Abstracts
Background:
Cardiovascular Diseases (CVD) are the leading cause of death in Brazil.
Objective:
To estimate total CVD, cerebrovascular disease (CBVD), and ischemic heart disease (IHD) mortality rates in adults in the counties of the state of Rio de Janeiro (SRJ), from 1979 to 2010.
Methods:
The counties of the SRJ were analysed according to their denominations stablished by the geopolitical structure of 1950, Each new county that have since been created, splitting from their original county, was grouped according to their former origin. Population Data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), and data on deaths were obtained from DataSus/MS. Mean CVD, CBVD, and IHD mortality rates were estimated, compensated for deaths from ill-defined causes, and adjusted for age and sex using the direct method for three periods: 1979–1989, 1990–1999, and 2000–2010, Such results were spatially represented in maps. Tables were also constructed showing the mortality rates for each disease and year period.
Results:
There was a significant reduction in mortality rates across the three disease groups over the the three defined periods in all the county clusters analysed, Despite an initial mortality rate variation among the counties, it was observed a homogenization of such rates at the final period (2000–2010). The drop in CBVD mortality was greater than that in IHD mortality.
Conclusion:
Mortality due to CVD has steadily decreased in the SRJ in the last three decades. This reduction cannot be explained by greater access to high technology procedures or better control of cardiovascular risk factors as these facts have not occurred or happened in low proportion of cases with the exception of smoking which has decreased significantly. Therefore, it is necessary to seek explanations for this decrease, which may be related to improvements in the socioeconomic conditions of the population.
Cardiovascular Diseases/mortality; Demographic Data; Data Interpretation, Statistical; Local Government
Fundamento:
Doenças do aparelho circulatório são a primeira causa de morte no Brasil.
Objetivo:
Estimar taxas de mortalidade por Doenças do Aparelho Circulatório (DAC), Doenças Cerebrovasculares (DCBV) e Doenças Isquêmicas do Coração (DIC) nos adultos dos municípios do estado do Rio de Janeiro (ERJ), de 1979 a 2010.
Métodos:
Os municípios do ERJ foram analisados de acordo com a estrutura geopolítica do ano 1950, agrupando os municípios emancipados a partir dessa data com sua sede original. Populações foram obtidas no IBGE e óbitos obtidos no DataSus/MS. Calcularam-se taxas médias de mortalidade por DIC, DCBV e DAC, compensadas pelas causas mal definidas e ajustadas pelo método direto em três períodos: 1979 a 1989, 1990 a 1999 e 2000 a 2010, representadas espacialmente em mapas. Também foram construídas tabelas com as taxas de mortalidade.
Resultados:
Houve redução da mortalidade pelos três grupos de causas no decorrer dos períodos em todos os agregados municipais analisados, com importante redução das taxas e homogeneização dessas no último período. A queda da mortalidade por DCBV foi maior do que a por DIC.
Conclusão:
A mortalidade por doenças do aparelho circulatório apresentou queda nas últimas três décadas no ERJ. Essa redução não pode ser explicada pelo acesso aos procedimentos de alta tecnologia, nem tampouco pelo melhor controle dos fatores de risco cardiovasculares. Tornando necessária a busca de explicações para a queda da mortalidade cardiovascular, que podem estar relacionadas com melhorias nas condições socioeconômicos da população.
Doenças Cardiovasculares/mortalidade; Dados demográficos; Interpretação Estatística de Dados; Governo Local
Introduction
Cardiovascular diseases (CVD) are the primary cause of death worldwide, irrespective of
the per capita income of a country. According to the World Health Organization (WHO),
cardiovascular diseases were responsible for 17 million deaths in 2011, which represents
three out of every ten deaths. Of these, seven million people died from ischemic heart
diseases (IHD) and 6.2 million from stroke11 World Health Organization. (WHO). Media Centre. The top 10 causes of
death.[Accessed in 2014 May 10]. Available
from:www.who.int/mediacentre
www.who.int/mediacentre...
.
