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Published on: June 24, 2025

Out-of-Hospital Excess Mortality From Cardiovascular Diseases During the COVID-19 Pandemic in Brazil

Humberto G Moreira1, Thiago C Barreto1

  • 1Medical School, Federal University of Goias, Goiania, BRA.

Cureus
|June 3, 2026
PubMed

Insights

The COVID-19 pandemic significantly increased out-of-hospital deaths in Brazil, reversing a downward trend in cardiovascular disease mortality. This highlights the need for stronger emergency response systems during health crises.

Area of Science:

  • Public Health
  • Epidemiology
  • Cardiovascular Disease Research

Background:

  • The COVID-19 pandemic caused global health system disruptions, with limited data on indirect mortality, especially cardiovascular disease (CVD) deaths outside hospitals in low- and middle-income countries (LMICs).
  • Brazil, facing high COVID-19 mortality, provides a crucial setting to assess this indirect burden.

Purpose of the Study:

  • To quantify the impact of the pandemic on out-of-hospital mortality, specifically cardiovascular deaths, in Brazil.
  • To analyze trends in out-of-hospital deaths before and during the pandemic.

Main Methods:

  • Ecological time-series analysis of national mortality data in Brazil (2015-2021).
  • Inclusion of all deaths recorded outside health facilities.
  • Calculation of crude and age-sex adjusted mortality rates, standardized to the 2022 Census population.

Main Results:

  • Out-of-hospital deaths rose by 18.8% during 2020-2021 compared to the pre-pandemic average.
  • Age-sex adjusted out-of-hospital cardiovascular mortality rates increased in 2020-2021, reversing a prior decline.
  • Cardiovascular disease was the leading cause of death; ill-defined deaths increased by 44%, indicating diagnostic gaps.

Conclusions:

  • The pandemic period saw a significant increase in out-of-hospital mortality in Brazil, reversing cardiovascular mortality trends.
  • Findings emphasize the need for robust primary care and decentralized emergency systems during public health emergencies.
Abstract

Keywords:
cardiovascular deathcovid-19excess mortalityout-of-hospitalpublic health system

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