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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introdu&#231;&#227;o</span><p id="par0005" class="elsevierStylePara elsevierViewall">As neoplasias malignas da pele constituem grave problema e um grande desafio para o setor de sa&#250;de p&#250;blica&#46; O aumento das taxas de incid&#234;ncia e de mortalidade dessa doen&#231;a nas &#250;ltimas d&#233;cadas &#233; fen&#244;meno observado em diversos pa&#237;ses do mundo e representa alto impacto na vida das popula&#231;&#245;es&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Dentre o grupo de tumores malignos&#44; destaca&#8208;se o melanoma da pele&#44; c&#226;ncer que acomete todas as faixas et&#225;rias e apresenta alto potencial de gravidade e dissemina&#231;&#227;o&#46; Nesse tipo de neoplasia&#44; at&#233; 20&#37; dos pacientes desenvolvem doen&#231;a metast&#225;tica&#44; evidenciando&#8208;se a import&#226;ncia de medidas de preven&#231;&#227;o e diagn&#243;stico precoce&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> Em fun&#231;&#227;o do processo de transi&#231;&#227;o demogr&#225;fica&#44; epidemiol&#243;gica e ao envelhecimento populacional&#44; uma significativa parcela desses casos ocorre em pacientes idosos&#44; o que demanda cuidados e atendimento m&#233;dico individualizado&#46; A associa&#231;&#227;o frequente de outras comorbidades&#44; bem como as particularidades decorrentes da senesc&#234;ncia&#44; podem indicar maior risco para quadros graves e com piores progn&#243;sticos&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">No Brasil&#44; o c&#226;ncer atualmente &#233; a segunda causa mais frequente de morte&#44; superado apenas por doen&#231;as cardiovasculares&#46; Em&#160;2018&#44; segundo dados do Instituto Nacional de C&#226;ncer &#40;INCA&#41;&#44; estimam&#8208;se aproximadamente 6&#46;260 novos casos de melanoma no pa&#237;s&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">6</span></a> Associado a essa crescente incid&#234;ncia de neoplasias malignas cut&#226;neas e ao envelhecimento populacional&#44; o Brasil conta ainda com outro grande desafio&#58; a m&#225; distribui&#231;&#227;o de m&#233;dicos especialistas em Dermatologia por seu territ&#243;rio&#46; Segundo dados da Demografia M&#233;dica de&#160;2018&#44; conta&#8208;se com 8&#46;317 especialistas no pa&#237;s&#44; a grande maioria concentrados nas regi&#245;es Sul e Sudeste &#40;74&#44;5&#37;&#41;&#44; sem experi&#234;ncia para realizar procedimentos cir&#250;rgicos dermatol&#243;gicos e com atendimento predominantemente urbano e privado&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">7</span></a> Devido &#224; vasta extens&#227;o territorial e &#224; marcante diversidade sociodemogr&#225;fica&#44; epidemiol&#243;gica e cultural&#44; notam&#8208;se diferen&#231;as significativas nas taxas de incid&#234;ncia e mortalidade nas diferentes macrorregi&#245;es brasileiras&#44; inferindo&#8208;se&#44; portanto&#44; grande complexidade no enfrentamento dessa doen&#231;a por parte dos agentes e setores competentes em sa&#250;de&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A patog&#234;nese molecular do melanoma maligno ainda n&#227;o foi completamente compreendida&#46; Entretanto&#44; sabe&#8208;se que existe uma interface entre predisposi&#231;&#227;o gen&#233;tica&#44; fatores ambientais e manifesta&#231;&#245;es fenot&#237;picas das intera&#231;&#245;es entre gene e ambiente&#46; Dentre os fatores que tornam os idosos um grupo de risco para o desenvolvimento de melanoma maligno cut&#226;neo est&#225; a exposi&#231;&#227;o &#224; radia&#231;&#227;o ultravioleta &#40;UV&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> Idosos com hist&#243;ria de longas jornadas de trabalho em ambiente ao ar livre&#44; como pescadores e trabalhadores das &#225;reas rurais&#44; devem ter especial aten&#231;&#227;o&#46; Outro fator que influencia diretamente o aumento na incid&#234;ncia de neoplasias malignas dermatol&#243;gicas em indiv&#237;duos na terceira idade &#233; a migra&#231;&#227;o populacional de aposentados para cidades litor&#226;neas&#44; resultando em uma rotina com maior tend&#234;ncia &#224; fotoexposi&#231;&#227;o cr&#244;nica e ao desenvolvimento de dermatoses&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Embora muitos estudos demonstrem o comportamento das taxas de mortalidade