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Cardiovascular Mortality During the COVID-19 Pandemics in a Large Brazilian City: A Comprehensive Analysis
Luisa C C Brant1, Pedro C Pinheiro1, Antonio L P Ribeiro1
1School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Insights
COVID-19 disrupted cardiovascular disease (CVD) care in Brazil, leading to more deaths at home, especially among older and vulnerable populations. This highlights increased health inequities during the pandemic.
Area of Science:
- Public Health
- Epidemiology
- Cardiology
Background:
- COVID-19 pandemic impacted healthcare systems globally.
- Brazil's decentralized public health response to COVID-19 may have varied effects on cardiovascular disease (CVD) outcomes.
- Understanding these impacts is crucial for public health preparedness.
Purpose of the Study:
- To analyze the impact of COVID-19 on CVD outcomes in Belo Horizonte (BH), Brazil.
- To assess changes in CVD mortality, home deaths, hospitalizations, and in-hospital mortality.
- To investigate differential effects by sex, age, social vulnerability, and pandemic phase.
Main Methods:
- Ecological study using BH's Mortality and Hospital Information System data (residents ≥30 years).
- CVD defined using ICD-10 Chapter IX; social vulnerability classified by socioeconomic index.
- Compared observed 2020 rates (epidemiological weeks 10-48) to expected rates (2015-2019 mean), calculating Risk Ratios (RiR).
Main Results:
- No significant change in overall CVD mortality rates (RiR 1.01).
- Increased CVD deaths occurred at home (RiR 1.32) with decreased hospitalizations (RiR 0.89).
- Home deaths rose significantly in older adults and showed an increasing gradient with higher social vulnerability.
Conclusions:
- Disruption of CVD care during COVID-19 is suggested by increased home deaths and reduced hospitalizations.
- Older and socially vulnerable populations were disproportionately affected, exacerbating health inequities in BH.
- Findings underscore the need for resilient healthcare systems to manage pandemics without compromising chronic disease care.
Introduction:
The impact of COVID-19 pandemics on cardiovascular diseases (CVD) may be caused by health system reorganization and/or collapse, or from changes in the behaviour of individuals. In Brazil, municipalities were empowered to define regulatory measures, potentially resulting in diverse effects on CVD morbimortality.
Objective:
To analyse the impact of COVID-19 pandemics on CVD outcomes in Belo Horizonte (BH), the sixth greater capital city in Brazil, including: mortality, mortality at home, hospitalizations, intensive care unit utilization, and in-hospital mortality; and the differential effect according to sex, age range, social vulnerability, and pandemic's phase.
Methods:
Ecological study analysing data from the Mortality and Hospital Information System of BH residents aged ≥30 years. CVD was defined as in Chapter IX from ICD-10. Social vulnerability was classified by a composite socioeconomic index as high, medium and low. The observed age-standardized rates for epidemiological weeks 10-48, 2020, were compared to the expected rates (mean of 2015-2019). Risk ratios (RiR) were analysed and 95% confidence intervals were calculated for all estimates. Population projected to 2020 for BH and its census tracts were used to calculate rates.
Results:
We found no changes in CVD mortality rates (RiR 1.01, 95%CI 0.96-1.06). However, CVD deaths occurred more at homes (RiR 1.32, 95%CI 1.20-1.46) than in hospitals (RiR 0.89, 95%CI 0.79-0.99), as a result of a substantial decline in hospitalization rates, even though proportional in-hospital deaths increased. The rise in home deaths was greater in older adults and in had an increasing gradient in those more socially vulnerable (RiR 1.45); for high (RiR 1.45), medium (RiR 1.32) and low vulnerability (RiR 1.21).
Conclusion:
The greater occurrence of CVD deaths at home, in parallel with lower hospitalization rates, suggests that CVD care was disrupted during the COVID-19 pandemics, which more adversely affected older and more socially vulnerable individuals, exacerbating health inequities in BH.
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