Análise dos critérios de aposentadoria, do Instituto Nacional do Seguro Social, na cardiopatia chagásica, no período de janeiro de 1994 a março de 1999, no município de Uberlândia, Minas Gerais

Abstract

The Chagas Disease, primarily found in rural populations into poverty and without knowledge, has reached the cities peripheries due to the increasing migration to urban areas. An endemic disease of high social-economic cost, where the most of the patients, who do not show symptoms, carries the disease chronic phase, working in heavy works and developing the chagasic cardiopathy, main cause of the work incapacity or death. An evaluation in the criteria of the insured people retirement has been made within the period from 01/01/1994 to 03/31/1999, listed by the National System of Information of the Social Security, comparing electro-cardiogram data and functional class by the time of the retirement with the current ones, analyzing the disease progression and possible predictable factors of the worst diagnosis. The criteria of benefits of the INSS are: increased cardiomegaly; cardiac congestive insufficiency; significative electro-cardiogram changes, such as serious non-rhythmical ones; His bundle left wing blockade; right wing blockade associated with fore-superior divisional blockade of the left wing; atrial fibrilation and significative undernourishment, due to the digestive ways of the disease. From the 167 analyzed insured people, 126 (75,45%) were male. From the 54 ones (28%), already dead, the males were predominant 47 (87,03%), from which 51 death certificates were found, 39 (76,47%) by Chagas Disease, 12 for other causes and 3 were not found. The average age by the time of the benefits requirements was 52,05 (± 8,52) years old, they were at the time of evaluation with an average time of benefit of 6,9 (± 2,8) years, average age of 60,30 (± 8,37) years old. The deaths occurred in an average of 4,16 (± 2,52) years after the beginning of the benefit, with an average age of 56,41 (± 9,54) years old. Within the professions and occupations, drivers, general services and arm workers were predominant. Analyzing the electro-cardiograms changes, the intra-ventricular blockades 99 (68,75%) were found, with predominancy of the complete right wing blockade associated with fore-superior divisional blockade of the left wing 48 (33,33%), extra-systoles 85 (59,02%), having a predominancy of the ventricular ones 69 (47,91%). Comparing the electro-cardiograms of the retirement at the insured people deaths with those who were alive, were found higher numbers of vetricular extra-systoles and ventricular re-polarization changes, statisticaly significant. In 93 insured people cases, the functional class and the electro-cardiogram were re-evaluated, analyzing the disease progression. Within these examined patients, there is not any of them who are capable, some are evolving well after quitting the physical efforts. The complete right wing blockade associated with fore-superior x divisional blockade of the left wing, has not demonstrated to be of a higher seriousness, in the absence of the symptoms, they must be treated as the isolated blockades. Therefore, being incapable for great efforts and that do not cause risks to themselves or others, must not being treated as disability, as it is treated currently. These are factors of higher seriousness: male gender and severe changes such as the ventricular extra-systoles, ventricular re-polarization changes, moderate cardiomegaly and severe cardiac insufficiency, functional classes III and IV.