In Brazil, CVD also represent the main cause of deaths, corresponding to 28.6% of all
causes of mortality in 2011. This is also the case in the state of Rio de Janeiro (SRJ),
where CVD were responsible for 29.1% of all deaths. The two main groups of deaths from
CVD are IHD and cerebrovascular diseases (CBVD), which respectively comprised 30.8% and
30% of CVD deaths in Brazil and 31.6% and 27.6% of CVD deaths in the SRJ22 Ministério da Saúde. DATASUS: informações de saúde - estatísticas
vitais. [Acesso em 2014 maio 12]. Disponível em:www.datasus.gov.br.
www.datasus.gov.br...
.
Though it is still the major cause of mortality worldwide, mortality due to CVD began to decline in industrialized countries after the 1950s. In Brazil, this downturn began to be noted in the late 1970s33 Prata PR. The epidemiologic transition in Brazil. Cad Saude Publ Rio de Janeiro. 1992;8 (2):168-75.,44 Yunes J, Ronchezel VS. Evolução da mortalidade geral, infantil e proporcional no Brasil. Rev Saúde Publica. 1974;8(supl):3-48., with a significant reduction in CVD mortality rates, despite some significant regional differences55 de Lolio CA, Lotufo PA, Lira AC, Zanetta DM, Massad E. [Mortality trends due to myocardial ischemia in capital cities of the metropolitan areas of Brazil, 1979-89]. Arq Bras Cardiol. 1995;64(3):213-6..
There are no studies assessing the evolution of mortality due to CVD and their two main groups, IHD and CBVD, by county units, which prompted us to conduct this study in the counties of the SRJ.
According to the 2010 census, the SRJ had 15,989,929 inhabitants, or 8.4% of the
country's population; it is divided into 92 counties, with a population density of
365.23 inhabitants/km22 Ministério da Saúde. DATASUS: informações de saúde - estatísticas
vitais. [Acesso em 2014 maio 12]. Disponível em:www.datasus.gov.br.
www.datasus.gov.br...
according to IBGE66 Ministério do Planejamento Orçamento e Gestão. Instituto Brasileiro de
Geografia e Estatística.(IBGE). [Acesso em 2014 maio 17]. Disponível em: Disponível
em:www.ibge.gov.br.
www.ibge.gov.br...
. The state's gross domestic product (GDP)
corresponds to 11.3% of the national GDP. Theses counties of the state have a very
heterogeneous socioeconomic structure77 Santos VC, Lemos JJS. Mapeamento da pobreza no Estado do Rio de Janeiro:
um estudo através de análise multivariada. In: XLII Congresso Brasileiro de Economia
e Sociologia Rural (SOBER), Cuiabá; 2004..
The aim of this study was to estimate mortality rates due to CVD, CBVD, and IHD in adults from the counties of the state of Rio of Janeiro, from 1979 to 2010.
Materials and methods
A descriptive study of historical series of adults, i.e., people aged 20 years or over, in the counties of the SRJ, from 1979 to 2010.
The counties of SRJ were analyzed according to their denomination established by the geopolitical structure of the year 1950, Each new county that have since been created, splitting from their original county, was grouped according to their former origin. This grouping led to a reduction in the total number of counties in existence in 2010 in SRJ, from 92 to 56 clusters for purposes of analysis in this study. These groupings were created with a view to future analyses that will consider information on county clusters available since 1950. Eight new counties were created in SRJ between 1950 and 1980, 28 new counties were subsequently added. These new counties, in general still have small population sizes which also justified to group the data according to the original county cluster.
The population data were obtained from the website of the Brazilian Institute of
Geography and Statistics (IBGE)66 Ministério do Planejamento Orçamento e Gestão. Instituto Brasileiro de
Geografia e Estatística.(IBGE). [Acesso em 2014 maio 17]. Disponível em: Disponível
em:www.ibge.gov.br.
www.ibge.gov.br...
, for the years
of the 1980, 1991, 2000 and 2010 censuses years, and the 1996 population count.
Population fractions corresponding to sex and age bracket were obtained, for each
10-year interval. To estimate the intercensal interpolations and the extrapolations for
the year 1979, the arithmetic progression method was used for each fraction of sex and
age. The intercensal estimates provided by IBGE were not used, due to the change of
method adopted in 2007, which caused abrupt and improbable inflections in all age
brackets. These inflections alone could cause disruptions in the estimations of the
mortality rates.
