Ciência & Saúde Coletiva ISSN: 1413-8123 [email protected] Associação Brasileira de Pós-Graduação em Saúde Coletiva Brasil

Ramos de Souza, Edinilsa; Carvalho de Lima, Maria Luiza The panorama of urban violence in and its capitals Ciência & Saúde Coletiva, vol. 11, núm. 2, abril-junho, 2006, p. 0 Associação Brasileira de Pós-Graduação em Saúde Coletiva , Brasil

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The panorama of urban violence ARTIGO ARTICLE in Brazil and its capitals

Panorama da violência urbana no Brasil e suas capitais

Edinilsa Ramos de Souza 1 Maria Luiza Carvalho de Lima 2

Abstract This article presents a descriptive epi- Resumo Faz-se uma análise epidemiológica des- demiological analysis of accidents and violence in critiva da morbidade e da mortalidade por aci- Brazil and in the Brazilian capitals in recent dentes e violência no Brasil e suas capitais, em years. The data used were made available by sev- anos mais recentes para os quais as informações eral sources: the Mortality Information System estão disponíveis. Usam-se dados dos Sistemas de and the Hospital Information System of the Min- Informações sobre Mortalidade e de Internações istry of Health; the National Safety Department Hospitalares, do Ministério da Saúde; da Secre- of the Ministry of Justice and the National De- taria Nacional de Segurança, do Ministério da partment of Transit of the Ministry of the Cities. Justiça; e do Departamento Nacional de Trânsito, The population data for the years 2002 and 2003 do Ministério das Cidades. Os dados populacio- were made available by the DATASUS of the nais de 2002 e 2003 são os disponibilizados pelo Ministry of Health. The authors emphasize some Datasus/MS. Destacam-se algumas situações que already known aspects: the high homicide rates persistem no Brasil: elevadas taxas de homicídios and high death rates due to traffic accidents, the e de mortes por acidentes de trânsito, concen- concentration of these events in the population of tração dos eventos na população jovem, negra e young black males and the complexity and multi- do sexo masculino e a complexidade e multide- plicity of determinants of these phenomena. The terminação desses fenômenos. Como novo, apon- text points to a new scenery involving the spread- ta-se um processo de disseminação de homicídios ing of homicides to neighbor communities of met- para outros municípios das regiões metropolita- ropolitan areas and to the inner regions of the nas e do interior dos Estados. Destaca-se a mag- 1 Centro Latino States. They further verify higher morbidity than nitude da morbidade em relação à mortalidade. Americano de Estudos mortality rates. It calls attention to , Destacam-se Porto Velho, Macapá, Vitória, Rio de Violência e Saúde Jorge Macapá, Vitória, Rio de Janeiro and Cuiabá with de Janeiro e Cuiabá, com os maiores indicadores Careli, Departamento de Epidemiologia e Métodos the highest indicators for intentional violence – de violência intencional – elevadas taxas de ho- Quantitativos em Saúde, high rates of homicides and injuries – and to Pal- micídios e de lesões corporais e Palmas, onde ocor- ENSP, Fiocruz. mas, with high death rates from traffic accidents rem altas taxas de mortalidade por acidentes de Av. Brasil 4036, sala 700, Manguinhos, 21040-361, and non-fatal victims per 10 thousand vehicles. transporte e de vítimas não fatais por 10 mil veí- Rio de Janeiro RJ. Key words External causes, Homicides, Traffic culos. [email protected] accidents, Violence and Health Palavras-chave Causas externas, Homicídios, 2 Departamento de Medicina Social Centro de Acidentes de transporte, Violência e Saúde Ciências da Saúde, UFPE. Souza, E. R. & Lima, M. L. C. 364 edr ae oo,ageandsocialspace color, race, gender, according varies therisk to lation uniformly, showed doesnotaffectthepopu- thatviolence in fthecountry of gions beingtaken violence to theinner re- sense of inthe violence”, the call of “interiorization adynamic someauthors vealed anotherprocess, causes are concentrated deathsfrom external thetotal of about 75%of where populationdensity high ban areas with deaths. violent numbering amuch of higher infactrepresent- iceberg, anenormous the tipof show only under-recording into consideration, even taking fromdeath rates however, violence age andcapitals. cides according to differences inrelation to sex, accidents andhomi- andtransportation traffic ratesfrombidity external causesfocusingon andmor- analyzingmortality lence inBrazil, oto drugs of port forthetrans- ascorridors and othersserving asproducerssome municipalities participate where different States, Brazilian of inner regions istakingthrough the route trade illegaldrugs creasing trend since the80s centersurban show inBrazil acontinuously in- war. instatein countries of iseven greater than lethal andnonlethalevents, indicators basedon andcriminal demiological expressed intheepi- inBrazil, social violence The unprecedented of andintensity magnitude Introduction cent years. capitals inre- in Brazilian dents and violence dueto acci- morbimortality analysisof logical This study represents adescriptive epidemio- Methods thousand inhabitants tween 5and6premeditated 100 deathsper habitants andtheUnited Sates show rates be- 3 premeditated 100thousandin- deathsper West-European countries show rates lower than sand inhabitantsinthe80sto 75.2in2002. causes (accidents per100thou- andviolence) passedfromBrazil 59.0deathsfrom external Health, According of to datafrom theMinistry inthe among thehighest continent.American Different studies carried outinthecountry Different studiescarried Although being clearlymore intenseAlthough inur- This article presents a picture of urban vio- urban presents apicture of This article The deathrates from inthemain violence ,9 8, . 7 2 . In part thisisdueto In the part . . ,6 1, recent studiesre- , 1 and rank todayand rank ,4 5 4, 3, .The in its Transit lished by theNational of Department pub- accidents fortheyearing traffic 2002, 60% about isonlyof improving, gradually though al- Northeast andCenter-West thispercentage, North, theregions in themunicipalities of while palities count onregular deathregistries, munici- where more than80%of the country, able intheStates intheSouthandSoutheastof are They more reli- theSIMvaries. the dataof Thecoverageat theDATASUS. of andquality Information SystemMortality (SIM)available andwere extracted from the occurred in2003, Diseses/ICD10) ternational Classificationof theIn- dents from of external causes(V01-Y98 aueo thedataprocessing system nature of thedatadependson of and thereliability ties linked to this system through agreements theUnified Health System orfacili- network of to the clude admissionsinhospitalsbelonging dataproduced the by thissystem onlyin- ly, Final- forthesamepatient. admission registry by morethe information generating thanone compromising afactcapableof ple admissions, There isalsonocontrol asrefers to multi- care. inpatient lessthan48hof tion andrequiring sider acute quickevolu- healthproblems with itdoesnotcon- ever shows somelimitations: Thissystem how- Authorization (AIH). forms processing theHospital Admission charge of in ICD10) were collected from the AIH/SUS, the external causes(S00-T98of quences of andsomeotherconse-sions dueto injuries wasavailable. forwhich information years, Thedatarefer to recent Justice. of the Ministry linkedand theNational to Department Safety Cities of theMinistry Transit of of partment theNational De- Health, of theMinistry tem of TheHospital Information Sys- three sources: tically alldeathsare recorded. occurrences registered in the National System based on thenumber of Transit, of partment theNational De- collected from the statisticsof were dataaboutinjuries the Finally, capitals. States Brazilian and of dents inthegreater part acci- traffic of andtheseriousness morbidity andestablishingthedimension of evaluating thissystem provides indicators for allowing sit, Tran- of cation from someState Departments thesub-recording dueto under-notifi- spite of We regard- alsoanalyzed theinformation h otlt aarfrt etso resi- datarefer to deathsof The mortality The information regardingThe information hospitaladmis- rates were collectedThe morbidity from 10 nulSaitc fTraffic Accidents Annual of Statistics ntecptl,o h te ad prac- ontheotherhand, In thecapitals, . 1 2 3 4 15 14, 13, 12, 11, 16 .In . Ciência & Saúde Coletiva, 11(2):363-373, 2006 365 1 In 2003,In the mortality external rate from in Brazil and Homicide its characteristics Fifty-one thousand and forty-three Brazil- the contrary,To by taken measures the shy external causes (Table 1), (Table causes external a turning them into priority and justi- interventions with to respect them in this to fying given the special attention article. 120.1 per 100 thou- 53.8 to causes varied from the Braziliansand inhabitants among capitals 2).(Table of Seven death the 27 capitals showed causes higher external than 90 per from rates Velho, 100 thousand inhabitants (Porto Boa Vista, Macapá, , Vitória, Rio de Janeiro and Cuiabá); eight capitals (, Belém, São Luís, , Natal, Pessoa, João Floria- rates lower showed Alegre) nópolis and Porto 50 and 69 per 100 thousand inhabi- (between between rates tants) and the other 12 showed 70 and 89 per inhabitants. 