Indicadores de saúde da população quilombola versus população não quilombola: revisão sistemática com metálise

Abstract

This thesis aims to identify studies on health indicators related to quilombola communities and the non-quilombola population in Brazil, in addition to performing a comparative analysis between the data presented in these studies. The thesis was structured in three main parts: a literature review chapter, which addresses the main theoretical aspects related to the topic; a results chapter, which presents a systematic review article with meta-analysis; and, finally, the final considerations, which bring reflections and conclusions on the research findings. In the systematic review article with meta-analysis, the search for publications was carried out in the PubMed, SciELO, LILACS, SCOPUS and Virtual Health Library databases. Cross-sectional studies conducted in Brazil that focused on both quilombola communities and the general (non-quilombola) population were included. The search terms used were registered in the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH). The search for studies was carried out on June 15, 2024. Study selection and data extraction were conducted independently by two researchers. The Rayyan application (https://www.rayyan.ai/) was used to select articles based on title and abstract, as well as to exclude duplicate articles. The methodological quality assessment of eligible studies was done using JBI’s (Joanna Briggis Institute) critical appraisal tools and data extraction was performed using JBI Extraction for quantitative studies. In the meta-analysis, the DerSimonian and Laird random-effects model was used, with the double arcsine transformation for the data. Statistical heterogeneity was investigated by calculating the inverse of the variance in a random-effects model, to understand the variability between studies. For statistical analyses, the population was segmented into quilombola and non-quilombola. The primary outcome analyzed was the prevalence of systemic arterial hypertension (SAH) in both the quilombola and non quilombola populations. The analyses were conducted using the statistical software Stata/SE 18.0 for Windows®. A total of 3,078 articles related to the quilombola population were found, of which 17 were included in the systematic review. Arterial hypertension emerged as one of the main indicators investigated, with prevalence rates ranging from 26% to 61.7%. Other outcomes addressed included obesity, metabolic syndrome, dyslipidemia, and mental health problems such as depression, among others. In the non-quilombola population, 6,593 articles were identified, of which 23 were included in the systematic review. Among these studies, arterial hypertension was the most prevalent outcome, with a rate of 27%. It was followed by overweight, with 18%, and metabolic syndrome, with 9%. For the meta-analysis, eight articles on the quilombola population and eight on the non-quilombola population were included. The prevalence of hypertension in the non-quilombola population was 27% (95% CI: 21%-33%), with high heterogeneity (I² = 99.86%). For the quilombola population, the prevalence of hypertension was 38% (95% CI: 31%-43%), also with high heterogeneity (I² = 93.43%). The differences in the prevalence of hypertension between the quilombola and non-quilombola populations were statistically significant (p = 0.02). It was observed that the prevalence of hypertension is higher in the quilombola population compared to the non-quilombola population. These data highlight the health disparities faced by quilombola communities, revealing that being quilombola is an additional risk factor for hypertension. This highlights the urgent need for more effective public health interventions and policies to improve the health of the black Brazilian population, especially quilombola communities.