The data relating to deaths were obtained from the DataSus website22 Ministério da Saúde. DATASUS: informações de saúde - estatísticas
vitais. [Acesso em 2014 maio 12]. Disponível em:www.datasus.gov.br.
www.datasus.gov.br...
and itemized by the fractions that were our primary interest of
the study: CVD, corresponding to those recorded in chapters VII of ICD-988 Organização Mundial de Saúde (OMS) - Manual da classificação
internacional de doenças, lesões e causas de óbitos. 9ª. rev. São Paulo: Centro da
OMS para Classificação das Doenças em Português; 1979. or IX of ICD-1099 Organização Mundial de Saúde. (OMS). Classificação estatística
internacional de doenças e problemas relacionados à saúde. 10ª rev. São Paulo: EDUSP;
1995.; IHD, corresponding to codes 410-414 of ICD-9 or I20-I25 of ICD-10; and
CBVD, corresponding to codes 430-438 of ICD-9 or I60-I69 of ICD 10. Deaths due to
ill-defined causes, covered in chapter XVI of ICD-9 and XVIII of ICD-10, and total
deaths due to all causes were also used for compensation. ICD-9 remained in effect until
1995, while ICD-10 took effect from 1996.
As the rates of mortality due to ill-defined causes in SRJ increased significantly after 19901010 Soares GP, Brum JD, Oliveira GM, Klein CH, Silva NA. Mortalidade por doenças isquêmicas do coração, cerebrovasculares e causas mal definidas nas regiões do estado do Rio de Janeiro, 1980-2007. Rev SOCERJ. 2009;22(3):142-50., the decision was made to compensate this increase by proportionally allocating the deaths from ill-defined causes to the deaths resulting from CVD, IHD, and CBVD, in the same proportion that these deaths occurred i.e., excluding ill defined deaths. After adding the deaths due to CVD, IHD and CBVD with the corresponding proportion of deaths from ill-defined causes, the mortality rates of the study participants, adjusted for sex and age, were estimated using the direct method1111 Vermelho LL, Costa AJL, Kale PL. Indicadores de saúde. In: Medronho RA (org). Epidemiologia. 2ª ed. São Paulo: Editora Atheneu; 2011.,1212 Pagano M, Gauvreau K. Princípios de bioestatística. 2ª. ed. São Paulo: Pioneira Thompson Learning; 2004.. The standard population used for the adjustments was from the 2000 census in the SRJ, stratified into seven age groups (20-29 years; 30-39 years; 40-49 years; 50-59 years; 60-69 years; 70-79 years; and 80 years or over) for each sex. These rates were considered compensated and adjusted.
The compensated and adjusted mean CVD, IHD, and CBVD mortality rates were calculated in three periods: 1979-1989; 1990-1999; and 2000-2010. The decision was made to construct rates for these periods rather than annual rates, which fluctuate substantially for a high percentage of the counties, due to their small populations, even considering the clustering described previously. Each of these periods was represented spatially on maps1313 Medronho RA, Werneck GL, Perez MA. Distribuição das doenças no espaço e no tempo. In: Medronho RA. Epidemiologia. 2ª ed. São Paulo: Editora Atheneu; 2011. with the geopolitical division of the counties of SRJ of 1950. A colour scale was attributed to CVD according to the variation of the mortality rates in the periods, starting from 200 deaths per 100,000 and thereafter at intervals of 100 deaths per 100,000 inhabitants. For IHD and CBVD, the scale starts at 50 deaths per 100,000 inhabitants and continues at intervals of 50 deaths per 100,000 inhabitants.
Tables were constructed with the compensated and adjusted mean CVD, CBVD, and IHD mortality rates, in the same three periods, grouping the counties by SRJ healthcare regions. In this study, the regional division used by the Rio de Janeiro State Department of Health (SESRJ) was modified in the Metropolitan Region, which henceforth constituted the Metropolitan Belt, encompassing all the counties of the region except for the counties of Rio de Janeiro and Niterói, which became two independent regions. The other regions, Middle Paraíba, Mountain, North, Coastal Lowlands, Northwest, Mid-South, and Ilha Grande Bay, are those defined by the SESRJ. The standard deviations between the mean mortality rates of the counties of each region, and between all the counties in the three periods for the CVD, CBVD, and IHD mortality rates, were also estimated.