100 thousand Any- way, the distribution of external deaths from the same characteristics causes in Brazil shows found in other countries but it also has specific and peculiar aspects, be under- need to which the problem. face for being able to stood in 2003, murdered ians were nearly 140 deaths re- is that neither the daily The worst per day! me- ports on homicides in the communication in the studies produced dia nor the knowledge on the issue carriedled out in the country have of the development to for solid mechanisms facing the problem. a fatalistic view led to of the authorities have . 18 . A possible limitation of this 17 The population data for the years 2002 and The population data for the years Mortality: the tip of the iceberg of Brazilian violence 2002,In 126,657 individuals died in Brazil causes, specific external Among aggressions Table 1 Distribution of mortality (number, causes. specific external from and rate) proportion Brazil, 2003. Specific external causes accidentsTraffic Falls and submersion drowning Accidental smoke, to Exposure and flames fire Poisoning, substances noxious to or exposure intoxication injury self-inflicted Intentionally Aggressions cases intention Indeterminate warfare and interventions Legal causesAll other external 258Total per 100 thousand inhabitants (1) Rates 0.2 5,972 n 1,007 0.1 4.7 33,620 7,861 0.8 % 3.4 26.5 11,101 6.2 Rate 0.6 491 6,017 19.0 8.8 4.4 9,287 0.4 51,043 4.8 6.3 7.3 40.3 0.3 3.4 28.9 5.3 126,657 100.0 71.6 Results and discussion Results of Statistics Safety and Criminal Justice Public 2003 for the year 2003 were based on estimations drawn from the drawn based on estimations from 2003 were 2002 census, the DATASUS/ by made available Ministry of Health system is under-registration as a result of as a result under-registration is system un- departments. police some from der-notification The variations of in the number occurrences and procedures different the also due to were and record- for the collection adopted systems ing of criminal of each information by the 27 of forces civil police the country. The under- registration of the public safety by occurrences authorities varies in intensity the dif- among in this paper. capitals studied ferent from accidents and violence. accidents from rep- This number 12.5% ofresents all-cause deaths, with a mor- causes oftality external rate from 71.6% per 100 thousand inhabitants. The scale of violence does ascending:not stop in the death risk increased the 80s and in 3.4% in rela- to 17% in relation the 90s oftion to the past century. the high-(homicides) and traffic show accidents in 2003:est rates 28.9 and 19.0 per 100 thou- sand inhabitants respectively. sub- These two 66,8% of concentrate groups all deaths from Souza, E. R. & Lima, M. L. C. 366 Center-West Region South Region Traffic accidents Region Southeast Homicides causes External Northeast Region North Region Capitals rates Mortality 2 Table (1) Rates 100thousandinhabitants per rslaD 3. 497. 47543. 331. 26.9 35.7 25.4 11.7 13.0 9.2 43.3 60.6 42.4 27.5 33.8 15.4 11.3 22.5 27.8 22.2 5.4 7.9 46.2 44.6 9.2 4.5 7.9 8.4 64.7 23.9 13.8 37.0 53.4 37.5 20.8 32.4 6.0 86.0 15.6 78.6 5.0 28.8 3.9 22.4 28.5 83.7 6.8 26.3 24.9 5.2 96.4 3.2 17.3 38.5 62.6 4.4 26.8 19.2 25.4 137.2 2.1 27.3 2.4 7.2 58.0 47.0 16.5 146.1 54.8 7.0 169.2 52.1 78.3 14.6 55.8 6.4 8.4 28.6 5.3 8.1 47.7 33.0 65.1 4.5 6.3 25.4 20.8 75.4 91.7 5.3 28.9 3.8 66.9 20.7 134.3 23.7 7.5 22.9 26.3 48.0 111.3 26.8 27.0 36.1 95.7 15.2 6.8 12.9 112.2 13.4 7.3 83.4 6.9 128.0 36.1 2.5 51.2 122.0 3.1 97.5 Brasília/DF 5.3 66.4 36.6 23.0 40.6 93.8 99.1 4.2 34.3 Goiânia/GO 54.1 18.5 23.8 73.5 26.4 14.5 7.0 Cuiabá/MT 149.8 22.7 34.2 20.9 33.8 /MS 103.7 2.0 180.0 9.9 29.9 4.7 88.7 1.8 24.2 134.6 74.6 24.4 172.9 47.6 79.4 16.3 4.1 37.2 25.9 43.5 25.4 85.2 2.5 27.8 /RS 9.1 71.1 21.2 100.9 24.3 7.0 Florianópolis/SC 23.3 3.7 156.8 59.2 134.5 15.8 21.5 /PR 48.8 39.8 142.1 60.3 21.2 5.7 41.5 26.1 26.6 28.8 67.1 162.8 51.2 3.5 192.5 19.0 73.8 5.0 3.1 São Paulo/SP 11.8 41.9 66.0 13.7 36.6 39.5 Rio deJaneiro/RJ 107.0 29.0 21.4 58.3 45.9 127.9 Vitória/ES 79.3 52.5 19.5 4.5 /MG 133.3 3.4 35.0 20.1 118.7 76.1 68.7 90.9 50.3 7.1 101.8 53.8 55.9 Salvador/BA 30.2 7.3 Aracaju/SE 26.0 13.9 64.3 121.9 96.8 Maceió/AL 63.8 158.0 97.9 Recife/PE 93.6 25.3 João Pessoa/PB 82.3 17.6 Natal/RN 168.2 /CE 112.4 120.1 21.3 Teresina/PI 30.4 146.6 São Luís/MA 210.4 Palmas/TO Macapá/AP Belém/PA Boa Vista/RR Manaus/AM Rio Branco/AC Porto Velho/RO ne mn h rzla aias Analyzing ences capitals. among the Brazilian andlocallevel regional presented below. national, homicide on anddynamics of distributions cies, imagination. inthecitizens andinthecollectiveunsafety Theresult isfearandasensation of criminality. and itsinstitutionsbeingtoo weak forfacing theState theideaof this problem andfortified 1 rmetra ass oiie n rfi ciet codn osx rzla aias 2003. capitals, Brazilian accidents according homicidesandtraffic to sex. from external causes, The homicide rates show important differ- The homicide rates show important regions