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Sarcopenia (the loss of muscle mass, strength and skeletal muscle function) increases mortality and the risk of hospitalization in the older population. Although it is known that older adults with type 2 diabetes mellitus (T2DM) have a higher risk of dynapenia and sarcopenia, few studies have investigated these conditions in middle-aged populations. The objective of this study was to investigate whether T2DM, its duration, the presence of albuminuria, and glycemic control are associated with sarcopenia and its components in adults. The cross-sectional analysis was based on data from visit 2 of the Brazilian Longitudinal Study of Adult Health (2012-2014). The 2018 European Working Group on Sarcopenia in Older People criteria were used to define dynapenia, low appendicular muscle mass (LAMM), and sarcopenia (absent/probable/confirmed). The explanatory variables were: T2DM; duration of T2DM; T2DM according to the presence of albuminuria; and glycemic control (HbA1C < 7%) among people with T2DM. A total of 12,132 participants (mean age = 55.5, SD: 8.9 years) were included. The odds ratio for LAMM was greater among those with T2DM, T2DM duration from 5 to 10 years, and T2DM without albuminuria. Chances of dynapenia were higher among those with T2DM, T2DM duration > 10 years, and T2DM with and without albuminuria. The variables T2DM, T2DM ≥ 10 years, and T2DM with albuminuria increased the odds of probable sarcopenia, and T2DM duration from 5 to 10 years increased the odds of confirmed sarcopenia. The results support the importance of frequently monitoring the musculoskeletal mass and strength of individuals with T2DM to prevent sarcopenia and related outcomes.

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Abstract: Sarcopenia (the loss of muscle mass, strength and skeletal muscle function) increases mortality and the risk of hospitalization in the older population. Although it is known that older adults with type 2 diabetes mellitus (T2DM) have a higher risk of dynapenia and sarcopenia, few studies have investigated these conditions in middle-aged populations. The objective of this study was to investigate whether T2DM, its duration, the presence of albuminuria, and glycemic control are associated with sarcopenia and its components in adults. The cross-sectional analysis was based on data from visit 2 of the Brazilian Longitudinal Study of Adult Health (2012-2014). The 2018 European Working Group on Sarcopenia in Older People criteria were used to define dynapenia, low appendicular muscle mass (LAMM), and sarcopenia (absent/probable/confirmed). The explanatory variables were: T2DM; duration of T2DM; T2DM according to the presence of albuminuria; and glycemic control (HbA1C < 7%) among people with T2DM. A total of 12,132 participants (mean age = 55.5, SD: 8.9 years) were included. The odds ratio for LAMM was greater among those with T2DM, T2DM duration from 5 to 10 years, and T2DM without albuminuria. Chances of dynapenia were higher among those with T2DM, T2DM duration > 10 years, and T2DM with and without albuminuria. The variables T2DM, T2DM ≥ 10 years, and T2DM with albuminuria increased the odds of probable sarcopenia, and T2DM duration from 5 to 10 years increased the odds of confirmed sarcopenia. The results support the importance of frequently monitoring the musculoskeletal mass and strength of individuals with T2DM to prevent sarcopenia and related outcomes.

Resumo: A sarcopenia (perda de massa muscular, força e função muscular esquelética) aumenta a mortalidade e o risco de hospitalização em idosos. Idosos com diabetes mellitus tipo 2 (DMT2) apresentam risco elevado de desenvolver dinapenia e sarcopenia, mas poucos estudos investigaram populações de meia-idade. O objetivo foi investigar se DMT2, sua duração, a presença de albuminúria e o controle glicêmico estão associados à sarcopenia e seus componentes em adultos. Análise transversal baseada nos dados da segunda visita do Estudo Longitudinal de Saúde do Adulto (2012-2014). Os critérios do European Working Group on Sarcopenia in Older People [Grupo de Trabalho Europeu sobre Sarcopenia em Pessoas Idosas] de 2018 foram usados para definir dinapenia, baixa massa muscular apendicular e sarcopenia (ausente/provável/confirmada). As variáveis explicativas foram: DMT2; duração do DMT2; DMT2 de acordo com a presença de albuminúria; e controle glicêmico (HbA1c < 7%) entre pessoas com DMT2. Foram incluídos 12.132 participantes (idade média de 55,5; DP: 8,9 anos). A razão de chances para baixa massa muscular apendicular foi maior entre pessoas com DMT2, duração do DMT2 entre 5 e 10 anos e DMT2 sem albuminúria. As chances de dinapenia foram maiores entre pessoas com DMT2, duração do DMT2 > 10 anos e DMT2 com e sem albuminúria. DMT2, DMT2 ≥ 10 anos e DMT2 com albuminúria aumentaram as chances de sarcopenia provável e duração do DMT2 entre 5 e 10 anos aumentaram as chances de sarcopenia confirmada. Os resultados reforçam a importância do monitoramento frequente da massa e da força muscular em indivíduos com DMT2 para prevenir a sarcopenia e desfechos relacionados.