The quantitative procedures were conducted using the Excel-Microsoft1414 Microsoft Excel. Microsoft Corporation. Versão 2007. Redmond,
Washington, 2007. and STATA1515 Statistics/Data Analysis. STATA Corporation: STATA, Version 8,2.
University of Texas, USA, 2005 programs. Maps were created using the cartographic base of IBGE1616 Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de
Geografia e Estatística.(IBGE). Base cartográfica. [Acessado em 2014 maio 10].
Disponível em: www.mapas.ibge.gov.br.
www.mapas.ibge.gov.br...
and drawn using the Microsoft Paint1717 Microsoft Paint. Microsoft Corporation. Versão 6.1. Redmond, WA,
2009. program.
Results
We noted that the mean CVD mortality rates (Figure 1 and Table 1) decreased gradually over the three periods analysed. In the first period, from 1979 to 1989, all but three of the county clusters had mean CVD mortality rates above 500 deaths per 100,000 inhabitants, while 13 had rates of more than 700 deaths per 100,000 inhabitants. These rates decreased gradually until the last period, when all the county clusters had rates of between 200 and 500 deaths per 100,000 inhabitants due to CVD. The mean CVD mortality rate in the state was 347.1 deaths per 100.000 inhabitants in the most recent period, compared to 656.8 deaths per 100.000 inhabitants in the earliest period. Besides the gradual decrease in cardiovascular mortality, we also noted a tendency towards homogenization of mortality rates among the county clusters and regions over time, which can be observed in the maps, and in the reduction of standard deviations (Figure 1 and Table 1).
Mean CVD mortality rates per 100,000 inhabitants, compensated and adjusted by sex and age, in the counties of the state of Rio de Janeiro in three periods, from 1979 to 2010.
Mean CVD mortality rates per 100,000 inhabitants of the counties, compensated and adjusted by sex and age, according to the healthcare regions of the State of Rio de Janeiro, in three periods, from 1979 to 2010
The highest CVD mortality rates from 1979 to 1989 occurred in the region of Middle Paraíba; from 1990 to 1999, the highest rates were in the Metropolitan Belt Region; and from 2000 to 2010, the highest values again occurred in Middle Paraíba. The lowest CVD mortality rates for the three periods were recorded in the county of Niterói.
CBVD (Figure 2 and Table 2) and IHD (Figure 3 and Table 3) mortality rates exhibited a behavior that closely resembled that of the CVD mortality rates, with a gradual reduction in rates over the periods, and a tendency towards homogenization of the rates for the SRJ, regions, and county clusters in the last period. In the SRJ, in the most remote and intermediate periods, there were higher mortality rates due to CBVD than due to IHD; however, in the last period, the figures were very similar, with a slight predominance of deaths due to IHD. This did not mean there was an increase in IHD mortality rates, as these also decreased over time, but only that there was a greater reduction in mortality rates due to CBVD than those resulting from IHD.
Mean CBVD mortality rates per 100,000 inhabitants, compensated and adjusted by sex and age, in the counties of the state of Rio de Janeiro in three periods, from 1979 to 2010.
Mean CBVD mortality rates per 100,000 inhabitants of the counties, compensated and adjusted by sex and age, according to the healthcare regions of the State of Rio de Janeiro in three periods, from 1979 to 2010
Mean mortality IHD rates per 100,000 inhabitants, compensated and adjusted by sex and age, in the counties of the state of Rio de Janeiro in three periods, from 1979 to 2010.
Mean IHD mortality rates per 100,000 inhabitants of the counties, compensated and adjusted by sex and age, according to the healthcare regions of the State of Rio de Janeiro in three periods, from 1979 to 2010.
Discussion
Based on the data submitted, it can be seen that the mortality rates due to CVD, CBVD,
and IHD gradually decreased in all the county clusters and regions of the SRJ over the
study periods analysed, similar to the global tendency towards a reduction in
cardiovascular mortality in recent decades1818 Truelsen T, Mähönen M, Tolonen H, Asplund K, Bonita R, Vanuzzo D. Trends
in stroke and coronary heart disease in the WHO MONICA project. Stroke.
