BPM, Malta DC, Claro RM. Sistema de vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico (Vigitel): mudança na metodologia de ponderação. Epidemiol Serv Saúde 2017; 26(4): 701-12. https://doi.org/10.5123/S1679-49742017000400003
https://doi.org/10.5123/S1679-4974201700... ,¹⁵15 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis. Vigitel Brasil 2021: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2021. Brasília: Ministério da Saúde; 2021..

Sample

This study considered the population aged 65 years old or older, as it is the same used for post-stratification in the Vigitel analyses.

Between 2006 and 2022, approximately 162,673 people aged 65 years old or older were interviewed, as follows: 6,069 (2006); 6,215 (2007); 6,679 (2008); 6,886; (2009); 7,340 (2010); 8,074 (2011); 7,580 (2012); 10,400 (2013); 8,417 (2014); 13,349 (2015); 13,649 (2016); 15,727 (2017); 15,338 (2018); 17,583 (2019); 8,941 (2020); and 10,426 (2021).

Variables

For the present study, the following variables evaluated by Vigitel were included:

1. Morbidity: high blood pressure and self-reported diabetes.

2. Risk factors: smoking; abusive consumption of alcoholic beverages; overweight; obesity; and soft drink consumption (variable added to Vigitel in 2007).

3. Protective factors: recommended consumption of fruits and vegetables (variable added to Vigitel in 2008) and practice of leisure-time physical activity (LTPA) (variable added to Vigitel in 2009).

The full description of the variables is in Supplementary Material 1.

Data analysis

The variables were described in terms of prevalence by year the survey was carried out and stratified according to the total aged population and sex (female and male).

This study used the analysis of interrupted time series, a methodology that aims to verify whether there was an effect of intervention/event/event on the trends of a given measure of interest¹⁶16 Bernal JL, Cummins S, Gasparrini A. Interrupted time series regression for the evaluation of public health interventions: a tutorial. Int J Epidemiol 2017; 46(1): 348-55. https://doi.org/10.1093/ije/dyw098
https://doi.org/10.1093/ije/dyw098... . Thus, the following periods and the respective events were considered for the analysis: 2006 to 2021 (complete period); 2006 to 2014 (implementation of the strategic action plan to face NCDs in Brazil 2011–2022 and economic stability)⁶6 Malta DC, Morais Neto OL, Silva Junior JB. Apresentação do plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis no Brasil, 2011 a 2022. Epidemiol Serv Saúde 2011; 20(4): 425-38. http://dx.doi.org/10.5123/S1679-49742011000400002
http://dx.doi.org/10.5123/S1679-49742011... ,¹¹11 Silva AG, Teixeira RA, Prates EJS, Malta DC. Monitoramento e projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras. Ciênc Saúde Coletiva 2021; 26(4): 1193-206. https://doi.org/10.1590/1413-81232021264.42322020
https://doi.org/10.1590/1413-81232021264... ; and 2015 to 2021 (occurrence of economic crisis, with implementation of austerity policies¹⁷17 Hone T, Mirelman AJ, Rasella D, Paes-Sousa R, Barreto ML, Rocha R, et al. Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities. Lancet Global Health 2019; 7(11): e1575-e1583. https://doi.org/10.1016/S2214-109X(19)30409-7
https://doi.org/10.1016/S2214-109X(19)30... ,¹⁸18 Massuda A, Hone T, Leles FAG, Castro MC, Atun R. The Brazilian health system at crossroads: progress, crisis and resilience. BMJ Global Health 2018; 3(4): e000829. https://doi.org/10.1136/bmjgh-2018-000829
https://doi.org/10.1136/bmjgh-2018-00082... , and COVID-19 pandemic, recognized by the World Health Organization [WHO], on March 11^th, 2020)¹⁹19 World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19-11 March 2020 [Internet]. Genebra: WHO; 2020. [cited on Aug. 29, 2022]. Available at: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
https://www.who.int/director-general/spe... .

