Cardiovascular disease mortality in a Central-West Brazilian capital: A spatial, temporal, and ecological analysis

In Brazil, regional disparities in cardiovascular disease (CVD) mortality persist, with no population-based study having examined CVD mortality at the municipal level in the Central-West region. This study analysed the epidemiological profile, temporal trends, spatial distribution, and socioeconomic correlates of CVD mortality in Campo Grande, Mato Grosso do Sul, Brazil (2013-2022). A population-based ecological study used data from the Brazilian Mortality Information System. Five CVD groups were analysed: ischaemic heart disease (IHD), heart failure (HF), arrhythmias (ARR), cardiomyopathies (CMP), and inflammatory heart diseases (INF). Temporal trends were assessed using Poisson, Prais-Winsten, and Joinpoint regression. Spatial distribution was examined through Kernel Density Estimation and Local Indicators of Spatial Association (LISA). Socioeconomic correlates were assessed using Spearman's correlation with neighbourhood-level indicators. Of 59,392 registered deaths, 8,148 (13.7%) were CVD-related. IHD was the dominant cause (79.5%), with males accounting for 59.3% of deaths (IRR 1.59; 95% CI 1.46-1.74) and individuals aged ≥60 years representing 75.2%. Overall crude CVD mortality increased by 26.1% over the study period, with an estimated mean annual increase of 2.5% (APC + 2.5%/year; 95% CI 1.7-3.3; p < 0.001) and significant acceleration after 2019. A striking proportion of IHD deaths occurred outside hospital settings (67.3%), with home deaths alone surpassing hospital deaths (43.9% vs. 32.7%). Spatial analysis identified significant high-high mortality clusters in central-western neighbourhoods and low-low clusters in eastern neighbourhoods (13 and 5 neighbourhoods, respectively; Global Moran's I = 0.555, p < 0.001), with cluster patterns varying by disease group. Socioeconomic correlates showed a consistent pattern across most CVD groups, with higher mortality in more socioeconomically advantaged neighbourhoods, except for inflammatory heart disease, which showed the opposite pattern. This first municipal-level CVD mortality analysis in Central-West Brazil identified significant spatiotemporal heterogeneity and a high burden of out-of-hospital IHD deaths, providing actionable evidence for geographically targeted cardiovascular prevention strategies.