2003;34(6):1346-52.,1919 Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al;
American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
Heart disease and stroke statistics - 2014 update: a report from the American Heart
Association. Circulation. 2014;129(3):e28-e292.. The mean
cardiovascular mortality rates in SRJ occupy intermediate values when compared with
those of several countries. In the last period of the study, from 2000 to 2010, the mean
CVD mortality rate was 347.1, the mean CBVD mortality rate was 105.9, and the mean IHD
mortality rate was 109.6 deaths per 100,000 inhabitants. We can compare these with the
mortality rates from the same causes in other regions worldwide in a similar period. In
the decade of 2000-2010, the lowest CVD mortality rates were observed in Japan, with
about 100 deaths per 100,000 inhabitants. As for IHD, the lowest rates occurred in Japan
and Korea, with 38 and 37 deaths per 100,000 inhabitants, respectively; the lowest CBVD
mortality rates are those of Israel and Switzerland, with 28 and 29 deaths per 100,000
inhabitants, respectively. The highest IHD and CBVD mortality rates are reported for the
Russian Federation, with 524 and 313 deaths per 100,000 inhabitants, respectively.
Evidence allows us to assume that the CVD mortality rate in the Russian Federation is
higher than 1000 deaths per 100,000 inhabitants. With such high rates, Russia leads the
ranking of 35 countries in terms of mortality by cardiovascular disease, well ahead of
the country occupying the second place, Slovakia, which had IHD and CBVD mortality rates
of 324 and 112 deaths per 100,000 inhabitants, respectively. If we were to include SRJ
in this ranking, it would occupy fourth place in CBVD mortality, only coming behind
Russia, Slovakia, and Hungary. As for IHD mortality, SRJ is in 18th place,
with lower mortality than countries like the United States, the United Kingdom, and
Canada, but above Latin American countries like Chile and Mexico2020 Organization for Economic Cooperation and Development (OECD). Health at
a Glance 2011. OECD Indicators. [Acesso em 2014 jul. 20]. Disponível
em:http://dx.doi.org/10.1787/health_glance-2011-en
http://dx.doi.org/10.1787/health_glance-...
.
A similar reduction in CVD, IHD, and CBVD mortality rates in the county clusters of SRJ was also observed in Brazil, in the Metropolitan Region of São Paulo2121 Mansur AP, Favarato D. Mortalidade por doenças cardiovasculares no Brasil e na região metropolitana de São Paulo: atualização 2011. Arq Bras Cardiol. 2012;99(2):755-61., but with a shorter analysis period, from 1990 to 2009. The trend towards a reduction of cardiovascular mortality was the same as in SRJ, which had a drop in IHD mortality, but the most accentuated reduction occurred in CBVD. All the SRJ regions showed a drop in IHD and CBVD mortality rates. However, in the comparison between CBVD and IHD, presented variable mortality rates behaviours among the healthcare regions. In the Metropolitan Belt, the North, and Ilha Grande Bay, the predominance of CBVD was maintained from the most remote to the most recent period, for the county of Rio de Janeiro the opposite was seen with predominance of IHD mortality over CRVD throughout the entire period. The Mid-South, Mountain, Northwest, and Middle Paraíba CRVD mortality rates predominate over IHD for the period of 1979-1989 and IHD mortality rates predominate over CRVD for the period of 2000-2010. In Ilha Grande Bay, the highest rate in the period of 1979-1989 was for CBVD, while in the last period, the rates of CBVD and IHD were similar (Tables 2 and 3).