Trend analysis was performed using generalized Prais-Winsten linear regression, which corrects for the effect of first-order serial autocorrelation²⁰20 Antunes JLF, Cardoso MRA. Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol Serv Saúde 2015; 24(3): 565-76. https://doi.org/10.5123/S1679-49742015000300024
https://doi.org/10.5123/S1679-4974201500... .

The annual percentage change (APC) was also calculated for each analyzed variable, based on the following formula²¹21 Kim HJ, Luo J, Chen HS, Green D, Buckman D, Byrne J, et al. Improved confidence interval for average annual percent change in trend analysis. Stat Med 2017; 36(19): 3059-74. https://doi.org/10.1002/sim.7344
https://doi.org/10.1002/sim.7344... :

Beta 1 (β1) refers to the angular coefficient of the Prais-Winsten regression.

The 95% confidence intervals (95%CI) of the APC measurements were also calculated, using the following formula²¹21 Kim HJ, Luo J, Chen HS, Green D, Buckman D, Byrne J, et al. Improved confidence interval for average annual percent change in trend analysis. Stat Med 2017; 36(19): 3059-74. https://doi.org/10.1002/sim.7344
https://doi.org/10.1002/sim.7344... :

Where: the t in the formula refers to the Student's t test by the degrees of freedom for time periods and with a confidence level of 95%, while e corresponds to the standard error. Prais-Winsten regression and standard error β1 values were generated using a statistical analysis program.

Regression results were interpreted as follows: significant trend when the β of the regression was different from zero and the p-value was lower than or equal to 0.05. Thus, there was an increasing trend when β was positive, a decreasing trend if β was negative, and a stationary trend when no statistically significant difference was identified.

For data analysis, post-stratification weights used in Vigitel were considered¹⁴14 Bernal RTI, Iser BPM, Malta DC, Claro RM. Sistema de vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico (Vigitel): mudança na metodologia de ponderação. Epidemiol Serv Saúde 2017; 26(4): 701-12. https://doi.org/10.5123/S1679-49742017000400003
https://doi.org/10.5123/S1679-4974201700... ,¹⁵15 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Análise em Saúde e Vigilância de Doenças não Transmissíveis. Vigitel Brasil 2021: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados brasileiros e no Distrito Federal em 2021. Brasília: Ministério da Saúde; 2021..

Analyses were performed using Stata software (Stata Corp. LP, College Station, Texas, United States), version 14.0, and data organization and graphing were performed using Microsoft^® Office Excel 2016.

Ethical aspects

Vigitel complied with Resolution 466/2012, which involves research with human beings. The data are available for public access and use, and their collection was approved by the National Commission for Ethics in Research on Human Beings of the Ministry of Health. The informed consent was obtained orally at the time of telephone contact with the interviewees.

RESULTS

Figure 1 represents the time series of the prevalence of high blood pressure and diabetes, as well as the risk and protection factors for NCDs, from 2006 to 2021, according to sex, with the representation of interruption, which makes it possible to visualize variations in the prevalence of indicators from 2015. Full results can be found in Supplementary Material 2.

Self-reported high blood pressure increased significantly among aged males (APC=0.66%; 95%CI 0.06–1.27). Diabetes showed a growing trend for the total aged population (APC=1.88; 95%CI 1.13–2.64), males (APC=2.32; 95%CI 1.56–3.10), and females (APC =1.60; 95%CI 0.77–2.44) (Figure 1).

With regard to risk factors, considering the entire period, the trend was for a decline in the prevalence of smoking among all aged people (APC=−2.16; 95%CI −2.77; −1.54) and for those of the male sex (APC=-3.50; 95%CI −4.38; −2.62). On the other hand, among females, the trend was one of stability. Alcohol abuse showed a growing trend among the total aged population (APC=3.16; 95%CI −0.09; 6.51) and females (APC=6.33; 95%CI 2.65–10.15), with stability among males. As for overweight, there was an upward trend for the total number of aged people (APC=1.11; 95%CI 0.92–1.30), among males (APC=1.13; 95%CI 0.77–1.50) and among females (APC=1.07; 95%CI 0.85–1.29). Similarly, obesity also increased significantly, respectively: APC=1.87 (95%CI 1.29–2.45), APC=2.84 (95%CI 1.51–4.18), and APC= 1.47 (95%CI 1.03–1.92). For soft drinks consumption, the trend was decreasing for the total aged population (APC=−4.32; 95%CI −6.25; −2.35), among male participants (APC=-3.99; 95%CI −6.08; −1.86), and among females (APC=−4.73; 95%CI −6.74; −2.68) (Figure 1).