to geographic Differences according thetenden-The present analysesevidenced oa oa Total F M Total F M Total F M on ntecptl fteSuho the coun- the South of found inthe capitals of thelowest rates are Finally, found in Cuiabá. is rate violence thehighest in theCenter-West, and SãoPaulo capitalsand are themostviolent RiodeJaneiro Vitória, In theSoutheast, tals. capi- and Macapá appearasthe mostviolent Porto Velho In theNorthern region, country. lowed by Maceió occupying the4 fol- rate inthecountry, thehighest out with Recife st thecountry, Northeastern of region Among thecapitalsin habitants inRecife. tants inNatal and66.4%per100thousand in- ing between 18.5%per100thousandinhabi- the year 2003we thattherates are observe vary- th place inthe ands Ciência & Saúde Coletiva, 11(2):363-373, 2006 367 fauna . analysis of An . 23 4, 20, 24 showed a higher of number showed homi- 25 Further to the differences between cities, between the differences Further to Differences according to age, to according Differences sex and race/color characteristic ofA remarkable the epidemi- metropolitan areas in Brazil carried areas Canometropolitan out by & Santos is exactly the internal connection of connection the internal is exactly different the countrycities and capitals in with the in- illegal tradeternational narcotics, in arms, children, and women stones, precious and flora/wood. – organized These systems in turn of illegal activities, and highly dangerous in the countrywith so- – are routes established ofcial potentiators homicides some studies already demonstrated disparitiessome studies already cities inside the different cides in poorer neighborhoods and lower num- neighborhoodscides in poorer and lower bers in the privileged of areas cities, the evi- of influence dencing the strong the variable in- come. however Comparing the Brazilian States the same authors found the impact of the vari- ables income, education and inequality be to less significant than the for the homicide rates variable urbanization. words, other In the high- er the population density, the higher the homi- cide rates. ological of pattern the high homicide are coef- population. ficients in an increasingly younger and including adolescents the age groups In adults,young 19 years, 15 to from are the rates extraordinarily higher than those found in the 3).general population (Table the to relation In general rate, is 1.5 times higher the coefficient than in 15 and 29 years between in the group et M F Total M F Total M F Total . revealed a spread of a spread revealed homicides 7 . 4, 19, 20, 21, 22 et al et investigated the hypothesis of the hypothesis investigated an associa- The spatial distribution of deaths from Different hypotheses and variables hypotheses were Different Lima 21 from external causes, external from and age. sex to homicides and traffic according accidents Brazilian capitals, 2003. . 1 homicide among Brazilian capitals with differ- ent population densities, urbanization percent- ages, and Con- Indicators Development Human ditions of that indicate seems to Life Indicators this problem, in besides being strongly present the big cities of the country, affects other social but both common and involves as well spaces also distinct determinants. One of these factors tion between hightion between and human homicide rates indicators,development life conditions, inequal- ities in the distribution of income, ed- to access ucation etc. association They found an inverse of violencebetween and indicators poverty and illiteracy, of showing that the complexity vio- in a linear way explained can neither be lence a singlenor by cause. in the State ofin the State dis- two involving tinct poles: of one these poles with high homi- region ofcide rates is the metropolitan Recife ofand the other is a cluster mak- municipalities ing part of the marijuana polygon in the inner region of the State. This is what the authors call the “interiorization” of violence. In another also carriedstudy out in Pernambuco, Lima al used for explaining these spatial differences. used for explaining partThe greater of under- to attempts studies on the basis ofstand the determinants socio- indicators,economical to principally as refers (inequality poverty in the distribution relative of income) try. is the city of exception The only situ- Natal in the Northeast. ated (1) Rates per 100 thousand inhabitants (1) Rates Table 3 Mortality rates groups (in years)Age 0-910-1415-1920-2425-2930-39 External causes40-4950-59 136.860 + 21.9Total 77.0 Homicides 13.9 20.4 129.5 36.2 221.8 8.2 9.1 19.4 205.8 3.3 21.6 164.3 11.1 14.8 74.7 20.8 149.4 121.4 19.1 accidents Traffic 19.4 111.9 21.4 152.5 90.0 0.9 78.2 4.3 132.6 119.7 44.35 83.4 115.5 65.8 21.3 0.7 6.5 1.7 7.7 8.78 104.7 77.5 7.4 69.7 25.9 