Resumen: La sarcopenia (pérdida de masa muscular, fuerza y función muscular esquelética) aumenta la mortalidad y el riesgo de hospitalización en ancianos. Los ancianos con diabetes mellitus tipo 2 (DMT2) presentan un mayor riesgo de sufrir dinapenia y sarcopenia, pero pocos estudios han investigado poblaciones de mediana edad. El objetivo fue investigar si la DMT2, su duración, la presencia de albuminuria y el control glucémico están asociados con la sarcopenia y sus componentes en adultos. Análisis transversal basado en los datos de la visita 2 del Estudio Longitudinal de Salud del Adulto en Brasil (2012-2014). Se utilizaron los criterios del European Working Group on Sarcopenia in Older People [Grupo de Trabajo Europeo sobre Sarcopenia en Personas Mayores] del 2018 para definir dinapenia, baja masa muscular apendicular y sarcopenia (ausente/probable/confirmada). Las variables explicativas fueron las siguientes: DMT2; duración de la DMT2; DMT2 según la presencia de albuminuria; y control glucémico (HbA1c < 7%) entre personas con DMT2. Se incluyeron 12.132 participantes (edad media = 55,5, DE: 8,9 años). La razón de probabilidades de masa muscular apendicular baja fue mayor entre personas con DMT2, duración de la DMT2 entre 5 y 10 años y DMT2 sin albuminuria. Las probabilidades de dinapenia fueron mayores entre las personas con DMT2, duración de la DMT2 > 10 años y DMT2 con y sin albuminuria. Las condiciones de DMT2, DMT2 ≥ 10 años y DMT2 con albuminuria aumentaron las probabilidades de sarcopenia probable y la duración de la DMT2 entre 5 y 10 años las probabilidades de sarcopenia confirmada. Los resultados refuerzan la importancia del monitoreo frecuente de la masa y de la fuerza musculoesquelética en individuos con DMT2 para prevenir la sarcopenia y los desenlaces relacionados.

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BACKGROUND AND AIMS: Food intake influences uric acid (UA) levels and hyperuricemia (HU), but evidence on the role of ultra-processed foods (UPFs) are scarce. The association between UPFs consumption and (1) HU prevalence and UA levels; (2) HU cumulative incidence; and (3) UA level change over a 4-year period was investigated. METHODS AND RESULTS: Cross-sectional and longitudinal analyses were performed using baseline (2008-2010, aged 35-74 years) and second visit (2012-2014) data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Participants with glomerular filtration rate <60 mL/min/1.73 m2, bariatric surgery, implausible caloric intake, and using urate-lowering therapy (ULT) at baseline were excluded (all analyses). Participants with HU at baseline were excluded from longitudinal analyses. UPFs consumption was assessed using a food frequency questionnaire (FFQ) and categorized by the NOVA classification system (100 g/day). HU was defined as UA≥6.8 mg/dL. Linear, logistic, and mixed-effect linear regressions investigated the associations between UPFs consumption and UA/HU, adjusted for covariates. The final samples included 13,923 (cross-sectional) and 10,517 (longitudinal) individuals. The prevalence of HU was 18.7%, and the cumulative incidence was 4.9%. Greater UPFs consumption was associated with a greater prevalence of HU (OR:1.025 95%CI: 1.006; 1.044) and higher UA levels (ß:0.024 95%CI: 0.016; 0.032). Every additional consumption of 100 g/day of UPFs raised the 4-year cumulative incidence of HU by 5.6% (95%CI: 1.021; 1.092). However, UPFs were not associated with the pace of UA level changes during the study period. CONCLUSION: The present study shows that greater UPFs consumption is associated with another deleterious health consequence: higher UA levels and the risk of having HU.

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OBJECTIVE: To investigate the association between birth weight and bone mineral content (BMC), and whether this relationship differs between men and women. METHODS: A total of 10,159 participants from the ELSA-Brasil cohort were eligible for this analysis. The outcome was the z-score of the ratio BMC (kg)/height (m). The exposure was the low birth weight (< 2.5kg). The magnitude of the associations was estimated by mean differences and their respective 95% confidence intervals (95%CI) using linear regression. All analyses were presented for the total population and stratified by sex. RESULTS: Most were women (54.98%), and the mean age was 52.72 years (SD ± 6.6). In the crude model, we observed that low birth weight was associated with a lower mean BMC/height z-score, compared to adequate birth weight (mean difference: -0.30; 95%CI: -0.39 to -0.21), and this effect was stronger in men (mean difference: -0.43; 95%CI: -0.56 to -0.30) than in women (mean difference: -0.31; 95%CI: -0.44 to -0.19). After adjusting for age, sex per total population, race/skin color, maternal education, individual education, and current weight, there was a considerable reduction in the magnitude of the association (total population: -0.10; 95%CI: -0.14 to -0.06; men: -0.13; 95%CI: -0.21 to -0.06; women: -0.13; 95%CI: -0.21 to -0.05). CONCLUSION: Low birth weight is related to BMC/height z-score in both sexes with no indication of differences by sex. The magnitude of the associations was attenuated after adjustment for the current weight.

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Body fat distribution seems to have different effects in cardiovascular diseases (CVD). We aimed to estimate the associations between lower limbs and trunk fat ratio and the 10-year CVD risk, and isolated risk factors in men and women. A total of 10,917 participants from ELSA-Brasil were eligible for this cross-sectional study. Associations between lower limb/trunk fat ratio with the percentage of 10-year CVD risk - according to the Framingham Risk Score - and its risk factors (systolic blood pressure, total cholesterol and HDL-cholesterol, diabetes, and use of antihypertensive medication) were performed using generalized linear models, linear and logistic regressions. All analyses were stratified by gender and adjustments were made by age, self-reported skin color, educational attainment, alcohol consumption, leisure physical activity, hypolipidemic drug use and, for women, menopausal status. In this study, 55.91% were women, with a mean age of 52.68 (SD = 6.57) years. A higher lower limb/trunk fat ratio was related to lower 10-year CVD risk, as well as a reduction in systolic blood pressure, total cholesterol, and antihypertensive drug use, also an increasing HDL-cholesterol in both genders, but this relationship was stronger in women. Besides, a protective relationship to diabetes was observed in women. Higher fat accumulation in the lower body, when compared to the trunk, seems to have a lower risk of CVD and associated risk factors - even in the presence of fat in the abdominal region - with women presenting lower risks than men.

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Blacks and Browns have major health disadvantages, are less likely to rise in the social hierarchy throughout the course of life, and pertain to lower socioeconomic levels than Whites as a result of structural racism. However, little is known about the mediating role of intergenerational mobility in the association between race/skin color and health. The aim of the present study was to investigate the association between racism and self-rated health and to verify to what extent intergenerational social mobility mediates this association. This was a cross-sectional study conducted with data from 14,386 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010). Maternal education, education of the participant, socio-occupational class of the head of household, and socio-occupational class of the participant were used in the indicators of intergenerational social mobility (educational and socio-occupational). Logistic regression models were used. The prevalence of poor self-rated health was 15%, 24%, and 28% among Whites, Browns, and Blacks, respectively. After adjustments for age, sex, and research center, greater chances of poor self-rated health were found among Blacks (OR = 2.15; 95%CI: 1.92-2.41) and Browns (OR = 1.82; 95%CI: 1.64-2.01) when compared to Whites. Intergenerational educational and socio-occupational mobility mediated, respectively, 66% and 53% of the association between race/color and poor self-rated health in Blacks, and 61% and 51% in Browns, respectively. Results confirm racial iniquity in self-rated health and point out that unfavorable intergenerational social mobility is an important mechanism to explain this iniquity.

Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.

Negros y mulatos presentan grandes desventajas de salud, poseen menores oportunidades de ascensión en la jerarquía social en el trascurso de su vida, y menores niveles socioeconómicos que los blancos, como resultado del racismo estructural. No obstante, poco se sabe sobre el papel mediador de la movilidad intergeneracional en la asociación entre racismo y salud. El objetivo de este estudio fue investigar la asociación entre racismo y autoevaluación de salud, así como verificar en qué medida la movilidad social intergeneracional interfiere en esa asociación. Se trata de un estudio transversal, realizado con datos de 14.386 participantes de la base de referencia (2008-2010) del Estudio Longitudinal de Salud de Adultos (ELSA-Brasil). La escolaridad materna, del participante, clase socio-ocupacional del jefe de familia y clase socio-ocupacional del participante compusieron los indicadores de movilidad social intergeneracional (educacional y socio-ocupacional). Se utilizaron modelos de regresión logística. La prevalencia de autoevaluación de mala salud fue de 15%, 24% y 28% entre blancos, mulatos/mestizos y negros, respectivamente. Tras los ajustes por edad, sexo y centro de investigación, se encontraron mayores oportunidades de autoevaluación de mala salud entre negros (OR = 2,15; IC95%: 1,92-2,41) y mulatos/mestizos (OR = 1,82; IC95%: 1,64-2,01), cuando se compara con los blancos. La movilidad educacional y socio-ocupacional intergeneracional mediaron, respectivamente, 66% y 53% de la asociación entre raza/color y autoevaluación de mala salud en negros, y 61% y 51% en mulatos/mestizos, respectivamente. Los resultados confirman la inequidad racial en la autoevaluación de salud y apuntan que la movilidad social intergeneracional desfavorable es un importante mecanismo para explicar esa inequidad.

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ABSTRACT OBJECTIVE To investigate the association between birth weight and bone mineral content (BMC), and whether this relationship differs between men and women. METHODS A total of 10,159 participants from the ELSA-Brasil cohort were eligible for this analysis. The outcome was the z-score of the ratio BMC (kg)/height (m). The exposure was the low birth weight (< 2.5kg). The magnitude of the associations was estimated by mean differences and their respective 95% confidence intervals (95%CI) using linear regression. All analyses were presented for the total population and stratified by sex. RESULTS Most were women (54.98%), and the mean age was 52.72 years (SD ± 6.6). In the crude model, we observed that low birth weight was associated with a lower mean BMC/height z-score, compared to adequate birth weight (mean difference: −0.30; 95%CI: −0.39 to −0.21), and this effect was stronger in men (mean difference: −0.43; 95%CI: −0.56 to −0.30) than in women (mean difference: −0.31; 95%CI: −0.44 to −0.19). After adjusting for age, sex per total population, race/skin color, maternal education, individual education, and current weight, there was a considerable reduction in the magnitude of the association (total population: −0.10; 95%CI: −0.14 to −0.06; men: −0.13; 95%CI: −0.21 to −0.06; women: −0.13; 95%CI: −0.21 to −0.05). CONCLUSION Low birth weight is related to BMC/height z-score in both sexes with no indication of differences by sex. The magnitude of the associations was attenuated after adjustment for the current weight.

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RESUMO

Body fat distribution seems to have different effects in cardiovascular diseases (CVD). We aimed to estimate the associations between lower limbs and trunk fat ratio and the 10-year CVD risk, and isolated risk factors in men and women. A total of 10,917 participants from ELSA-Brasil were eligible for this cross-sectional study. Associations between lower limb/trunk fat ratio with the percentage of 10-year CVD risk - according to the Framingham Risk Score - and its risk factors (systolic blood pressure, total cholesterol and HDL-cholesterol, diabetes, and use of antihypertensive medication) were performed using generalized linear models, linear and logistic regressions. All analyses were stratified by gender and adjustments were made by age, self-reported skin color, educational attainment, alcohol consumption, leisure physical activity, hypolipidemic drug use and, for women, menopausal status. In this study, 55.91% were women, with a mean age of 52.68 (SD = 6.57) years. A higher lower limb/trunk fat ratio was related to lower 10-year CVD risk, as well as a reduction in systolic blood pressure, total cholesterol, and antihypertensive drug use, also an increasing HDL-cholesterol in both genders, but this relationship was stronger in women. Besides, a protective relationship to diabetes was observed in women. Higher fat accumulation in the lower body, when compared to the trunk, seems to have a lower risk of CVD and associated risk factors - even in the presence of fat in the abdominal region - with women presenting lower risks than men.

A distribuição de gordura no corpo parece ter efeitos diferentes nas doenças cardiovasculares (DCV). Objetivou-se estimar as associações da razão de gordura entre membros inferiores e tronco com o risco de DCV em 10 anos e os fatores de risco independentes em homens e mulheres. Um total de 10.917 participantes do ELSA-Brasil eram elegíveis para este estudo transversal. As associações da razão de gordura entre os membros inferiores e tronco com o percentual de risco de DCV em 10 anos, de acordo com a Escala de Risco de Framingham, e os respectivos fatores de risco (pressão arterial sistólica, colesterol total e HDL colesterol, diabetes e uso de medicação anti-hipertensiva), foram avaliados com modelos lineares generalizados, lineares e de regressão logística. Todas as análises foram estratificadas por sexo, e os ajustes foram feitos por idade, raça/cor, escolaridade, consumo de álcool, atividade física, uso de medicação hipolipemiante e, para as mulheres, estado de menopausa. Na amostra do estudo atual, 55,91% eram mulheres, com média de idade de 52,68 anos (DP = 6,57). A maior diferença entre a gordura dos membros inferiores e tronco foi associada com menor risco de DCV em 10 anos e com redução na pressão arterial sistólica, colesterol total e uso de medicação anti-hipertensiva, assim como um aumento no HDL colesterol em ambos os sexos (mas essa correlação foi mais forte em mulheres). Além disso, foi observada uma relação protetora contra diabetes, apenas em mulheres. O acúmulo maior de gordura nos membros inferiores, comparado com o tronco, parece estar associado a um risco menor de DCV e aos fatores de risco, mesmo na presença de gordura na região abdominal, e esse efeito é mais forte nas mulheres que nos homens.

Las distribuciones de grasa corporal parecen tener diferentes efectos en las enfermedades cardiovasculares (ECV). Nuestro objetivo fue estimar las asociaciones entre extremidades inferiores/ratio de grasa troncal y el riesgo de ECV a los 10 años, y sus factores de riesgo aislados, en hombres y mujeres. Un total de 10.917 participantes de ELSA-Brasil fueron elegibles para este estudio transversal. Las asociaciones de la ratio de grasa entre la parte inferior del cuerpo y el tronco, con el porcentaje de riesgo de ECV a los 10 años, según la Escala de Riesgo de Framingham, y sus factores de riesgo (presión sanguínea sistólica, colesterol total y colesterol HDL, diabetes, y uso de medicación antihipertensiva), se realizaron usando modelos lineales generalizados, regresiones lineales y logísticas. Todos los análisis fueron estratificados por sexo y los ajustes se hicieron por edad, raza/color de piel autoinformado, nivel educativo, consumo de alcohol, actividad física durante el ocio, uso de medicamentos hipolipemiantes y, para mujeres, estatus menopáusico. En este estudio, un 55,91% fueron mujeres, con una media de edad de 52,68 (SD = 6,57) años. Una ratio de masa adiposa más alta entre las extremidades inferiores/tronco estuvo asociada a un riesgo menor de ECV en 10 años, también una reducción en la presión sistólica sanguínea, colesterol total, y el consumo de medicamentos antihipertensivos, también en un incremento del colesterol HDL en ambos sexos, pero esta relación fue más fuerte en mujeres. Asimismo, una relación protectora frente a la diabetes se observó solo en mujeres. Una acumulación más alta de grasa en las extremidades inferiores, comparada con la del tronco, parece tener un riego más bajo de ECV y sus factores de riesgo, incluso con la presencia de grasa en la región abdominal, además este efecto es más fuerte en mujeres comparadas con los hombres.

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Resumo: Pretos e pardos apresentam grandes desvantagens de saúde, possuem menores chances de ascensão na hierarquia social no curso de vida e menores níveis socioeconômicos do que brancos como resultado do racismo estrutural. Entretanto, pouco se sabe sobre o papel mediador da mobilidade intergeracional na associação entre racismo e saúde. O objetivo do presente estudo foi investigar a associação entre racismo e a autoavaliação de saúde, e verificar em que medida a mobilidade social intergeracional media essa associação. Estudo transversal realizado com dados de 14.386 participantes da linha de base (2008-2010) do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Escolaridade materna, escolaridade do participante, classe sócio-ocupacional do chefe de família e classe sócio-ocupacional do participante compuseram os indicadores de mobilidade social intergeracional (educacional e sócio-ocupacional). Modelos de regressão logística foram utilizados. A prevalência de autoavaliação de saúde ruim foi de 15%, 24% e 28% entre brancos, pardos e pretos, respectivamente. Após ajustes por idade, sexo e centro de investigação foram encontradas maiores chances de autoavaliação de saúde ruim entre pretos (OR = 2,15; IC95%: 1,92-2,41) e pardos (OR = 1,82; IC95%: 1,64-2,01) quando comparados aos brancos. A mobilidade educacional e sócio-ocupacional intergeracional mediaram, respectivamente, 66% e 53% da associação entre a raça/cor e autoavaliação de saúde ruim em pretos, e 61% e 51% em pardos, respectivamente. Resultados confirmam a iniquidade racial na autoavaliação de saúde e apontam que a mobilidade social intergeracional desfavorável é um importante mecanismo para explicar essa iniquidade.