As for the protective factors for NCDs, the consumption of fruits and vegetables and the practice of LTPA remained stable for the total population and for both sexes (Figure 1).

Tables 1 and 2 show the results of the interrupted time series, carried out in two periods (2006 to 2014 and 2015 to 2021), respectively, according to sex.

Self-reported high blood pressure was stable in both periods. Diabetes increased significantly from 2006 to 2014 and stabilized from 2015 to 2021. Between 2006 and 2014, the prevalence of smokers decreased (p<0.05); and, from 2015 to 2021, the trends continued to decline among the total aged population and among males, however, there was stability in the prevalence for females (p=0.41). As for the abusive consumption of alcoholic beverages, the trends were stable in both periods (p>0.05). From 2015 to 2021, there was stability in the prevalence of overweight and obesity among aged males and for the total population in relation to obesity (p>0.05). Soft drinks consumption decreased in the first period (2007 to 2014) only among men, remaining stable among the other segments of the studied population. The consumption of fruits and vegetables and the practice of LTPA showed a trend of stability in both analyzed periods (Tables 1 and 2).

DISCUSSION

Brazilian capitals registered, from 2006 to 2021: stability of high blood pressure for the total aged population; increased diabetes; reduction in the prevalence of smokers; increase in alcohol abuse, overweight, and obesity; decline in soft drink consumption; and stability of fruit and vegetable consumption and LTPA. Analyzing the interrupted time series, it is noteworthy that, between 2015 and 2021, there was stability in the prevalence of female smokers, overweight among men, obesity in the total aged population and among men, soft drinks consumption, and diabetes.

Increased burden of high blood pressure and diabetes is also driven by growth in modifiable risk factors, socioeconomic inequalities, and population aging²²22 Odukoya O, Fox RS, Hayman LL, Penedo FJ. The International Society for Behavioral Medicine (ISBM) and the Society of Behavioral Medicine (SBM) advocate for the inclusion of behavioral scientists in the implementation of the Global Action Plan for the prevention of non-communicable diseases (NCDs) in low- and middle-income countries. Transl Behav Med 2021; 11(6): 1286-88. https://doi.org/10.1093/tbm/ibaa128
https://doi.org/10.1093/tbm/ibaa128... ,²³23 Rocha AS, Pinho BATD, Lima EN. Hipertensão arterial entre idosos: comparação entre indicadores do Ceará, do Nordeste e do Brasil. Rev Bras Promoc Saúde 2021; 34: 10795. https://doi.org/10.5020/18061230.2021.10795
https://doi.org/10.5020/18061230.2021.10... .

Since 1990, the prevalence of type 2 diabetes has increased by 30% in men and 26% in women. It is estimated that, by 2040, diabetes will be the third leading cause of death in Brazil²⁴24 Duncan BB, Cousin E, Naghavi M, Afshin A, França EB, Passos VMA, et al. The burden of diabetes and hyperglycemia in Brazil: a global burden of disease study 2017. Popul Health Metrics 2020; 18(Suppl 1): 9. https://doi.org/10.1186/s12963-020-00209-0
https://doi.org/10.1186/s12963-020-00209... . A study with data from the National Health Survey (Pesquisa Nacional de Saúde – PNS), editions of 2013 and 2019, showed an increase in self-reported diabetes, from 6.2% (95%CI 5.9–6.8) to 7.7% (95%CI 7.4–8.0), and also high blood pressure, from 21.4% (95%CI 20.8–22.0) to 23.9% (95%CI 23.5–24.4)²⁵25 Malta DC, Silva AG, Gomes CS, Stopa SR, Oliveira MM, Sardinha LMV, et al. Monitoramento das metas dos planos de enfrentamento das Doenças Crônicas Não Transmissíveis: resultados da Pesquisa Nacional de Saúde, 2013 e 2019. Epidemiol Serv Saúde 2022; 31(nspe1): e2021364. https://doi.org/10.1590/SS2237-9622202200008.especial
https://doi.org/10.1590/SS2237-962220220... . Socioeconomic inequalities related to NCDs should also be considered, since the highest incidence of these diseases occurs in black or brown individuals, illiterate or with incomplete primary education, who do not have private health insurance, and with lower income²⁶26 Malta DC, Bernal RTI, Lima MG, Silva AG, Szwarcwald CL, Barros MBA. Desigualdades socioeconômicas relacionadas às doenças crônicas não transmissíveis e suas limitações: Pesquisa Nacional de Saúde, 2019. Rev Bras Epidemiol 2021; 24: E210011.SUPL.2. https://doi.org/10.1590/1980-549720210011.supl.2
https://doi.org/10.1590/1980-54972021001... . It is noteworthy that there has been a significant increase in the diagnosis, treatment, and control of these diseases, but there is still a need to reduce socioeconomic and health inequalities.