42.5 51.7 70.0 0.8 3.1 60.6 6.1 21.9 4.8 40.9 52.8 23.86 46.96 5.18 27.5 7.19 2.7 47.33 6.96 4.3 7.95 3.44 3.69 11.3 7.20 42.70 15.5 27.4 28.2 46.37 4.3 26.9 5.5 6.72 8.07 46.80 24.2 31.05 26.6 14.65 7.02 29.1 18.9 Souza, E. R. & Lima, M. L. C. 368 oiierts(e 0 huadihbtns o ae,according to skincolor –2003. andageinBrazil Homicide rates (per100thousandinhabitants)formales, 1 Graph Rates per 100 thousand inhabitants 100 120 140 160 180 200 20 40 60 80 0 0-4 the intensity with which violence isdecimating which violence with the intensity Anyhow, inothersocieties. tic alsoobserved forwomen. thantherate 9.1 higher themasculinepopulationshows arate served, where thelowest wasob- ratio risk Branco, Even inRio thatforwomen. times higher where formenwas24.8 therate Florianópolis, in Thesamepattern wasobserved population. thanforthefeminine 23.7 e21.6timeshigher 24.7, from homicidewere respectively 39.5, formendying therisk andSalvador, Aracaju Maceió, In theNortheastern citiesJoão Pessoa, forfemales. thantherisks considerably higher adults from 25to 29years is15.2. men/women fory ratio is17.2andtheratio amongyoung aged20to people 24the higher: iseven thisratio In someagegroups, for males. 12.3timeshigher ratio arisk male inhabitants, inhabitants inrelation to 4.3/100thousandfe- 52.8/100thousandmale wasof in thecountry therate In 2003, rates inmales. higher variably population. general thaninthe is2.1timeshigher therisk years, andinthegroup between 25and29 higher therate is2.5times age, 20 and24years of inthegroup between the populationasawhole; h vrotlt fmenisacharacteris- of The overmortality formalesare therisks also In thecapitals, The difference according to sex reveals in- 5-9 10-14 15-19 20-29 oung 30-39 oilcaatrsi,asynonym forsocial a socialcharacteristic, is It thatinBrazil isknown “color” ly violence. dead- young malesare of thus themainvictims Black deathsaswell. violent of the distribution endsupinprovokingple inBrazil in inequality sanitation)amongblackandwhite peo- health, andaccess totary socialresources (education, mone- of tions thattheunequaldistribution there are indica- different notificationsources, promised by elevated under-registration by the thedataregarding arethough thisvariable com- Al- concentration between 20and29years. thehighest butwith people inallagegroups, 1shows forblack Graph homiciderates higher people self-identifiedasblackormulatto). black population(understood asthesumof homicideinthe of risk matic concentration of sex andviolence masculine the complex relation between youth, approach to thequestionforunderstanding agender-related whostarted researchers, ber of homicide. tions of concentra- thehighest thegroups with adults, respect to adolescentsmainly with andyoung socialandfamiliarstructure, the economical, consequencesremarkable andhasserious for is masculinesex inourcountry of individuals 40-49 Further toFurther ageandsex adra- oneobserves hspolmde h teto fanum- This problem drew theattention of 50-59 6 7 8 9 0 1 2 33 32, 31, 30, 29, 28, 27, 26, 60-69 70-79 . 0+Age 80 + People Black People White Ciência & Saúde Coletiva, 11(2):363-373, 2006 369 th and 4 nd s population. The num- ’ ria and in men/women) (7.7 place in the general morbidityplace ó th . of in terms Some differences causes 17 . 34 Traumatisms, with 81.9%, the main spe- are In Brazil,In it happens with homi- the way The differences in the death rate from traf- in the death rate from The differences violenceDisease from in Brazil: the hidden part of the iceberg Brazil,In in 2005, 11,429,133 patients were The highest risk ratio for men was found in place. in- cific cause for hospital admissions due to juries and poisonings, intoxications by followed drugs,from medicinal and non-medicinal sub- (6.5%),stances med- due to other complications ical treatment (5.7%), burnings (3.9%) and other causes (1.7%). the studies, to According partthe greater of traumatisms of is the result popu- falls and traffic and the young accidents lation, in the case of like homicide, is the most affected 59 years and increases again at an age of and increases 59 years 60 or more.years the contrary On homicides, to traffic victimize principally accidents the elder- ly; withincrease the rates age and the main cars strikingcause are pedestrians. cides, the main victimsof traffic are accidents men; gender however between the differences smaller.are The risk ratio of male overmortality in 2003 was 4.4. The ratio higher is for the group and (6.6 men/women) 25 and 29 years between (6.4). 