relacionadas ao melanoma maligno da pele ao redor do mundo&#44; pouco ainda se sabe sobre a tend&#234;ncia temporal de mortalidade dessa doen&#231;a no Brasil nos &#250;ltimos anos&#44; especialmente na popula&#231;&#227;o idosa&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">1&#44;9&#8211;11</span></a> S&#227;o necess&#225;rios estudos que indiquem como as particularidades relacionadas &#224; terceira idade influenciam na din&#226;mica dessa taxa em cada macrorregi&#227;o do pa&#237;s&#46; Mais informa&#231;&#245;es a respeito desse tema s&#227;o necess&#225;rias no intuito de auxiliar o desenvolvimento de pol&#237;ticas p&#250;blicas que visem reduzir o impacto dessa doen&#231;a em idosos&#46; Diante do exposto&#44; este artigo tem por objetivo analisar a tend&#234;ncia temporal da mortalidade por melanoma maligno da pele em idosos do Brasil&#44; entre os anos de 2001 e 2016&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudo descritivo de tend&#234;ncia temporal da taxa de mortalidade de melanoma maligno da pele em idosos&#44; segundo macrorregi&#245;es e sexo&#44; no per&#237;odo de&#160;2001&#160;a&#160;2016&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Os dados sobre as mortes por melanoma foram extra&#237;dos do Sistema de Informa&#231;&#245;es sobre Mortalidade &#40;SIM&#41;&#44; e as informa&#231;&#245;es relativas &#224; popula&#231;&#227;o residente do Brasil e suas macrorregi&#245;es foram obtidas do censo populacional de 2010 e das estimativas populacionais do Instituto Brasileiro de Geografia e Estat&#237;stica &#40;IBGE&#41; para os demais anos&#46; Foram utilizados os &#243;bitos por melanoma maligno da pele &#40;C43&#41; da Classifica&#231;&#227;o Internacional de Doen&#231;as &#40;CID&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>10&#46; Os &#243;bitos foram estudados segundo a vari&#225;vel sexo&#46; Incluiu&#8208;se no estudo apenas os indiv&#237;duos maiores de 60 anos&#46; Para a Organiza&#231;&#227;o Mundial da Sa&#250;de &#40;OMS&#41;&#44; o marcador para o in&#237;cio da terceira idade em pa&#237;ses em desenvolvimento&#44; como o Brasil&#44; &#233; a idade de 60 anos&#59; para na&#231;&#245;es desenvolvidas&#44; 65 anos&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">12</span></a> N&#227;o foram utilizados dados referentes a melanoma <span class="elsevierStyleItalic">in situ</span> &#40;CID<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>10&#58;&#160;D&#46;03&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Para a descri&#231;&#227;o e an&#225;lise dos dados foram calculados&#44; para cada ano do calend&#225;rio&#44; os coeficientes m&#233;dios brutos de &#243;bitos por melanoma maligno da pele&#44; segundo macrorregi&#227;o&#44; em cada sexo&#46; Os coeficientes foram calculados para cada&#160;100&#46;000&#160;habitantes&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Foi realizada a an&#225;lise de tend&#234;ncia das taxas de mortalidade para o Brasil e suas macrorregi&#245;es&#44; empregando&#8208;se a t&#233;cnica estat&#237;stica de regress&#227;o linear simples&#44; com uso do software Stata&#44; vers&#227;o&#160;14&#46;0 &#40;<span class="elsevierStyleItalic">StataCorp</span>&#44; Texas&#44; USA&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Foram consideradas&#44; como vari&#225;vel resposta&#44; tamb&#233;m denominada vari&#225;vel dependente&#44; as taxas de mortalidade&#44; e a vari&#225;vel explicativa&#44; ou vari&#225;vel independente&#44; os anos do estudo&#46; Admitiu&#8208;se tend&#234;ncia linear estatisticamente significativa somente quando a probabilidade de ter ocorrido foi igual ou menor do que&#160;0&#44;05&#59; ou seja&#44; p &#8804; 5&#37;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Por tratar&#8208;se de um estudo em que foram utilizados dados de dom&#237;nio p&#250;blico e sem a identifica&#231;&#227;o dos indiv&#237;duos&#44; n&#227;o foi necess&#225;rio submeter o trabalho ao Comit&#234; de &#201;tica em Pesquisa &#40;CEP&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="par0060" class="elsevierStylePara elsevierViewall">No per&#237;odo de&#160;2001&#160;a&#160;2016&#44; houve&#160;12&#46;712&#160;&#243;bitos por melanoma maligno da pele em idosos no Brasil&#46; A maioria &#40;56&#44;8&#37;&#41; ocorreu na popula&#231;&#227;o masculina&#46; Verifica&#8208;se constante aumento do n&#250;mero de &#243;bitos com o passar dos anos&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">O coeficiente de mortalidade na popula&#231;&#227;o geral &#40;ambos os sexos&#41; de idosos por melanoma maligno da pele subiu de 3&#44;83&#47;100&#160;mil habitantes em 2001 para 4&#44;47&#47;100 mil habitantes em 2016&#44; o que representa um aumento de aproximadamente 16&#44;7&#37;&#46; Nas diferentes macrorregi&#245;es&#44; excetuando&#8208;se a regi&#227;o Sudeste&#44; tamb&#233;m se observou crescimento em ambos os sexos&#44; ao comparar os anos de 2001 e 2016&#46; Constatou&#8208;se redu&#231;&#227;o dos coeficientes de mortalidade para o sexo feminino na regi&#227;o Norte &#40;aproximadamente 6&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#44; evidenciou&#8208;se que a regi&#227;o Sul apresentou os maiores coeficientes de mortalidade em todos os anos da an&#225;lise&#44; variando de 6&#44;54 em 2001 para 8&#44;04 em&#160;2016 &#40;ambos os sexos&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">No sexo feminino&#44; observou&#8208;se tend&#234;ncia de aumento nos coeficientes de mortalidade por melanoma maligno da pele nas regi&#245;es Nordeste &#40;p &#8804; 0&#44;001&#41;&#44; Centro&#8208;Oeste &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41; e para o Brasil &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; No sexo masculino&#44; houve tend&#234;ncia de aumento em todas as regi&#245;es&#44; excetuando&#8208;se a regi&#227;o Sudeste&#46; Al&#233;m disso&#44; na regi&#227;o Centro&#8208;Oeste observou&#8208;se o maior incremento&#44; de 0&#44;18 &#243;bitos a cada 100&#46;000 homens&#46; Para ambos os sexos&#44; tamb&#233;m se observou tend&#234;ncia de aumento em todas as regi&#245;es&#44; com exce&#231;&#227;o da regi&#227;o Sudeste &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabela 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discuss&#227;o</span><p id="par0080" class="elsevierStylePara elsevierViewall">O aumento da mortalidade entre idosos por melanoma maligno da pele no Brasil e em suas diferentes macrorregi&#245;es acompanha a tend&#234;ncia observada no mundo nas &#250;ltimas d&#233;cadas&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> Os n&#250;meros absolutos de morte por esse agravo no pa&#237;s tamb&#233;m crescem ao longo dos anos&#44; acompanhando o crescimento gradual da popula&#231;&#227;o idosa brasileira&#46; Esse aumento &#233; particularmente evidente nas regi&#245;es Nordeste&#44; Centro&#8208;Oeste e no Brasil como um todo&#44; onde todas essas regi&#245;es apresentaram aumento significativo para ambos os sexos&#46; Al&#233;m disso&#44; durante as an&#225;lises&#44; observaram&#8208;se maiores coeficientes para a popula&#231;&#227;o masculina idosa&#44; quando comparados aos coeficientes da popula&#231;&#227;o feminina idosa&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">O crescimento da mortalidade indica um potencial desafio de sa&#250;de p&#250;blica para as pr&#243;ximas d&#233;cadas&#46; A vigil&#226;ncia cont&#237;nua nesse grupo et&#225;rio &#233; necess&#225;ria&#44; pelas particularidades da doen&#231;a em idades mais elevadas&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a> Quando comparados a grupos mais jovens&#44; a mortalidade por melanoma &#233; significativamente maior nos idosos&#44; considerando&#8208;se a idade como um mau fator progn&#243;stico&#46; Em idosos&#44; a incid&#234;ncia de les&#245;es de maior espessura&#44; maior &#237;ndice mit&#243;tico e com ulcera&#231;&#245;es &#233; alta&#44; representando c&#226;ncer de pior evolu&#231;&#227;o&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;5</span></a> Ainda sobre isso&#44; destaca&#8208;se que a popula&#231;&#227;o idosa apresenta menor capacidade de repara&#231;&#227;o de &#225;cido desoxirribonucleico &#40;DNA&#41; nuclear&#46; A exposi&#231;&#227;o solar intensa apresenta efeito cumulativo&#44; apontando maiores chances do aparecimento de neoplasias malignas&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">13</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Na popula&#231;&#227;o idosa&#44; tamb&#233;m &#233; frequente a associa&#231;&#227;o da doen&#231;a com outras comorbidades preexistentes&#44; o que impacta diretamente no progn&#243;stico desses pacientes&#46; Outras poss&#237;veis explica&#231;&#245;es para a descoberta tardia de