Ischaemic heart disease deaths in Brazil: current trends, regional disparities and future projections

Abstract

Objective: To quantify the trend of ischaemic heart disease (IHD) deaths in Brazil during the last decade (2000-2010) for various population characteristics and to forecast the upcoming mortality trends across regions in Brazil until the year 2015.

Design: Nationwide comparative observational study.

Patients and methods: The population studied encompassed all adult residents (≥ 20 years) living in five Brazilian regions between 2000 and 2010. Demographic, economic and mortality data were obtained from Brazilian National Mortality Data System and National Applied Economics Research Institute. Subnotified deaths were redistributed proportionally to IHD deaths. Age-standardised mortality rates (ASMRs) per 100 000 inhabitants, by sex and region, were calculated employing a standard Brazilian population and constructing multivariate regression models to quantify and to project temporal trends.

Main outcome measures: Absolute numbers of death due to IHD and region-specific death rates in Brazil by age and sex.

Results: During the study period, 627 786 men and 452 690 women died due to IHD in Brazil. ASMR trends across all regions for men and women converged, driven by a declining trend in the South and Southeast and an opposite incline in the North and Northeast (p < 0.05). Future projections demonstrated potential widening of the observed North-South gap in coming years.

Conclusions: The IHD death trend in Brazil has changed from a decline to a stagnant state. However, a significant discrepancy in mortality trends exists between the northern and southern regions, which is likely to widen further. Reappraisal of the public health policies tailored to populations with diverse socioeconomic structures is urgently required.

Keywords: Coronary Artery Disease; Myocardial Ischaemia And Infarction (IHD); Quality Of Care And Outcomes.