Trends in mortality due to non-communicable diseases in the Brazilian adult population: national and subnational estimates and projections for 2030

Abstract

Background: Monitoring and reducing premature mortality due to non-communicable diseases (NCDs) is a global priority of Agenda 2030. This study aimed to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and to project those for 2030 as well as the risk factors (RFs) attributed deaths according to estimates of the Global Burden of Disease Study.

Methods: We analyzed cardiovascular diseases, chronic respiratory diseases, neoplasms, and diabetes, and compared the mortality rates in 1990 and 2017 for all of Brazil and states. The study used the definition of premature mortality (30-69 years) that is used by the World Health Organization. The number of deaths, mortality rates, DALYs, and years of life lost (YLL) were used to compare 1990 and 2017. We analyzed the YLL for NCDs attributable to RFs.

Results: There was a reduction of 35.3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCDs in 2017. The DALY rate decreased by 33.6%, and the YLL rate decreased by 36.0%. There were reductions in NCDs rates in all 27 states. The main RFs related to premature deaths by NCDs in 2017 among women were high body mass index (BMI), dietary risks, high systolic blood pressure, and among men, dietary risks, high systolic blood pressure, tobacco, and high BMI. Trends in mortality rates due to NCDs declined during the study period; however, after 2015, the curve reversed, and rates fluctuated and tended to increase.

Conclusion: Our findings highlighted a decline in premature mortality rates from NCDs nationwide and in all states. There was a greater reduction in deaths from cardiovascular diseases, followed by respiratory diseases, and we observed a minor reduction for those from diabetes and neoplasms. The observed fluctuations in mortality rates over the last 3 years indicate that if no further action is taken, we may not achieve the NCD Sustainable Development Goals. These findings draw attention to the consequences of austerity measures in a socially unequal setting with great regional disparities in which the majority of the population is dependent on state social policies.

Keywords: Brazil; Disability-adjusted life years; Global burden of disease; Mortality; Non-communicable diseases; Sustainable Development Goals.

Fig. 1

Proportional mortality according to groups of causes and proportion of deaths in the adult population between 30 and 69 years old in Brazil in 1990 and 2017. Legend: Proportion of total deaths according to communicable, maternal, neonatal, and nutritional diseases; non-communcable diseases; and injuries and proportion of deaths in the adult population between 30 and 69 years old and other ages in Brazil in 1990 and 2017

Fig. 2

Age-standardized mortality rate by noncommunicable chronic diseases, in the population between 30 and 69 years of age (per 100,000) in Brazil from 2000 to 2017. Legend: Trends of age-standardized mortality rate by non-communicable chronic diseases (yellow line), cardiovascular diseases (orange line), neoplasms (green line), diabetes (blue line), and chronic respiratory diseases (gray line) in the population of individuals between 30 and 69 years of age (per 100,000) in Brazil from 2000 to 2017. *NCD = cardiovascular diseases, neoplasms, diabetes, and chronic respiratory disease

Fig. 3

Percentage of annual changes in the age-standardized mortality rate due non-communicable chronic diseases among population between 30 and 69 years of age in Brazil from 1990 to 2017. Legend: Annual percent changes in the age-standardized mortality rate due to noncommunicable chronic diseases (cardiovascular diseases, neoplasms, diabetes, and chronic respiratory diseases) among individuals aged between 30 to 69 years of age in Brazil from 1990 to 2017

Fig. 4

DALYs attributable to risk factors for a men and b women in the population from 30 to 69 years of age according to the GBD study in Brazil in 1990 and 2017. Legend: DALYs due to cardiovascular diseases (orange bars), chronic respiratory diseases (green bars), diabetes (blue bars), and neoplasms (yellow bars) and attributable to GBD level-2 risk factors for a men and b women in the population from 30 to 69 years of age according to the GBD study in Brazil in 1990 and 2017

Fig. 5

Projections of the rates of premature mortality due to NCD in the Brazilian population for 2030. Legend: Trend (full black line) and projections of age-standardized due to NCD based on 2000 to 2017 (black dashed line), 2010 to 2017 (yellow dotted line), 2015 to 2017 (red dashed line), and SDG (yellow dashes line) estimations and the SDG 2030 target (green dotted line) in the Brazilian population from 30 to 69 years of age in the population for 2030. *NCD = cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases