Fiocruz presents new data from study assessing the health of the population of Brumadinho

Researchers from Fiocruz Minas and the Federal University of Rio de Janeiro (UFRJ) have just completed another phase of the study assessing the living conditions, health status, and demands on healthcare services of the population in Brumadinho, following the disaster caused by the collapse of the Vale mining company's dam, which marked its sixth anniversary on January 25th. The children aged 0 to 6 years assessed presented results that showed increased detection rates of metals in urine. The presence of at least one of five metals (cadmium, arsenic, mercury, lead and manganese) was detected in all samples analyzed. The total percentage of children with arsenic levels above the reference value rose from 42% in 2021 to 57% in 2023 and, in regions close to disaster areas and active mining, the percentage increase between one year and the next is even more significant.

The 'Brumadinho Integrated Health Actions Program' is a study being conducted on two fronts: one focusing on the population over 12 years of age, called 'Saúde Brumadinho' (Brumadinho Health), and another targeting children aged 0 to 6 years, named the 'Projeto Bruminha' (Bruminha Project)

The study aims to detect changes in these conditions over the medium and long term, and thus the participants have been monitored annually since 2021. A compilation of the data collected during the first year of follow-up had already been made. Now, the analysis includes data from the third year, 2023, allowing a comparison to be made between the periods. Of the metals, arsenic appears most frequently above the reference limits, detected in around 20% of samples among adults and in around 9% of samples among adolescents. However, among this group, depending on where they live, the percentage of samples with arsenic above the limit reaches 20.4%.

However, as mentioned in the survey, it is worth noting that all metals showed a high percentage of detection in both years, with more significant reductions in median values for manganese and less significant reductions for arsenic and lead when comparing 2021 and 2023. This shows that exposure to these metals in the municipality continues to be widespread in all regions investigated, albeit at lower levels in the last year investigated.

According to the researchers, the results show exposure to metals and not intoxication, which can only be considered after clinical assessment and other tests to define the diagnosis. Thus, a medical assessment is recommended for all research participants who presented levels above the recommended biological limits to allow for analyzing the results in the general context of their health. Further, there is a need for a care network that allows tests for these metals to be carried out not only on the population identified by the project, but also to meet other demands in the municipality. This organization of the service network is of essence, considering that exposure to the metals investigated remains widespread throughout the municipality between 2021 and 2023.

One of the aspects assessed in the survey is the municipality's metal exposure profile. Cadmium, arsenic, mercury, lead and manganese were measured using blood and/or urine tests. In the population over the age of 12, the results showed that there was exposure to these metals in the two years analyzed, but in 2023, the percentage of samples detected with metals above the reference values decreased. Arsenic is the most frequently found to be above the reference limits, detected in around 20% of samples among adults and in around 9% of samples among adolescents, but among this group, depending on where they live, the percentage of samples with arsenic above the limit is as high as 20.4%. Lead and mercury showed a detection rate in 100% of the samples in 2023, but only 6.8% of the samples showed lead dosages above the reference values.

Health conditions

Another point analyzed refers to the health conditions of the population, based on previous medical diagnoses and the perception of the participants themselves. When asked how they rated their health, the majority of adults and adolescents, both in 2021 and 2023, rated it as good/very good, with variations between regions of residence. However, the percentage of the adult population who rated their health as bad or very bad remained high in the regions affected by the mud or in the region with mining activity.

Among adolescents, when asked if they had ever been diagnosed with chronic diseases, the most frequent answers in 2021 were asthma or asthmatic bronchitis, mentioned by 12.7% of respondents. By 2023, this percentage had risen to 14%. There was an increase in the prevalence of some conditions, such as high cholesterol, which rose from 4.7% in 2021 to 10.1% in 2023; and a group of diseases including emphysema, chronic bronchitis or chronic obstructive pulmonary disease, which rose from 2.7% in 2021 to 10.7% in 2023.

Still concerning chronic diseases, in 2021, when asked if any doctor had ever diagnosed these conditions, adults mainly mentioned hypertension (27.9%), high cholesterol (20.9%) and chronic back problems (19.7%). In 2023, these diseases will continue to be the most prevalent, but with an increase in the frequency with which they occur: hypertension was cited by 30% of adults, high cholesterol by 28.5% and chronic back problems by 22.8%. There was also an increase in the medical diagnosis of diabetes among adults, which rose from 8.7% to 10.7% between the two years assessed.

The survey also investigated the presence of symptoms and other signs in the 30 days before the interview. In 2021, adults mainly reported nasal irritation (31.8%), numbness or cramps (25.2%) and a dry cough (23.5%). In 2023, the frequency of these conditions increased to 40.3%, 34.4% and 21.5%, respectively. These symptoms were also the most cited among adolescents in both 2021 and 2023, but with little change between one year and the next.

"The worsened perception of health is an extremely important indicator for assessing the general health condition of a population, reflecting a negative impact on this condition among the residents of the areas affected by the mud and the mining activity. With regard to chronic conditions, it should be highlighted the high burden of respiratory diseases and the reporting of signs and symptoms, which demonstrate the need for greater attention from health services in this area. This may be related to environmental conditions, such as the spread of dust due to the nature of production activity," says Fiocruz Minas researcher Sérgio Peixoto, general coordinator of the study.

Mental health

The mental health assessment included questions about the medical diagnosis of some conditions. The results showed little change from one year to the next. Among adolescents, when asked about the diagnosis of depression, the percentage was 9.9% in 2021 and 10.6% in 2023. Among adults, 21.3% reported a medical diagnosis of depression in 2021 and 22.3% in 2023, higher than the 10.2% reported by Brazilian adults in the National Health Survey carried out by the Brazilian Institute of Geography and Statistics (IBGE) in 2019. A diagnosis of anxiety or sleep problems was reported by 32.8% of respondents over the age of 18 in 2021 and 32.7% in 2023.

The researchers also applied the Patient Health Questionnaire-9-PHQ-9 and the General Anxiety Disorder-GAD7 scales, which include questions about some feelings and symptoms and show that the participant may have depression or anxiety, but it is not considered a clinical diagnosis for these conditions. The application of scales to screen for mental disorders has shown an increase in the frequency of these conditions. Among adults, 28.8% had a major depressive episode in 2021, while in 2023, this figure was 38.4%. Among those with an anxiety disorder, the numbers reached 19.2% in 2021 and 30.8% in 2023. Among adolescents, these conditions also saw an increase, with 27.3% reporting a major depressive episode in 2021 and 31.4% in 2023. Anxiety disorder was mentioned by 15.9% of adolescents in 2021 and 23.3% in 2023.

Difficulty sleeping on three or more nights a week in the last 30 days was reported by 26.7% of the adult population of Brumadinho in 2021; 2023 saw an increase in this figure, reaching 35.1%. Among adolescents, this difficulty was reported by 18.3% in 2021, and 17.4% in 2023.

"These figures show the need to assess mental health actions in the municipality, given the continued high burden of mental disorders in the population in the two years assessed. It is necessary to prioritize intersectoral strategies, considering the complexity of the problem and the specificities of each territory," explains the coordinator.

Use of health services

The study also showed that there has been an increase in demand for health services in the municipality. Regarding medical appointments, in 2023, 44.1% of adolescents reported having had three or more appointments; in 2021, this number was only 21.7%. Among adults, 53.7% had three or more appointments in 2023, and 38.6% in 2021.

According to the results, the Brazilian Unified Health System (SUS, in the Portuguese acronym) is the main reference for those interviewed. In 2021, 56.8% of adults and 59.6% of adolescents said that Primary Health Care (PHC) professionals were the most sought after. By 2023, this percentage had risen to 64% among adults and 66% among adolescents.

Among adults, 34.9% said they had private health insurance in 2021 and 39.8% in 2023. Among adolescents who said they had health insurance, this figure was 27.8% in 2021 and 33.9% in 2023.

"The high use of health services and the mention of the public service as the main reference for health care demonstrate the high demand for the SUS in the municipality, but also the great potential of this system to carry out effective interventions aimed at minimizing the impact on the population's health," Peixoto points out.

Children's health

In addition to the assessment of exposure to metals, the children were also assessed about neuromotor, cognitive and emotional development, using the Denver II Test. The results showed that, from one year to the next, there was a reduction in the number of children at risk of delayed development of the skill(s) expected for their age group. In 2021, 42.5% were in the risk group, and in 2023, 28.3% of all those assessed.

The study also assessed the children's growth charts, which consider height, weight and body mass index. Between 2021 and 2023, most of the children had a normal Body Mass Index (BMI). Concerning obesity (BMI > 30) and overweight (BMI > 25), there was an improvement in the indexes. In 2021, around 11% of children were considered obese; in 2023, this percentage fell to 4.6%. Overweight children were 12.5% in 2021 and 4.6% in 2023.

For the researchers, this improvement in the children's assessment can be explained by the return to school activities and social life, after the social isolation due to the COVID-19 pandemic. The team recommends monitoring those who show changes in anthropometric indicators and in the acquisition of skills associated with neuropsychomotor, social and cognitive development. It also suggests coordination between the municipal health and education teams, since school activities have great potential to stimulate child development.

The research

Entitled Programa de Ações Integradas em Saúde de Brumadinho (Brumadinho Integrated Health Actions Program), the study is being carried out on two work fronts: one focusing on the population over 12 years of age, called Saúde Brumadinho (Brumadinho Health), and another aimed at children between 0 and 6 years of age, which has been given the name Projeto Bruminha (Bruminha Project). In 2021, the sample consisted of 3,297 participants, including 217 children, 275 adolescents aged between 12 and 17, and 2,805 adults over the age of 18. In 2023, there were 2,825 participants: 130 children, 175 adolescents and 2,520 adults.

When structuring the sample, the researchers sought to cover the entire territorial extension of the municipality. In the Saúde Brumadinho project, the sample was segmented into three geographical regions, including the areas directly exposed to the tailings dam collapse; the region of residents in areas with mining activity but not affected by the mud; and the portion considered not to be directly exposed to the dam collapse or mining activity, randomly made up of the remainder of the municipality. As to the Projeto Bruminha, the study sample included all children aged between 0 and 6 years living in four selected locations: Córrego do Feijão, Parque da Cachoeira, Tejuco and Aranha, the first two being located on the tailings slurry route, the third in an active mining region and the last far from these three areas.

The research is based on various sources of data, including blood and/or urine tests taken by all participants to check the dosage of metals in the body, interviews that assess a series of health-related aspects, as well as physical and anthropometric assessments.

The Saúde Brumadinho project, aimed at adults and adolescents, investigates health conditions and behaviors, sociodemographic profile, contact with water and mud, and use of health services and medication, among other points, which allow a fairly complete picture to be drawn up of the current health situation in the municipality. The Projeto Bruminha, in turn, checks the children's growth and neuromotor development, anthropometric changes and reports of respiratory illnesses, as well as metal dosages. The data resulting from the research could guide the structuring of health services, contributing to better organizing the Unified Health System (SUS) at the state and municipal levels to respond to the population's demands for care.

The Programa de Ações Integradas em Saúde de Brumadinho is funded by the Ministry of Health, through the Department of Science and Technology of the Secretariat of Science, Technology, Innovation and Strategic Health Supplies (Decit/SCTIE/MS). Access the full reports of the Saúde Brumadinho e Projeto Bruminha (Portuguese), showing all the analyses carried out.