The prevalence of aged smokers has decreased over the years. However, among women, the decline occurred only in the first period analyzed (2006 to 2014). The reduction of smoking in Brazil is also observed among the adult population²⁷27 Malta DC, Silva AG, Machado IE, Sá ACMGN, Santos FM, Prates EJS, et al. Trends in smoking prevalence in all Brazilian capitals between 2006 and 2017. J Bras Pneumol 2019; 45(5): e20180384. http://dx.doi.org/10.1590/1806-3713/e20180384
http://dx.doi.org/10.1590/1806-3713/e201... , reflecting the commitment that the country assumed globally to reduce the prevalence of smokers by 30%⁶6 Malta DC, Morais Neto OL, Silva Junior JB. Apresentação do plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis no Brasil, 2011 a 2022. Epidemiol Serv Saúde 2011; 20(4): 425-38. http://dx.doi.org/10.5123/S1679-49742011000400002
http://dx.doi.org/10.5123/S1679-49742011... . Despite this reduction, the habit of smoking is still a Public Health problem, especially among the aged population, who, due to prolonged exposure to tobacco, are at greater risk of diseases, comorbidities, and premature deaths caused by tobacco²⁸28 Zaitune MPA, Barros MBA, Lima MG, César CLG, Carandina L, Goldbaum M, et al. Fatores associados ao tabagismo em idosos: Inquérito de Saúde no Estado de São Paulo (ISA-SP). Cad Saúde Pública 2012; 28(3): 583-96 https://doi.org/10.1590/S0102-311X2012000300018
https://doi.org/10.1590/S0102-311X201200... . Therefore, it is necessary to strengthen the regulatory role of the government, prevention measures, and the treatment of smokers²⁹29 Caldeira S, Parecy SM, Maraschin MS, Ross C, Machineski GG, Ribeiro SA. Vivência de mulher idosa tabagista: um estudo na fenomenologia social de Alfred Schütz. REME Rev Min Enferm 2016; 20(1-7): e95. https://doi.org/10.5935/1415-2762.20160022
https://doi.org/10.5935/1415-2762.201600... .

From 2006 to 2021, alcohol abuse increased among the total aged population and among women. This growth may be related to widowhood, loneliness, loss of friends, retirement, isolation, anxiety, depression, and stress³⁰30 Eastman MR, Finlay JM, Kobayashi LC. Alcohol use and mental health among older american adults during the early months of the COVID-19 pandemic. Int J Environ Res Public Health 2021; 18(8): 4222. https://doi.org/10.3390/ijerph18084222
https://doi.org/10.3390/ijerph18084222... . It is important to highlight that the aged population is more vulnerable to the effects of alcohol and that, therefore, its consumption can cause cognitive and intellectual deficits, behavioral impairments, greater risk of exposure to falls and other injuries, in addition to medication interaction³¹31 Carvalho JKF, Pereira-Rufino LS, Panfilio CE, Silva RDA, Céspedes IC. Effect of chronic alcohol intake on motor functions on the elderly. Neurosci Lett 2021; 745: 135630. https://doi.org/10.1016/j.neulet.2021.135630
https://doi.org/10.1016/j.neulet.2021.13... . These effects are responsible for the increase in hospitalizations, deaths, and health costs³¹31 Carvalho JKF, Pereira-Rufino LS, Panfilio CE, Silva RDA, Céspedes IC. Effect of chronic alcohol intake on motor functions on the elderly. Neurosci Lett 2021; 745: 135630. https://doi.org/10.1016/j.neulet.2021.135630
https://doi.org/10.1016/j.neulet.2021.13... .