Niterói, which had a clearly higher rate of mortality from IHD than CBVD in the most
remote period, began to have similar rates of IHD and CBVD in the last period. It should
be emphasized that a less notable decline in the CBVD mortality rate was to be expected
in Niterói, as this was the county with the lowest mortality rate for this cause in the
initial period of the study. If we observe the relative reduction mortality rates for
the total period [(1979-1989) − (2000-2010) / (1979-1989) ] for CVD, we see that Niterói
had the greatest relative reduction (53%), and the Middle Paraíba region had the
smallest reduction (44%). The county of Niterói, in our study, was separated from the
Metropolitan Region because its socioeconomic pattern differs considerably from that of
the other counties of this region. Niterói has the third highest human development index
in Brazil and the highest in SRJ66 Ministério do Planejamento Orçamento e Gestão. Instituto Brasileiro de
Geografia e Estatística.(IBGE). [Acesso em 2014 maio 17]. Disponível em: Disponível
em:www.ibge.gov.br.
www.ibge.gov.br...
. Moreover,
according to a survey by Fundação Getulio Vargas (FGV), Niterói has the largest number
of people from Brazil's highest socioeconomic class (30.7%), based on data from the
Demographic Census of 20102222 Neri MC (coord). A nova classe média: o lado brilhante dos pobres. Rio
de Janeiro: FGV/CPS; 2010.. The county clusters
of the Middle Paraíba region, in turn, are those that underwent early industrialization
due to the establishment of the first steel plant in Brazil, in Volta Redonda. The steel
industry is admittedly one which causes great environmental pollution and unhealthy
working conditions.
In addition to the gradual decrease in mortality rates in the periods studied, it can
also be noted that the mortality rates in the county clusters across the three groups of
causes studied were homogenized, as is evident in the maps for the period 2000 to 2010.
This analysis can be summarized in two aspects. Mortality due to CVD has dropped in the
last three decades in the SRJ; this phenomenon was not isolated, and has also been noted
in other countries and in other Brazilian states. This reduction was not uniform among
the counties, with a relative overall reduction (between the first and last periods
studied) in CVD for the counties of Niterói (53%), the Mid South Region (49%) and Rio de
Janeiro (49%), and lesser reductions in the Middle Paraíba (44%), Ilha Grande Bay, (46%)
and Northwest regions (46%). This asymmetrical or diverse reduction of cardiovascular
mortality rates cannot be explained by increasing access to high technology procedures
such as myocardial revascularization surgery and angioplasty because of their poor
performance2323 Godoy PH, Klein CH, Souza e Silva NA, Oliveira GM, Fonseca TM.
Letalidade na cirurgia de revascularização do miocárdio no estado do Rio de Janeiro -
SIH/SUS - no período de 1999-2003. Rev SOCERJ. 2005;18(1):23-9.
24 Peterson ED, Coombs LP, DeLong ER, Haan CK, Ferguson TB. Procedural
volume as a marker of quality for CABG surgery. JAMA.
2004;291(2):195-201.-2525 Clark RE. Outcome as a function of annual coronary artery bypass graft
volume. The Ad Hoc Committee on Cardiac Surgery Credentialing of The Society of
Thoracic Surgeons. Ann Thorac Surg. 1996;61(1):21-6. and limited scope in Brazil, or by better control of classic
cardiovascular risk factors2626 Sposito AC, Caramelli B, Fonseca FA, Bertolami MC, Afiune Neto A, Souza
AD, et al.; Sociedade Brasileira de Cardiologia. IV Diretriz brasileira sobre
dislipidemias e prevenção da aterosclerose. Arq Bras Cardiol. 2007;88(supl
1):1-18.
27 Peres LA, Matsuo T, Delfino VD, Peres CP, Almeida Netto JH, Ann HK, et
al. Aumento na prevalência de diabete melito como causa de insuficiência renal
crônica dialítica - análise de 20 anos na região Oeste do Paraná. Arq Bras Endocrinol
Metab. 2007;51(1):111-5.
28 Sartorelli DS, Franco LJ. Tendências do diabetes mellitus no Brasil: o
papel da transição nutricional. Cad Saúde Pública, Rio de Janeiro. 2003;19(Sup.
1):S29-36.
29 Gus I, Fischmann A, Medina C. Prevalência dos fatores de risco da doença
arterial coronariana no estado do Rio Grande do Sul. Arq Bras Cardiol.
2002;78(5):478-90.
30 Passos VM, Assis TD, Barreto SM. Hipertensão arterial no Brasil:
estimativa de prevalência a partir de estudos de base populacional. Epidemiol Serv
Saúde. 2006;15(1):35-45.