30 and 39 years between However, more or driving cars than men die hit by women them profile ofprofile the country ber of injuries hospital admissions due to and poisonings in the capitals is still higher. These num- increasing demanded an ever causes have ber of re- hospital beds in the metropolitan gions, ranking they in the 2 are where Rio Branco (7.4).Rio Branco ratio (2.3) was The lowest found in Palmas. age and race/color to according fic accidents homogeneous distribution a more be- show sexes,tween be- the group to with exception showing a higher 20 and 39 years con- tween centration of deaths in men. of in the hospitals admitted Health the Unified the system. to linked or facilities System Com- pregnancy,plications involving childbirth and for the major responsible (23%) are childbed part (23%) of hospital admissions. Injuries and and violence were accidents poisonings due to for 786,768 admissions (6.8%),responsible oc- cupying the 6 the capitals Vit the capitals o ã m, S é the motor- – nia. The first, â o Paulo and Porto o Paulo ã , Aracaju, Salvador, Belo ó represented by 12,9% of by represented traffic acci- – Traffic accidents and their accidents Traffic characteristics in Brazil 2003,In killed in the 33,619 people were A detail deserving out is the be pointed to Brazilian capitals withThe two the most Differences according to sex, to according Differences age, race/color Although homogeneous, more the risk of s, Recife, Macei í situated in the North of in the North situated the country, is under- of process going a recent emancipation and de- velopment; the second, in the Center-West, is of among the cities with numbers increasing trafficdeaths from accidents. capitals Eleven 20 (Manaus, below numbers show Bel Lu country traffic due to accidents, a rate of 26.5 deaths per 100 thousand inhabitants. A great part of pedestrians (30%) involves these events a vehicle,hit by of occupants by followed vehi- cles (19.3%). for traffic Disrespect signals, ex- ofcess not only by consume speed and alcohol the pedestrian but also by besides the driver very bad conservation of and highways roads some ofare high for the responsible the factors traffic in Brazil. from death rate accidents ofappearance a category, is extremely which victimized in the Brazilian traffic cyclist dents. 2003, In in started that the rate zero at 4.4 and 0.5 deaths to increased 1980 had already of inhabi- per 100 thousand men and women tants respectively. of The increase acci- these categories like new occupation dents is due to and moto-taxi. moto-delivery trafficoutstanding death rates from accidents with of figures 100 thousand 30 in each over and Goi Palmas inhabitants are recognition and access to health, to access and recognition wealth, edu- cation and participation in the society. our In country, part the greater of the black popula- stratums of the lower in tion is concentrated the social pyramid. Horizonte, Rio de Janeiro, S dying from traffic higher is also dying from accidents for people.young peaks around The curve shows of15 years between age and in the age group 20 and 24 years. until than stabilizes The level Alegre). intermedi- show The other 13 capitals ranging rates ate 20 and 29 deaths per between these causes 100 thousand inhabitants from 2). (Table Souza, E. R. & Lima, M. L. C. 370 te te outby Duar- Astudy carried Vista andPalmas. Boa Manaus, RioBranco, them Porto Velho, among 10thousandvehicles, per fatal victims rates forfatalandnon- are thehighest showing thatthecapitalsinNorth again oneobserves ment andthehealthsector. depart- thetraffic systemsthe information of integrating This factshows clearlytheneedof deaths occurred later inthehealthservices. aboutthe having noinformation accident site, ment onlyregisters thedeathsoccurred atthe depart- Thisoccurs because thetraffic Transit. 12.3 registered by theNational of Department the tants registered by theMSwas19instead of 100thousandinhabi- per fatalvictims rate of the i.e. accidents, the deathrates from traffic Cities, Transit/Ministry of tional of Department theNa- Health thoseof with of the Ministry accidents. ber of vehicles andthenum- increase inthenumber of nolinearrelation wasfoundbetween the ing, per100thousandvehiclesvictims isdecreas- fatalandnon-fatal seen thattheevolution of vehicles increased inBrazil 28.8%but, ber of thenum- Between 1996and2002, torcyclists. followed by mo- mainly drivers orpassengers, age(66.4)and 18to 59years of sex (70.7%)of masculine are mainlyof The non-fatalvictims 8.5. wasof victims rate in100accidents with ty Themortali- 1.5victims. involves anaverage of shows victims thateachaccidents accident with accidents/ of Therelation victims fatal victims. correspondedthat each fatalvictim to 17non- per 100thousandinhabitants)oneobserved sand inhabitants)andnon-fatalaccidents ( fatal(12.3per 100thou- Comparing therates of from 81.5inS between thecapitalsranging avariation with 100thousandinhabitantswas219.5, tims per Therate forvic- them non-fataland5.6%fatal. 