The prevalence of overweight and obesity has increased globally³²32 Di Angelantonio E, Bhupathiraju SN, Wormser D, Gao P, Kaptoge S, Gonzalez AB, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet 2016; 388(10046): 776-86. https://doi.org/10.1016/S0140-6736(16)30175-1
https://doi.org/10.1016/S0140-6736(16)30... , which can be attributed to behavioral, environmental, socioeconomic, genetic³³33 Meldrum DR, Morris MA, Gambone JC. Obesity pandemic: causes, consequences, and solutions-but do we have the will? Fertil Steril 2017; 107(4): 833-9. https://doi.org/10.1016/j.fertnstert.2017.02.104
https://doi.org/10.1016/j.fertnstert.201... , and changes in body composition that occur with aging³⁴34 Batsis JA, Zagaria AB. Addressing obesity in aging patients. Med Clin North Am 2018; 102(1): 65-85. https://doi.org/10.1016/j.mcna.2017.08.007
https://doi.org/10.1016/j.mcna.2017.08.0... . Added to this is the spread of obesogenic environments and the increased consumption of ultra-processed and high-fat foods, a behavior that tends to increase in times of crisis, since such foods are more accessible when compared to fresh ones³⁵35 Martins APB, Levy RB, Claro RM, Moubarac JC, Monteiro CA. Increased contribution of ultra-processed food products in the Brazilian diet (1987-2009). Rev Saúde Pública 2013; 47(4): 656-65. https://doi.org/10.1590/S0034-8910.2013047004968
https://doi.org/10.1590/S0034-8910.20130... ,³⁶36 Claro RM, Maia EG, Costa BVL, Diniz DP. Food prices in Brazil: prefer cooking to ultra-processed foods. Cad Saude Publica 2016; 32(8): e00104715. https://doi.org/10.1590/0102-311X00104715
https://doi.org/10.1590/0102-311X0010471... . Obesity among aged people impacts not only morbidity and mortality, but also quality of life, increasing the risk of nursing home stays. Therefore, health promotion actions, such as healthy eating and the practice of physical activity, are effective and contribute to weight reduction, as well as the improvement of physical function and quality of life³³33 Meldrum DR, Morris MA, Gambone JC. Obesity pandemic: causes, consequences, and solutions-but do we have the will? Fertil Steril 2017; 107(4): 833-9. https://doi.org/10.1016/j.fertnstert.2017.02.104
https://doi.org/10.1016/j.fertnstert.201... ,³⁷37 Pinheiro MC, Moura ALSP, Bortolini GA, Coutinho JG, Rahal LS, Bandeira LM, et al. Abordagem intersetorial para prevenção e controle da obesidade: a experiência brasileira de 2014 a 2018. Rev Panam Salud Publica 2019; 43: e58. https://doi.org/10.26633/RPSP.2019.58
https://doi.org/10.26633/RPSP.2019.58... . Efforts to halt the growth of overweight and obesity must be sustainable by the government and, above all, advance in regulatory measures, for taxation on sugary drinks and ultra-processed foods³⁸38 World Health Organization. ‘Best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases [Internet]. Genebra: WHO; 2011 [cited on Aug. 29, 2022]. Available at: https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf
https://apps.who.int/iris/bitstream/hand... .