31 Repetto G, Rizzolli J, Bonatto C. Prevalência, riscos e soluções na
obesidade e sobrepeso: here, there, and everywhere. Arq Bras Endocrinol Metab
2003;47(6):633-5.
32 Klein CH, Souza e Silva NA, Nogueira AR, Bloch KV, Campos LH.
Hipertensão arterial na Ilha do Governador, Rio de Janeiro, Brasil. I. Metodologia.
Cad Saúde Pública, Rio de Janeiro. 1995;11(2):187-201.
33 Mendonça CP, Anjos LA. Aspectos das práticas alimentares e da atividade
física como determinantes do crescimento do sobrepeso/obesidade no Brasil. Cad Saúde
Pública, Rio de Janeiro. 2004;20(3):698-709.-3434 Ministério da Saúde. Instituto Nacional do Cancer (INCA). Coordenação de
Prevenção e Vigilância. Prevalência de tabagismo no Brasil. Dados dos inquéritos
epidemiológicos em capitais brasileiras. Rio de Janeiro; 2004..
These findings need a search for other explanations for these reduction in
cardiovascular mortality, such as improvements in the population's socioeconomic or
environmental. Throughout the 20th century and particularly after the 1950s,
Brazil experienced a period of progress that brought improvements in socioeconomic
indicators, although social inequalities still remains high and have only begun to
decrease in recent years, nevertheless preceding the drop in CVD mortality3535 Soares GP, Brum JD, Oliveira GM, Klein CH, Souza e Silva NA. Evolução de
indicadores socioeconômicos e da mortalidade cardiovascular em três estados do
Brasil. Arq Bras Cardiol. 2003;100(2):147-56.. All over the world, social inequalities, even in
so-called developed countries, are clearly associated with various diseases, including
cardiovascular conditions. It is estimated that the cost of social inequality is as high
as 39 billion pounds/year in the United Kingdom due to reduced life expectancy, murders,
worsening of mental health, and other health problems3636 The Equality Trust. The Cost of Inequality. (Accessed in 2014 Oct 15)
Available from:
https://www.equalitytrust.org.uk/resources/multimedia/cost-inequality.
https://www.equalitytrust.org.uk/resourc...
. In a recent study in the counties of Rio de Janeiro, we showed that the
differences between CBVD mortality between the administrative regions of this county
were ten times higher in the region with the lowest economic development index (Santa
Cruz-Campo Grande) than in the region with the highest HDI (Gávea). This increase in
mortality occurred 10 years earlier3737 Fonseca RHA. Análise espacial da mortalidade por doença cerebrovascular
no município do rio de janeiro, 2002 a 2007. Correlação com dados demográficos e
socioeconômicos [Tese]. Rio de Janeiro: Faculdade de Medicina. Universidade Federal
do Rio de Janeiro; 2012..
The evaluations performed in this article depend on the quality of information recorded in the death certificates. Therefore, this might be a limitation for the interpretations made herein. We must thus reinforce the attention that should be given for the constant improvement of information provided by the physicians and other related professionals at the moment of deaths. This improvement involves continuing education of healthcare professionals and the provision of adequate working conditions by public and private institutions. Other limits relate to the scope of the data, and the methods used to estimate population and deaths according to the causes. None of the methods used guarantee certainty, but they are simple, logical, and easily reproducible.
Future studies are necessary to relate the mortality due to the CVD and all the diagnostic components of this class to socioeconomic and social inequality indicators, as well as to environmental pollution in county clusters, which include variability of indicators and mortality. These socioeconomic and environmental variables appear to have a much greater impact on cardiovascular mortality than "classic" risk factors.
-
Sources of FundingThere were no external funding sources for this study.
-
Study AssociationThis article is part of the thesis of Doctoral submitted by Gabriel Porto Soares, from Universidade Federal do Rio de Janeiro.
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» www.who.int/mediacentre -
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» www.ibge.gov.br -
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Publication Dates
-
Publication in this collection
17 Mar 2015 -
Date of issue
May 2015
History
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Received
22 Oct 2014 -
Reviewed
09 Jan 2015 -
Accepted
12 Jan 2015