Epidemiology of cerebrovascular diseases in cuba, 1970 to 2006

Cerebrovascular diseases (CD) are a global health problem. They are the second and third causes of death in the world and in Cuba, respectively. Projections for year 2020 suggest they will continue to be among the main causes of death and disability, both in developed and developing countries. In 2006, the National Health System (NHS) presented its Public Health Projections in Cuba for Year 2015, which set the following specific goals for CD mortality reduction: overall mortality by 25%, female mortality by 30%, and hospital mortality by 30%.

Analyze CD mortality in Cuba from 1970 to 2006, before and after implementation of the National Program for Cerebrovascular Disease Prevention and Control (NPCD-PC) to obtain a better understanding of the current situation, which may serve as the basis to meet the goals set for year 2015.

CD mortality databases from the National Statistical Division of the Cuban Ministry of Public Health were used. The following variables were applied: sex, CD-related causes, and place of death. Crude and age-adjusted mortality rates were determined. Overall mortality, mortality by sex, years of potential life lost, hospital mortality, incidence, and prevalence were calculated.

Crude mortality rates showed a sustained increase within the time series under study; conversely, age-adjusted rates showed a decrease in mortality during the 1970s, were stable in the 1980s and 1990s and, finally, decreased since year 2000, when the NPCD-PC program was started in the country. The male/female ratio increased slightly from the late 1990s until 2005; yet female mortality has shown a tendency to increase. Between 1993 and 2002, cerebral hemorrhage caused more deaths than the cerebral infarction; since then, this profile has reversed. CD-related years of potential life lost (YPLL) showed a decrease from 1970 to 1975, followed by a sustained increase through 1985, and a gradual decrease since 1990. Hospital mortality diminished steadily from 1990 to 1999 and has remained stable since year 2000. Even though there was greater CD incidence from 2000 to 2001, it has decreased since then. However, prevalence has increased slightly every year from 2000 to 2005.

Although overall mortality and female mortality rates, in particular, increased following implementation of the NPCD-PC program, age-adjusted mortality, hospital mortality, and incidence diminished during the same period. Further study is recommended to determine specific actions required to achieve CD mortality reduction goals by 2015.