In this context, a decline in soft drinks consumption was observed, however, considering the interrupted series, there was stability. Sugary drinks, such as soft drink, are the main sources of added sugar in the diet, and high consumption is considered an important risk factor for NCDs. Therefore, WHO recommends reducing sugar consumption to less than 10% of daily calorie intake and implementing fiscal policies to increase the price of sugary drinks³⁹39 World Health Organization. Guideline: sugars intake for adults and children [Internet] Genebra: WHO; 2015 [cited on Aug. 29, 2022]. Available at: https://apps.who.int/iris/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1
https://apps.who.int/iris/bitstream/hand... . Taxes were implemented in several countries and had a positive impact on reducing purchases or sales of these beverages⁴⁰40 Sánchez-Romero LM, Canto-Osorio F, González-Morales R, Colchero MA, Ng SW, Ramírez-Palacios P, et al. Association between tax on sugar sweetened beverages and soft drink consumption in adults in Mexico: open cohort longitudinal analysis of Health Workers Cohort study. BMJ 2020; 369: m1311. https://doi.org/10.1136/bmj.m1311
https://doi.org/10.1136/bmj.m1311... . These results are noteworthy, as no regulatory measure regarding food taxation has been implemented in Brazil, making it necessary to review this agenda¹⁰10 Malta DC, Duncan BB, Barros MBA, Katikireddi SV, Souza FM, Silva AG, et al. Medidas de austeridade fiscal comprometem metas de controle de doenças não transmissíveis no Brasil. Ciênc Saúde Colet 2018; 23(10): 3115-22. https://doi.org/10.1590/1413-812320182310.25222018
https://doi.org/10.1590/1413-81232018231... .

Fruits and vegetables contain essential nutrients for health and are essential for a healthy eating pattern. Regular consumption of these foods is characterized as a protective factor for NCDs, promotes healthy aging, is predictive of longevity, and brings cognitive benefits⁴¹41 Nicklett EJ, Kadell AR. Fruit and vegetable intake among older adults: a scoping review. Maturitas 2013; 75(4): 305-12. https://doi.org/10.1016/j.maturitas.2013.05.005
https://doi.org/10.1016/j.maturitas.2013... . However, in the present study, no increase in consumption was observed among the aged, which is worrying. The low consumption of fruits and vegetables among the aged has been associated with economic conditions, rising food prices, lack of nutritional knowledge, reduced mobility and difficult access due to geographic location⁴²42 Brewer D, Dickens E, Humphrey A, Stephenson T. Increased fruit and vegetable intake among older adults participating in Kentucky's congregate meal site program. Educ Gerontol 2016; 42(11): 771-84. https://doi.org/10.1080/03601277.2016.1231511
https://doi.org/10.1080/03601277.2016.12... ,⁴³43 Almeida LFF, Novaes TG, Pessoa MC, Carmo AS, Mendes LL, Ribeiro AQ. Fruit and vegetable consumption among older adults: influence of urban food environment in a medium-sized Brazilian city. Public Health Nutr 2021; 24(15): 4878-87. https://doi.org/10.1017/S136898002000467X
https://doi.org/10.1017/S136898002000467... . The increase in the consumption of fruits and vegetables among the aged population requires intersectionality, subsidy for access to healthy foods, market regulation strategies that allow the production and distribution of fruits and vegetables, policies to face food and nutritional insecurity in Brazil, in addition to macroeconomic and social policies that make it possible to reduce prices and increase family income⁴⁴44 Claro RM, Monteiro CA. Renda familiar, preço de alimentos e aquisição domiciliar de frutas e hortaliças no Brasil. Rev Saúde Pública 2010; 44(6): 1014-20. https://doi.org/10.1590/S0034-89102010000600005
https://doi.org/10.1590/S0034-8910201000... ,⁴⁵45 Neder H, Alves Filho N, Souza S. Acesso à renda e inflação de preços de alimentos no Brasil: análise dos efeitos do programa Bolsa Família. Rev Econ Sociol Rural 2015; 53(1): 51-70. https://doi.org/10.1590/1234-56781806-9479005301003
https://doi.org/10.1590/1234-56781806-94... . Furthermore, it is necessary to encourage opportunities for communities and cities to implement actions that promote active, healthy, and sustainable aging, especially to deal with the vulnerabilities present in this population⁴³43 Almeida LFF, Novaes TG, Pessoa MC, Carmo AS, Mendes LL, Ribeiro AQ. Fruit and vegetable consumption among older adults: influence of urban food environment in a medium-sized Brazilian city. Public Health Nutr 2021; 24(15): 4878-87. https://doi.org/10.1017/S136898002000467X
https://doi.org/10.1017/S136898002000467... .

