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Published on: April 23, 2021
Cerebrovascular and hypertensive diseases as multiple causes of death in Brazil from 2004 to 2013
P B Villela1, C H Klein2, G M M Oliveira1
1Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rua Rodolpho Paulo Rocco 255, Ilha do Fundão, Rio de Janeiro, RJ 21941-913, Brazil.
Insights
Hypertensive diseases (HYPDs) were mentioned four times more often as a contributing cause of death than as the primary cause in Brazil. Better hypertension control is crucial for preventing deaths from these conditions.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Health
Background:
- Hypertensive diseases (HYPDs) and cerebrovascular diseases (CBVDs) are significant causes of mortality in Brazil.
- In 2013, HYPDs accounted for half the deaths attributed to CBVDs, highlighting a potential underestimation of HYPDs' impact.
- Understanding the role of HYPDs as multiple causes of death is crucial for effective public health strategies.
Purpose of the Study:
- To evaluate mortality related to HYPDs and CBVDs as multiple causes of death in Brazil.
- To analyze trends in the reporting of HYPDs and CBVDs on death certificates from 2004 to 2013.
- To assess the discrepancy between underlying causes and any mention of these diseases on death certificates.
Main Methods:
- Analysis of historical series of secondary data from Brazilian official registries (Mortality Information System).
- Data extracted from DATASUS, including death certificates (DCs).
- Evaluation of HYPDs and CBVDs based on their mention as underlying cause or any line on DCs, using ICD-10 codes.
Main Results:
- HYPDs were mentioned in 40.9% of DCs when CBVDs were the underlying cause, but CBVDs were mentioned in only 5.0% when HYPDs were the underlying cause.
- When HYPDs were mentioned without CBVDs, they were selected as the underlying cause 30.0% of the time.
- The frequency of any mention of HYPDs relative to underlying causes increased fourfold from 2004, while the relative frequency for CBVDs decreased.
Conclusions:
- Deaths related to HYPDs are mentioned up to four times more often as multiple causes than as underlying causes.
- These findings underscore the critical need for improved hypertension management to reduce mortality.
- Accurate recording of multiple causes on death certificates is essential for understanding disease impact.
Objectives:
The proportion of deaths attributed to hypertensive diseases (HYPDs) was only 50% of that registered for cerebrovascular diseases (CBVDs) in 2013 in Brazil. This article aims to evaluate mortality related to HYPDs and CBVDs as multiple causes of death, in Brazil from 2004 to 2013.
Study Design:
Analysis of historical series of secondary data obtained from Brazilian official registries.
Methods:
Data about the deaths were obtained from the Mortality Information System of the Brazilian Ministry of Health, available on the DATASUS website. CBVDs and HYPDs were evaluated according to their mentions as the underlying cause of death or entry in any line of the death certificates (DCs), according to their International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes.
Results:
When CBVDs were the underlying causes of death, HYPDs were mentioned in 40.9% of the DCs. When HYPDs were the underlying causes of death, CBVDs were mentioned in only 5.0%. When CBVDs were mentioned without HYPDs, they were selected as the underlying cause of death 74.4% of the time. When HYPDs were mentioned in DCs without CBVDs, HYPDs were selected 30.0% of the time. In 2004, the frequency of any mention of HYPDs relative to the frequency of HYPDs cited as underlying causes increased fourfold and was followed by a plateau until 2013. In contrast, the frequency of any mention of CBVDs relative to the frequency of CBVDs as underlying causes decreased in the same period. Because this study was based on DC records, it was limited by the way these documents were completed, which may have included lack of record of the causes related to the sequence that culminated in death.
Conclusion:
When deaths related to HYPDs were evaluated as multiple causes of death, they were mentioned up to four times more often than when they were selected as underlying causes of death. This reinforces the need for better control of hypertension to prevent deaths.
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