94.4%of in2002, inBrazil 337.190 victims accidents produced traffic Transit, of partment capitals. inallBrazilian file isobserved thispro- incidence apart, higher and groups of rzla ttswt espvry lower levels less poverty, StatesBrazilian with came to they theconclusion that contrary, onthe theStates, of urbanization the degree of tion between accidents deaths from and traffic These authorsdidnotfindarela- 1991-2002. trend from accidents curve intheperiod traffic nochange initsmortality be theonlyonewith et al nlzn h aasoni al ,once Analyzing intable4, thedatashown thestatisticaldatafor2002of Comparing According to datafrom theNational De- . 35 showed this region of the country to thecountry showed of thisregion ã o Lu í s to 528.2inBoa Vista. 207.3 The high (and for about three decades increas-The high fromtality accidents inBrazil. andviolence changed but alsosomenovel factsinmorbimor- someun- This analysisreveals theexistence of Conclusions centrate the greater part of injuries in2003. injuries of centrate thegreater part Macei Fortaleza, Teresina, theNort Thecapitalsof Amazonas. registered allinjuries inthe State of ing 99%of Manaus concentrat- of ample forthisisthecity An ex- these events isconcentrated inthecapitals. of part thegreater thecountry, in theNorth of theseven States situated In fourof in thecapitals. thelowestwith rates inthecountry. especiallyFortaleza andRecife national rate, allNortheastern below capitalsrank the trary, Onthecon- injuries. show ratesof alsohigh It isnoteworthy thatBras for example RioBranco (Table 4). tional rate, thanthena- valuesnearly4timeshigher with rates capitalspresent all high tion to Boa Vista, excep- with In theNorthern region, this rate. ing below thisnationalrate andother14above foundforthesameyearrate by theSIM. almost10timesmore thanthehomicide tants, 10thousandinhabi- per 390.7injuries of rate Thisfigure represents anational in thecapitals. them 25,4%of werejuries registered inBrazil, 618,097in- thatin2003, This organinformed theNational Department. Safety the dataof we basedon analyzed injuries from homicides, forthiscapital. rate theSIMshow alow mortality cause thedataof be- reservations certain ever must beseen with how- information This inthecountry. victims non-fatal fatalandthelowest of rate of rate thus thehighest showing non-fatalvictims, of thanthat higher fatalvictims of senting arate istheonlycapitalpre- data, in theinformed somemistake barring Aracaju, (65.3). Grande 74.7)andCampo Belo Horizonte of (aratio thanfatalvict times more non-fatalvictims ed indicators were found inCuritiba (101.4 fic accidents are related. process theurbanization traf- which factors of It istherefore to specifyto necessary dents. acci- deathratesfromcline to higher traffic in- populationgrowth andhigher illiteracy of Table 4alsoshows to beconcentrated injuries About half of the Brazilian capitalsare theBrazilian rang- of About half to deaths Seeking foranon-lethalparallel between thetwo ratios present-The highest ó and alsocon-Aracaju í lia andPorto Alegre heastern region heastern ims), Ciência & Saúde Coletiva, 11(2):363-373, 2006 371 2 10.000 vehicles 2 –– –– –– –– and concentration ofand concentration injuries. registered 1 Mortality and morbidity highly continue A new aspect in the panorama of violence of occurrences in the capitals victims per 10.000 vehicles victims per concentrated in the population of in the population concentrated males. young and vari- the complexity The studies also show ety of causes of these phenomena. ofin Brazil is the spreading cities homicides to rito Santo. Grosso and Mato Rio de Janeiro í Rates Concentration of Rate non-fatal of Rate fatal 303.6 17.8% 170.2 8.5 . Esp á admission from injury,admission from poisoning and other external causes (2005) the civil (2003) police SIM/MS SENASP/MJ NATRADEP ing) homicide rates remain and the same refers remain ing) homicide rates traffic from the deaths rates accidents.to The very little and in some regions dropped latter the imple- after even increasing they continue mentation in 1997 of of Code the new National Transit. polis/SC 7.74 774.3 9.5% 87.1 2.1 /AP 6.73 1,264.7 62.6% s/MA 8.36 521.3 36.4% 105.1 7.8 /AL 6.62 181.8 81.6% 77.7 2.6 ó /MT 6.62 470.1 30.5% í á ó á lia/DF 7.58 830.6 13.0% 95.6 2.4 nia/GO 10.81 325.5 28.1% 183.8 4.8 í ria/ES 10.77 763.0 26.5% m/PA 10.94 596.2 47.3% 79.4 4.2 â o Pessoa/PB 7.24 363.5 43.8% 63.1 8.5 é ó o Paulo/SP 9.53 344.5 19.2% 58.4 2.7 o Lu ã ã ã Aracaju/SESalvador/BABelo Horizonte/MGVit 10.74 11.79 8.72 252.6 249.5 371.2 58.3% 34.8% 9.6% 1.3 172.9 156.9 44.8 9.3 2.1 Curitiba/PRFlorian 10.08 253.5 18.8% 101.4 1.0 Rio de Janeiro/RJS 7.36 392.7 36.3% Porto Alegre/RSPorto 8.00 993.4 17.2% 146.9 3.1 Campo Grande/MSCuiab 11.37 ...... 