doen&#231;as cut&#226;neas malignas em idosos s&#227;o a maior dificuldade de detec&#231;&#227;o de les&#245;es em &#225;reas pouco evidentes como couro cabeludo e dorso&#44; maior preval&#234;ncia de defeitos de vis&#227;o&#44; menor import&#226;ncia com aspectos est&#233;ticos e de autocuidado com a pele e confus&#227;o com mudan&#231;as naturais e benignas da pele durante a senesc&#234;ncia&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">4&#44;5</span></a> Al&#233;m disso&#44; medidas de preven&#231;&#227;o como campanhas de incentivo &#224; fotoprote&#231;&#227;o&#44; campanhas de desaconselhamento do uso de cabines de bronzeamento artificial e o pr&#243;prio rastreamento para essas neoplasias malignas t&#234;m normalmente como p&#250;blico&#8208;alvo grupos et&#225;rios mais jovens&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Nas macrorregi&#245;es Sul e Norte&#44; a tend&#234;ncia de acr&#233;scimo nas taxas de mortalidade no sexo feminino n&#227;o acompanhou a do sexo masculino&#44; indicando oscila&#231;&#227;o no per&#237;odo&#46; Al&#233;m disso&#44; observou&#8208;se maiores coeficientes para a popula&#231;&#227;o masculina idosa&#46; Sugere&#8208;se que mulheres fazem diagn&#243;sticos em fases mais precoces da doen&#231;a&#44; principalmente devido &#224; maior utiliza&#231;&#227;o dos servi&#231;os de sa&#250;de&#44; aumentando as chances de cura e evitando piores desfechos em sa&#250;de&#46; Esse comportamento&#44; em geral&#44; &#233; atribu&#237;do &#224; maior autopercep&#231;&#227;o de sinais e sintomas&#44; mais preocupa&#231;&#245;es com rela&#231;&#227;o &#224; sa&#250;de e maior ades&#227;o a campanhas preventivas&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">15</span></a> Franzon et al&#46; &#40;2015&#41;&#44; ao analisarem os prontu&#225;rios de pacientes diagnosticados com melanoma durante cinco anos em um servi&#231;o especializado em c&#226;ncer de pele da cidade de Curitiba &#40;PR&#41;&#44; identificaram que os homens tinham diagn&#243;stico de melanoma mais tardio em compara&#231;&#227;o &#224;s mulheres&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">16</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Na macrorregi&#227;o Sudeste&#44; regi&#227;o com maior produto interno bruto &#40;PIB&#41; <span class="elsevierStyleItalic">per capita</span> segundo dados do Instituto de Pesquisa e Economia Aplicada &#40;IPEA&#41;&#44; foram observadas oscila&#231;&#227;o dos coeficientes de mortalidade entre os anos de 2001 e 2016&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> Esses dados corroboram estudos que indicam tend&#234;ncia &#224; estabiliza&#231;&#227;o do n&#250;mero de mortes pela doen&#231;a em regi&#245;es com maior desenvolvimento socioecon&#244;mico&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a> Esse comportamento &#233; observado principalmente em locais como Estados Unidos&#44; Austr&#225;lia e alguns pa&#237;ses europeus de origem n&#243;rdica&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">9&#44;18&#44;19</span></a> Esses estudos indicam que&#44; ao longo das &#250;ltimas d&#233;cadas&#44; nessas regi&#245;es&#44; as taxas de mortalidade por melanoma maligno cresceram em velocidade significativamente menor em compara&#231;&#227;o &#224; velocidade de crescimento das taxas de incid&#234;ncia da doen&#231;a&#46; Isso sugere que&#44; possivelmente&#44; est&#227;o sendo diagnosticadas les&#245;es mais finas&#44; menos agressivas e com melhor progn&#243;stico&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">O impacto de fatores como a constru&#231;&#227;o hist&#243;rica das popula&#231;&#245;es tamb&#233;m deve ser ressaltado&#46; Em todos os anos da an&#225;lise&#44; a regi&#227;o Sul apresenta as maiores taxas de mortalidade&#44; mesmo sendo uma regi&#227;o de alta latitude e clima temperado&#46; A forte coloniza&#231;&#227;o dessa regi&#227;o por descendentes europeus de pele clara pode influenciar no comportamento da doen&#231;a&#44; visto que um dos fatores de risco para o desenvolvimento dessa neoplasia &#233; a cor da pele&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> Em estudo realizado por Gandini et al&#46; &#40;2005&#41;&#44; concluiu&#8208;se que o risco relativo de desenvolver melanoma foi de 2&#44;06 para indiv&#237;duos com pele clara quando comparados aos indiv&#237;duos de pele