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Published on: September 26, 2018
[Mortality from cardiovascular diseases in three Brazilian states from 1980 through 2002]
Gláucia M M de Oliveira1, Carlos H Klein, Nelson A de Souza e Silva
1Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro (RJ), Brazil. glaucia@mls.com.br
Insights
Mortality from circulatory diseases, including ischemic heart disease and cerebrovascular disease, declined significantly in major Brazilian states after 1980. These improvements in circulatory disease mortality may be linked to economic development and better living conditions.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Research
Background:
- Circulatory diseases (CDs) represent a significant cause of adult mortality globally.
- Understanding regional variations in mortality rates is crucial for targeted public health interventions.
- Ill-defined causes of death can obscure true mortality patterns, necessitating careful statistical adjustment.
Purpose of the Study:
- To compare adult mortality trends from CDs, ischemic heart disease (IHD), and cerebrovascular disease (CVD) between 1980 and 2002.
- To analyze these trends in the Brazilian states of Rio de Janeiro, Rio Grande do Sul, and São Paulo, and their respective capital cities.
- To account for the impact of deaths from ill-defined causes on mortality rate calculations.
Main Methods:
- Estimated age- and sex-adjusted mortality rates for CDs, IHD, and CVD in adults aged 20 years and older.
- Weighted mortality rates to include a proportion of deaths from ill-defined causes.
- Employed linear regression models to determine mean values and annual differences in weighted, adjusted rates.
- Utilized the 2000 population of Rio de Janeiro state as the reference population.
Main Results:
- Weighted adjusted mortality rates from CDs declined annually, with rates ranging from -13.1 per 100,000 in Rio de Janeiro state to -8.7 per 100,000 in São Paulo city.
- Annual declines for IHD were highest in Rio de Janeiro city (-5.0 per 100,000) and state (-4.5 per 100,000).
- CVD mortality showed annual decreases from -6.5 per 100,000 in Rio de Janeiro state to -2.9 per 100,000 in Porto Alegre city.
Conclusions:
- Observed decreases in mortality from CDs, IHD, and CVD occurred post-1980.
- These declines are unlikely to be solely due to risk factor control or revascularization procedures.
- Potential contributing factors include economic development leading to improved living conditions and reduced infection exposure.
Objective:
To evaluate and compare adult mortality from diseases of the circulatory system (CDs), especially ischemic heart disease (IHD) and cerebrovascular disease (CVD), from 1980 through 2002 in the Brazilian states of Rio de Janeiro, Rio Grande do Sul, and São Paulo and their capital cities (respectively Rio de Janeiro, Porto Alegre, and São Paulo), taking into account the impact of deaths due to ill-defined causes on mortality rates.
Method:
We estimated mortality rates (crude and adjusted by age and sex) from CDs overall and from IHD and CVD among individuals aged 20 years or older. These rates were weighted with a portion of the deaths from ill-defined or unknown causes, in the same proportion as deaths from CDs, IHD, and CVD in relation to deaths overall, excluding deaths from ill-defined causes. Using linear regression models, we also estimated the mean values of and annual differences in the weighted adjusted mortality rates. The reference population was that of the state of Rio de Janeiro in 2000.
Results:
The annual decline in the weighted adjusted mortality rates from CDs ranged from -13.1 per 100,000 individuals in the state of Rio de Janeiro to -8.7 per 100,000 in the city of São Paulo. For IHD, the annual declines were greatest in the city of Rio de Janeiro (-5.0 per 100,000) and the state of Rio de Janeiro (-4.5 per 100,000), and smallest in the state of Rio Grande do Sul (-2.8 per 100,000) and the city of São Paulo (-2.7 per 100,000). With CVD, the range that was found extended from -6.5 per 100,000 in the state of Rio de Janeiro to -2.9 per 100,000 in the city of Porto Alegre.
Conclusion:
The decreases in weighted adjusted mortality rates from CDs, IHD, and CVD occurred after 1980, so it is unlikely that the declines resulted from controlling risk factors or from the practice of myocardial revascularization. The decreases might be related to a period of strong economic development preceding the declines, which translated into improved living conditions and reduced exposure to infections in the perinatal period and childhood.
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