143.6 2.2 Goi Bras S Teresina/PIFortaleza/CENatal/RNJo Recife/PEMacei 6.64 10.47 8.82 383.3 6.78 48.3 401.5 92.2% 61.5 63.4% 45.7% 138.5 205.2 27.1% 86.7 114.3 5.4 7.9 2.1 4.8 Palmas/TO 17.14 400.2 31.1% 232.8 6.4 Macap Porto Velho/ROPorto Rio Branco/ACManaus/AMBoa Vista/RRBel 8.70 9.73 5.55 7.36 1,118.5 1,538.8 720.0 271.9 43.6% 77.3% 99.0% 284.2 77.7% 329.9 161.4 344.6 10.7 10.6 10.3 17.4 ) Data not informed – Southeast 354.7 21.0% 87.8 3.4 South 609.8 15.7% 99.5 4.1 Center-West Northeast 255.4 42.3% 127.8 18.4 (*) Data incomplete (1) per 100 thousand inhabitants Rates (2) of The totals great regions and Brazil do not include: Amap ( BrazilNorth 6.88 390.7 771.9 25.4% 62.5% 104.6 159.2 6.2 11.1 Table 4 distributionProportional of injury, admissions due to hospital poisonig. Rates Areas Proportion of hospital Injuries registered at (2002) accidents Traffic Brazilian capitals, 2003. Souza, E. R. & Lima, M. L. C. 372 de Janeiro andCuiab hsz htProVlo Macapphasize thatPorto Velho, theevents. notifying the populationandby theagentsincharge of lent events are notperceived assuch bothby to under-recording andalsobecausemany vio- due inpart rates, inthemorbidity than shown there exists much more violence Consequently, thanmortality.show morbidity amuch higher Alldata accidents thanfatalvictims. traffic sit pointto of 17timesmore non-fatalvictims Tran- theNational of Department Dataof is 9.7. between homicidesandtheratio theseevents of thanthat is8.3timeshigher injuries number of The deathsfrom thesecauses. the number of than aredents andviolence 6.2timeshigher hospitaladmissionsdueto acci- the number of theSIM, according to dataof respect to events, With events to andcities deserve beemphasized. and urbanized. recently inregions also appearing occupied inothergoodsbut andillicittrade trafficking mostlyinconnection narcotics with States, the and municipalities of intheinnerregions the dataelaboration. Henrique daSilva Santos andThiagodeOliveira Pires in Alessandro We wantto acknowledge thecollaboration of Acknowledgments thepresent article. extent inthepreparation of ER SouzaandMLC Limahave to participated anequal Collaborations As refers to the cities, it is important to em- itis important As refers to thecities, regardSome detailswith to thestudied á are the capitals with the are thecapitalswith á ,Vit ó i,Rio ria, ihs ae fpremeditated violence of rates highest rates of homicides and injuries homicidesandinjuries of rates otlz,Jo Fortaleza, .SuaE,Mny C.An Minayo MCS. SouzaER, 1. References .Bro D,XmnsRA iaMC Mortalida- LimaMLC. Ximenes RAA, Barros MDA, 3. erespostas Criminalidade brasileira RamosS. 2. .SnaaF.Homic Santana FS. 5. .Cu G Homic Cruz OG. 4. lence, principally inthebigcities. principally lence, contribute to delinquencyandvio- sumerism for socialrecognition con- combined with struggle andunrestrained frustration gration, useinBrazil. drug tion of background forthecriminaliza- and cultural andtheinstitutional organized crime clusion, factors involving socialex- the interrelations of citiesweing theBrazilian needto understand dicators. low rates asrefers tosurprisingly thesetwo in- S Ontheotherhand, dents. most problematic asrefers acci- to city traffic 10thousandvehicles per isthe fatal victims (27.1%) involving inthiscapital. injuries occurrences may of bedueto thelow registry This rates. low injury homiciderates, high ior: violence Goi 0 n iaoMS oz R raies Viol organizers. SouzaER, Minayo MCS, In: e 90. d talidade porcausasexternas noBrasil: Universidade deS serta tend de porcausasexternas emcrian final decurso. Trabalho 2006. Claves/ENSP/Fiocruz; Rio deJaneiro: l 83-107. p. 2003. Fiocruz; RiodeJaneiro: brasileira. poraneidade Recife its standsoutwith NP icu;2004. Fiocruz; ENSP, talidade porviol efeitos dasdesigualdades socioecon an 142-9. cia soboolhardasa atr ieuepomn,familydisinte- Factors like unemployment, invad- violence For explaining thewave of fatalandnon- Palmas rates of itshigh with â ê i hwtelws ae fpremeditated nia show thelowest rates of ca os ncia: á lise dadistribui ê çã ca e17 95 Rev Sa ncias de1979a1995. – ] S o]. homicidesandinjuries. “ novos mediadores ã ã esa avdr Curitiba and Salvador, o Pessoa, al:Faculdade deSa o Paulo: ê í ã ncia [disserta dios noEstadodoRiodeJaneiro: al;1996. o Paulo; çã í ú ise avdr 1998-2001: dios emSalvador, o espacialesuaevolu de: a infrapol a de: ” á e ocasodo Afro Reggae. lise temporal damor- sui generis sui generis çã ã – ç o Paulo shows ] Rio de Janeiro: o]. whileTeresina, ú as eadolescentes: ePb20;35: de Pub 2001; í ô tica dacontem- micas na mor- ú é de P cadas de80 çã behav- – ú o [dis- high à blica, vio- ê n- Ciência & Saúde Coletiva, 11(2):363-373, 2006 373 - o á çã po- ncia o do ó o em ncias â de no ê çã ú n de la çã dios e o ó n R, Mi- í de. 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