Resumen: Negros y mulatos presentan grandes desventajas de salud, poseen menores oportunidades de ascensión en la jerarquía social en el trascurso de su vida, y menores niveles socioeconómicos que los blancos, como resultado del racismo estructural. No obstante, poco se sabe sobre el papel mediador de la movilidad intergeneracional en la asociación entre racismo y salud. El objetivo de este estudio fue investigar la asociación entre racismo y autoevaluación de salud, así como verificar en qué medida la movilidad social intergeneracional interfiere en esa asociación. Se trata de un estudio transversal, realizado con datos de 14.386 participantes de la base de referencia (2008-2010) del Estudio Longitudinal de Salud de Adultos (ELSA-Brasil). La escolaridad materna, del participante, clase socio-ocupacional del jefe de familia y clase socio-ocupacional del participante compusieron los indicadores de movilidad social intergeneracional (educacional y socio-ocupacional). Se utilizaron modelos de regresión logística. La prevalencia de autoevaluación de mala salud fue de 15%, 24% y 28% entre blancos, mulatos/mestizos y negros, respectivamente. Tras los ajustes por edad, sexo y centro de investigación, se encontraron mayores oportunidades de autoevaluación de mala salud entre negros (OR = 2,15; IC95%: 1,92-2,41) y mulatos/mestizos (OR = 1,82; IC95%: 1,64-2,01), cuando se compara con los blancos. La movilidad educacional y socio-ocupacional intergeneracional mediaron, respectivamente, 66% y 53% de la asociación entre raza/color y autoevaluación de mala salud en negros, y 61% y 51% en mulatos/mestizos, respectivamente. Los resultados confirman la inequidad racial en la autoevaluación de salud y apuntan que la movilidad social intergeneracional desfavorable es un importante mecanismo para explicar esa inequidad.

Abstract: Blacks and Browns have major health disadvantages, are less likely to rise in the social hierarchy throughout the course of life, and pertain to lower socioeconomic levels than Whites as a result of structural racism. However, little is known about the mediating role of intergenerational mobility in the association between race/skin color and health. The aim of the present study was to investigate the association between racism and self-rated health and to verify to what extent intergenerational social mobility mediates this association. This was a cross-sectional study conducted with data from 14,386 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline (2008-2010). Maternal education, education of the participant, socio-occupational class of the head of household, and socio-occupational class of the participant were used in the indicators of intergenerational social mobility (educational and socio-occupational). Logistic regression models were used. The prevalence of poor self-rated health was 15%, 24%, and 28% among Whites, Browns, and Blacks, respectively. After adjustments for age, sex, and research center, greater chances of poor self-rated health were found among Blacks (OR = 2.15; 95%CI: 1.92-2.41) and Browns (OR = 1.82; 95%CI: 1.64-2.01) when compared to Whites. Intergenerational educational and socio-occupational mobility mediated, respectively, 66% and 53% of the association between race/color and poor self-rated health in Blacks, and 61% and 51% in Browns, respectively. Results confirm racial iniquity in self-rated health and point out that unfavorable intergenerational social mobility is an important mechanism to explain this iniquity.

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OBJECTIVE: To analyse how testing the population influences the health indicators used to monitor the COVID-19 pandemic in the 50 countries with the highest number of diagnosed cases. METHODS: This was an ecological study using secondary data retrieved on 8/19/2020. Cumulative incidence, mortality rate, case-fatality rate, and proportion of positive tests were calculated. The data were described and presented graphically, with their respective Spearman Correlation Coefficients. RESULTS: The testing rate varied enormously between countries. Cumulative incidence and the proportion of positive tests were correlated with the number of tests, while the mortality rate and case-fatality rate showed low correlation with this indicator. CONCLUSION: Most countries do not test enough to ensure adequate monitoring of the pandemic, and this is reflected in the quality of the indicators. Expanding the number of tests is essential, but it needs to be accompanied by other measures, such as isolation of diagnosed cases and contact tracing.

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