Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug;22(8):1296-1309.
doi: 10.1111/jch.13922.

The slowdown in the reduction rate of premature mortality from cardiovascular diseases puts the Americas at risk of achieving SDG 3.4: A population trend analysis of 37 countries from 1990 to 2017

Ramon Martinez  1 , Patricia Soliz  1 , Oscar J Mujica  1 , Ludovic Reveiz  1 , Norm R C Campbell  2 , Pedro Ordunez  1
Affiliations

The slowdown in the reduction rate of premature mortality from cardiovascular diseases puts the Americas at risk of achieving SDG 3.4: A population trend analysis of 37 countries from 1990 to 2017

Ramon Martinez et al. J Clin Hypertens (Greenwich). 2020 Aug.

Abstract

Cardiovascular diseases (CVD) are leading causes of mortality and morbidity in the Americas, resulting in substantial negative economic and social impacts. This study describes the trends and inequalities of CVD burden in the Americas to guide programmatic interventions and health system responses. We examined the CVD burden trends by age, sex, and countries between 1990 and 2017 and quantified social inequalities in CVD burden across countries. In 2017, CVD accounted for 2 million deaths in the Americas, 29% of total deaths. Age-standardized DALY rates caused by CVD declined by -1.9% (95% uncertainty interval, -2.0 to -1.7) annually from 1990 to 2017. This trend varied with a striking decreasing trend over the interval 1994-2003 (annual percent change (APC) -2.4% [-2.5 to 2.2]) and 2003-2007 (APC -2.8% [-3.4 to -2.2]). This was followed by a slowdown in the rate of decline over 2007-2013 (APC -1.83% [-2.1 to -1.6]) and a stagnation during the most recent period 2013-2017 (APC -0.1% [-0.5 to 0.3]). The social inequality in CVD burden along the socio-demographic gradient across countries decreased 2.75-fold. The CVD burden and related social inequality have both substantially decreased in the Americas since 1990, driven by the reduction in premature mortality. This trend occurred in parallel with the improvement in the socioeconomic development and health care of the region. The deceleration and stagnation in the rate of improvement of CVD burden and persistent social inequality pose major challenges to reduce the CVD burden and the achievement of the United Nations' Sustainable Development Goals Target 3.4.

Keywords: cardiovascular diseases; epidemiology; global burden of disease; health inequalities; trend analysis.

PubMed Disclaimer

Conflict of interest statement

All authors declare no conflicts of interest with the content of this manuscript.

RM, PS, OJM, LR, and PO are staff members of the Pan American Health Organization. The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions or policies of the Pan American Health Organization.

Figures

Figure 1
Figure 1
Trends in age‐standardized rates of cardiovascular disease disability‐adjusted life years per 100 000 populations by sex in the Region of the Americas, 1990‐2017. A: Both sexes combined. B: Female. C: Male. Dots represent estimates of the age‐standardized Cardiovascular diseases DALYs rate per 100 000 population, and the lines represent time series trend segments which slope, summarized by the annual percentage change (APC), are statistically different
Figure 2
Figure 2
Age‐standardized rates of cardiovascular disease disability‐adjusted life years per 100 000 population in 2017 and average (mean) annual percentage change in 1990‐2017 (A) and 2010‐2017 (B) in both sexes combined by country. A: 1990‐2017. B: 2010‐2017. The light‐blue area represents a reduction in the average annual percentage change (downward trend), and the light‐orange area represents an increase in the average annual percentage change (upward trend)
Figure 3
Figure 3
Age‐standardized rate and percentage of disability‐adjusted life years per 100 000 population for cardiovascular disease causes by subregion, and country in 2017
Figure 4
Figure 4
Age‐standardized rates and percentage of disability‐adjusted life years per 100 000 population for cardiovascular disease causes by age and sex in the Region of the Americas, 2017
Figure 5
Figure 5
Age‐standardized years of life lost rates per 100 000 population from ischemic heart disease and stroke, both sexes combined in selected countries, 1990‐2017. This figure includes the 12 countries participating in the HEARTS initiative in the Region of the Americas as of the date of this study. United States and Canada are included as a reference for comparison
Figure 6
Figure 6
Health gradients of cross‐country inequality in the burden of cardiovascular disease, by cause category, both sexes combined in the Region of the Americas, 1990 and 2017. Dots represent countries for DALY rate and the SDI social position for a year (1990 or 2017) and cause‐specific cardiovascular diseases (CVD) category. Lines represent the best fit exponential regression for DALY rates on SDI social position, which visually approximate the slope of inequality. Cause‐specific CVD categories are label as follows: All‐CVD = all cardiovascular diseases combined; IHD = ischaemic heart disease; HHD = hypertensive heart disease. SDI: socio‐demographic index. DALY: disability‐adjusted life years
See this image and copyright information in PMC

References

    1. Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1‐25. - PMC - PubMed
    1. Martinez R, Soliz P, Caixeta R, Ordunez P. Reflection on modern methods: Years of life lost due to premature mortality ‐ A versatile and comprehensive measure for monitoring non‐communicable disease mortality. Int J Epidemiol. 2019;48(4):1367‐1376. - PMC - PubMed
    1. Lloyd‐Sherlock P, Ebrahim S, Martinez R, McKee M, Ordunez P. Reducing the cardiovascular disease burden for people of all ages in the Americas region: analysis of mortality data, 2000–15. Lancet Global Health. 2019;7(5):e604‐e612. - PubMed
    1. Hachinski V, Azarpazhooh MR. Stroke is a burdensome but preventable brain disorder. Lancet Neurol. 2016;15(9):892‐893. - PubMed
    1. Martinez R, Lloyd‐Sherlock P, Soliz P, et al. Trends in premature avertable mortality from non‐communicable diseases for 195 countries and territories, 1990–2017: a population‐based study. Lancet Global Health. 2020;8(4):e511‐e523. - PubMed

Publication types

LinkOut - more resources