The results of this study showed stability of LTPA in all analyzed periods, which highlights the need to increase it. There are factors that hinder the practice of physical activity among the aged population, such as: interpersonal barriers related to income, pain, illness or injury, physical limitation, fear of falling and getting hurt, and environmental barriers, such as lack of security, environmental characteristics, weather conditions, and the lack of places to practice physical activity close to home⁴⁶46 Socoloski TS, Rech CR, Correa Junior JA, Lopes RM, Hino AAF, Guerra PH. Barreiras para a prática de atividade física em idosos: revisão de escopo de estudos brasileiros. Rev Bras Ativ Fis Saúde 2021; 26: e0208. https://doi.org/10.12820/rbafs.26e0208
https://doi.org/10.12820/rbafs.26e0208... . Thus, it becomes necessary to plan actions aimed at the aged public, to increase the practice of PSFT, seeking behavioral changes for the adoption of an active lifestyle, in addition to creating and maintaining environments that allow equitable access to places and spaces for the practice of physical activity in their cities and communities.

Analyzing the interrupted time series, from 2015 onward there was stability in the prevalence of some indicators analyzed in the present study, which may be a consequence of the economic crisis and austerity in Brazil, which contributed to the increase in unemployment and inequalities and to the reduction of investments in social and health promotion policies, culminating in the weakening of the government's regulatory role, in addition to directly affecting health services¹¹11 Silva AG, Teixeira RA, Prates EJS, Malta DC. Monitoramento e projeções das metas de fatores de risco e proteção para o enfrentamento das doenças crônicas não transmissíveis nas capitais brasileiras. Ciênc Saúde Coletiva 2021; 26(4): 1193-206. https://doi.org/10.1590/1413-81232021264.42322020
https://doi.org/10.1590/1413-81232021264... ,⁴⁷47 Souza LEPF, Barros RD, Barreto ML, Katikireddi SV, Hone TV, Sousa RP, et al. The potential impact of austerity on attainment of the Sustainable Development Goals in Brazil. BMJ Global Health 2019; 4: e001661. http://dx.doi.org/10.1136/bmjgh-2019-001661
http://dx.doi.org/10.1136/bmjgh-2019-001... ,⁴⁸48 Rasella D, Basu S, Hone T, Paes-Sousa R, Ocké-Reis CO, Millett C. Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: a nationwide microsimulation study. PLoS Med 2018, 15(5): e1002570. https://doi.org/10.1371/journal.pmed.1002570
https://doi.org/10.1371/journal.pmed.100... .