escura&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">20</span></a> Al&#233;m disso&#44; esses dados tamb&#233;m corroboram o estudo de Mendes et al&#46; &#40;2005&#41;&#44; que ao analisarem a mortalidade atribu&#237;da ao melanoma no Brasil durante o per&#237;odo de 1980&#8208;2005&#44; para a popula&#231;&#227;o geral&#44; encontraram aumento dos coeficientes de mortalidade na regi&#227;o Sul&#44; destacando&#44; inclusive&#44; a previsibilidade desse cen&#225;rio&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Na regi&#227;o Nordeste&#44; observou&#8208;se tend&#234;ncia de aumento para homens&#44; mulheres e ambos os sexos&#46; Isso poder estar atrelado &#224; alta incid&#234;ncia de raios UV na regi&#227;o&#44; um dos principais fatores de risco para o desenvolvimento do melanoma maligno&#46; Dados do Instituto Nacional de Pesquisas Espaciais &#40;INPE&#41; mostram que o &#237;ndice UV de algumas capitais brasileiras encontra&#8208;se em n&#237;veis considerados muito altos ou extremos&#59; a maioria dessas capitais est&#225; localizada na regi&#227;o Nordeste do Brasil&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> Contudo&#44; n&#227;o se pode descartar uma melhora na qualidade das informa&#231;&#245;es como respons&#225;vel pelo incremento na mortalidade nessa regi&#227;o brasileira&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Como poss&#237;vel limita&#231;&#227;o do estudo&#44; aponta&#8208;se que os bancos de dados secund&#225;rios sofrem influ&#234;ncia direta da qualidade do preenchimento do atestado de &#243;bito e da sua abrang&#234;ncia heterog&#234;nea nas regi&#245;es brasileiras&#46; Mesmo uma an&#225;lise macrorregional pode sofrer in&#250;meras vari&#226;ncias dentro de seu territ&#243;rio&#46; &#201; necess&#225;rio que sejam realizados novos estudos que possibilitem outras associa&#231;&#245;es para compreender melhor a mortalidade atrelada ao melanoma maligno&#44; avaliando outros par&#226;metros&#44; como zona de resid&#234;ncia &#40;urbana&#44; rural&#41;&#44; localiza&#231;&#227;o anat&#244;mica&#44; renda e&#47;ou escolaridade&#46; Contudo&#44; o SIM &#233; um sistema de abrang&#234;ncia nacional e representa uma importante fonte do registro de &#243;bitos ocorridos no pa&#237;s &#8211; portanto&#44; seu aprimoramento e fortalecimento deve ser uma prioridade para a gest&#227;o de informa&#231;&#245;es sobre a mortalidade&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclus&#227;o</span><p id="par0120" class="elsevierStylePara elsevierViewall">Houve tend&#234;ncia de aumento dessa mortalidade na popula&#231;&#227;o idosa&#44; em ambos os sexos&#44; para todas as regi&#245;es do Brasil &#40;excetuando&#8208;se a regi&#227;o Sudeste&#41;&#46; Diante desse cen&#225;rio&#44; destaca&#8208;se que al&#233;m da detec&#231;&#227;o e diagn&#243;stico precoce&#44; existe a necessidade de avan&#231;os nas formas de distin&#231;&#227;o entre melanomas agressivos e melanomas indolentes&#44; no intuito de direcionar estrat&#233;gias de tratamento mais efetivas ao c&#226;ncer de pele&#46; A preven&#231;&#227;o por meio de campanhas e a conscientiza&#231;&#227;o da popula&#231;&#227;o quanto a esse tipo de neoplasia deve ser uma prioridade em sa&#250;de p&#250;blica no Brasil&#44; com aten&#231;&#227;o especial a grupos populacionais de risco&#44; como pessoas de maior faixa et&#225;ria&#46; Ainda sobre isso&#44; &#233; fundamental que o acesso &#224;s modalidades terap&#234;uticas nos diversos n&#237;veis de complexidade do sistema de sa&#250;de tamb&#233;m seja garantido &#40;acompanhamento cl&#237;nico com regular periodicidade&#44; disponibilidade de exames complementares&#44; consultas com m&#233;dicos especialistas&#44; procedimentos cir&#250;rgicos e medicamentos&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Suporte financeiro</span><p id="par0125" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Contribui&#231;&#227;o dos autores</span><p id="par0130" class="elsevierStylePara elsevierViewall">Rodrigo Vasconi S&#225;ez Brown&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Dan&#250;bia Hillesheim&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Yan&#225; Tamara Tomasi&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Daniel Holthausen Nunes&#58; An&#225;lise estat&#237;stica&#59; aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflito de interesses</span><p id="par0150" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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          "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Tend&#234;ncia dos coeficientes de mortalidade por melanoma maligno da pele de idosos&#44; por 100 mil habitantes&#44; no sexo masculino&#44; sexo feminino e em ambos os sexos&#46; Brasil &#40;2001&#160;a&#160;2016&#41;&#46;</p>"
