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Cardiovascular diseases mortality in Brazilian municipalities: estimates from the Global Burden of Disease study,
Luisa Campos Caldeira Brant1,2, Juliana Bottoni Souza3, Bruno Ramos Nascimento1
1School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Insights
Cardiovascular disease (CVD) mortality decreased in Brazil, but reductions were smaller in vulnerable regions and smaller municipalities. Targeted public health policies are needed for these areas to ensure equitable CVD risk reduction.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Diseases
Background:
- Cardiovascular disease (CVD) mortality has declined in Brazil due to improved healthcare access and risk factor management.
- Geographic and population-based disparities in this CVD mortality reduction across Brazilian municipalities remain unclear.
Purpose of the Study:
- To analyze the spatial and demographic variations in age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) across Brazilian municipalities between 2000 and 2018.
Main Methods:
- An ecological study utilizing Global Burden of Disease (GBD) estimates for ASMR in 5564 Brazilian municipalities.
- Visuospatial analysis, including Local Moran analysis, was employed to identify mortality clusters.
- Municipalities were stratified by population size (<30,000, 30,000-300,000, >300,000) within five regions.
Main Results:
- In 2000-2002, higher CVD ASMR were observed in more developed regions and larger municipalities, except in the South.
- By 2016-2018, CVD ASMR increased in the least developed Northern regions.
- The percentage reduction in CVD ASMR was significantly lower in smaller municipalities compared to larger ones across all regions, ranging from -3% (North, small) to -43% (South, large).
Conclusions:
- The reduction in CVD mortality in Brazil has been less effective in municipalities with smaller populations and in less developed regions.
- Developing targeted public health policies for smaller municipalities, especially in the Northern region, is crucial for achieving equitable CVD mortality reduction.
Background:
Age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) have decreased in Brazil in the last decades due to better control of risk factors and access to healthcare. However, how this reduction is distributed across the country's municipalities is unknown. We aimed to evaluate changes in CVD mortality rates across Brazilian municipalities from 2000 to 2018 using estimates from the Global Burden of Disease (GBD) study.
Methods:
In this ecological study, ASMR for CVD were estimated using GBD methodology for 5564 Brazilian municipalities from 5 regions in the triennials: 2000-2002, 2009-2011, 2016-2018. A visuospatial analysis was applied to create clusters in ASMR with Moran Local analysis. Municipalities were stratified by population size in <30,000, 30,000-300,000, and >300,000 inhabitants per region. The % changes in ASMR from 2000-2002 to 2016-2018 were calculated.
Findings:
In 2000-2002, ASMR for CVD were higher in more developed regions and in larger municipalities of all regions, except for the South. In 2016-2018, CVD ASMR increased in the least developed Northern regions. The % reduction in CVD ASMR was lower in small vs large municipalities within all 5 regions, varying from -3% in small Northern municipalities to -43% in large Southern municipalities.
Interpretation:
The reduction in CVD mortality in Brazil was lower in municipalities from the most vulnerable regions and smaller populations. Public policies tailored to these smaller municipalities, particularly on the least developed regions, must be considered a priority.
Funding:
Brazilian Ministry of Health [grant 148/2018] and Pan American Health Organization [Letter of Agreement SCON2021-00288].
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