This scenario became even more serious with the COVID-19 pandemic, which changed the behavioral patterns and lifestyles of the population⁴⁹49 Malta DC, Gomes CS, Szwarcwald CL, Barros MBA, Silva AG, Prates EJS, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde Debate 2020; 44(spe4): 177-90. https://doi.org/10.1590/0103-11042020E411
https://doi.org/10.1590/0103-11042020E41... . Among the aged, the pandemic intensified issues that were already present, such as the loss of social support, the trauma of stigma, and isolation. There was also a reduction in access to health services, which may reduce the possibilities of diagnosing NCDs, in addition to the negative impact on daily activities, mental health, and cognition of the aged⁵⁰50 Lebrasseur A, Fortin-Bédard N, Lettre J, Raymond E, Bussières EL, Lapierre N, et al. Impact of the COVID-19 pandemic on older adults: rapid review. JMIR Aging 2021; 4(2): e26474. https://doi.org/10.2196/26474
https://doi.org/10.2196/26474... . A study carried out with aged Brazilians who participated in the Behavioral Survey (ConVid) showed that, during the pandemic, only 8.3% of them (95%CI 6.4–10.7) continued to work normally, there was a decrease in income in almost half of the households of the aged, and 21.9% (95%CI 18.7–25.4) reported a worsening of their health status⁵¹51 Romero DE, Muzy J, Damacena GN, Souza NA, Almeida WS, Szwarcwald CL, et al. Idosos no contexto da pandemia da COVID-19 no Brasil: efeitos nas condições de saúde, renda e trabalho. Cad Saúde Pública 2021; 37(3): e00216620. https://doi.org/10.1590/0102-311X00216620
https://doi.org/10.1590/0102-311X0021662... . The pandemic also increased social and economic vulnerability, contributing to rising food prices and unemployment, consequently reducing access to food and increasing food insecurity and hunger⁵²52 Alpino TMA, Santos CRB, Barros DC, Freitas CM. COVID-19 e (in)segurança alimentar e nutricional: ações do Governo Federal brasileiro na pandemia frente aos desmontes orçamentários e institucionais. Cad Saúde Pública 2020; 36(8): e00161320. https://doi.org/10.1590/0102-311X00161320
https://doi.org/10.1590/0102-311X0016132... ,⁵³53 Santos LP, Schäfer AA, Meller FO, Harter J, Nunes BP, Silva ICM, et al. Tendências e desigualdades na insegurança alimentar durante a pandemia de COVID-19: resultados de quatro inquéritos epidemiológicos seriados. Cad Saúde Pública 2021; 37(5): e00268520. https://doi.org/10.1590/0102-311X00268520
https://doi.org/10.1590/0102-311X0026852... .

In the context of economic crisis, austerity, and pandemic, which compromise health results and indicators, it is paramount to integrate intersectoral public policies, strengthen actions to promote health, and encourage healthy living habits throughout life, as exposure to health risk factors in childhood and adolescence increases the chances of developing NCDs in adult life. It is also necessary to advance in regulatory measures and in the sustainability of programs and public policies to face NCDs and their risk factors in Brazil, as well as investing in social policies to reduce inequalities. In addition, it is necessary to expand access to diagnosis and treatment, in addition to improving the quality of care.

This study had the following limitations: collection by telephone, which may result in the exclusion of certain populations, though this issue is minimized by the use of data weighting factors, a measure that seeks to match the demographic characteristics of the Vigitel sample to the characteristics of the population total. Also, the age range considered (from 65 years of age), despite being restrictive, is the one that best fits when using the post-stratification weight. The fact that data were collected in a self-reported manner may result in under- or over-estimation of actual prevalence rates and generate less accurate estimates. However, validation studies of the Vigitel questionnaire show satisfactory reproducibility and validity results⁵⁴54 Mendes LL, Campos SF, Malta DC, Bernal RTI, Sá NNB, Velásquez-Meléndez G. Validity and reliability of foods and beverages intake obtained by telephone survey in Belo Horizonte, Brazil. Rev Bras Epidemiol 2011; 14(Suppl 1): 80-9. https://doi.org/10.1590/s1415-790x2011000500009
https://doi.org/10.1590/s1415-790x201100... –⁵⁶56 Moreira AD, Claro RM, Felisbino-Mendes MS, Velasquez-Melendez G. Validity and reliability of a telephone survey of physical activity in Brazil. Rev Bras Epidemiol 2017; 20(1): 136-46. https://doi.org/10.1590/1980-5497201700010012
https://doi.org/10.1590/1980-54972017000... .

In summary, it was found that, over the years, there has been an increase in diabetes, alcohol abuse, overweight and obesity, as well as a reduction in the prevalence of smokers and soft drink consumption, in addition to stability of the consumption of fruits and vegetables, the LTPA, and the occurrence of high blood pressure. Between 2015 and 2021, the prevalence of female smokers, overweight among men, obesity in the total aged population and among men, consumption of soft drinks and diabetes stabilized.

It is recommended to continue monitoring, to verify the trend of these indicators, mainly due to the economic context and the COVID-19 pandemic, in addition to the development of representative studies of the Brazilian aged population on the impact of the pandemic on morbidity and risk factors and of protection for NCDs.

ACKNOWLEDGMENTS:

To the National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq), for the Junior Postdoctoral fellowships of Alanna Gomes da Silva and productivity scholarships of Deborah Carvalho Malta.

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