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2004&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2007&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2016&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2001&#47;2016 &#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Norte</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>167&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;36&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;54&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&#44;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>77&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>12&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Macrorregi&#245;es&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Varia&#231;&#227;o m&#233;dia anual &#40;95&#37;&#160;IC&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Interpreta&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Valor p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;14 &#40;0&#44;06&#8208;0&#44;22&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;03 &#40;&#8722;0&#44;00&#8208;0&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oscila&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;086&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;08 &#40;0&#44;03&#8208;0&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;002</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Nordeste</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;14 &#40;0&#44;09&#8208;0&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#60; 0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;07 &#40;0&#44;04&#8208;0&#44;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">&#60; 0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;10 &#40;0&#44;07&#8208;0&#44;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sudeste</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;03 &#40;&#8722;0&#44;00&#8208;0&#44;07&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oscila&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;087&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;00 &#40;&#8722;0&#44;03&#8208;0&#44;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oscila&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;482&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;01 &#40;&#8722;0&#44;01&#8208;0&#44;03&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oscila&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;379&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sul</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;17 &#40;0&#44;08&#8208;0&#44;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;05 &#40;&#8722;0&#44;02&#8208;0&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oscila&#231;&#227;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;171&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;11 &#40;0&#44;06&#8208;0&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Centro&#8208;Oeste</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;18 &#40;0&#44;07&#8208;0&#44;29&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;12 &#40;0&#44;05&#8208;0&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;002</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ambos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;15 &#40;0&#44;08&#8208;0&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Brasil</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Masculino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;11 &#40;0&#44;08&#8208;0&#44;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleBold">0&#44;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;03 &#40;0&#44;01&#8208;0&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aumento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">0&#44;003</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;45&nbsp;\t\t\t\t\t\t\n
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