Cardiovascular Mortality in Brazil: Trends From Subgroups of Cause of Deaths and the Role of Social Development

Background Among causes of death, cardiovascular diseases do not represent a homogenous group. Social inequalities impact cardiovascular mortality in different ways when comparing ischemic heart diseases (IHD) and stroke and between different territories and population groups, considering their socioeconomic indicators. In this study, we aim to evaluate temporal trends from IHD and stroke mortality in Brazilian states. Methods We used data from Brazil at a sub-national level from 1996 to 2019, collected from the Global Burden of Disease (GBD) database, to accomplish the analysis. We calculated age-adjusted mortality rates and analyzed cardiovascular diseases, and then ischemic heart diseases and cerebrovascular diseases. We applied a time series analysis using joinpoint regression and we calculated annual percentage change. Results Brazil shows a long term declining trend for cerebrovascular diseases and ischemic heart disease. In both groups, there is a recent change in decreasing in adjusted mortality rates, varying in a subnational level. For cerebrovascular diseases, the reduction period occurs from 2014 (APC = -1.4, CI 95% -2.0 to -0.7). For ischemic heart diseases, the inflection occurs from 2005 (APC = -1.9, CI 95% -2.0 to -1.8). The proportional mortality for IHD is predominant among the states. There is no pattern to which we can relate development or spatial distribution between regions. We observed irregular trends for IHD mortality in 13 of the 27 states, where almost all of them had two inflection points. On the other hand, the trends in stroke mortality were irregular in most of the federal units, with the majority also showing two inflection points. Conclusion The Brazilian standard is in line with the theory of the cardiovascular revolution. In addition, the great heterogeneity between states requires special attention to deal with this change in mortality pattern. Policies for public health must consider the diversity levels in health and in socioeconomical development between Brazilian states.