Cerebrovascular Disease Mortality Trends in Brazil: An In-Depth Joinpoint Analysis.

Autor: McBenedict B; General and Specialized Surgery, Universidade Federal Fluminense, Niteroi, BRA., Hauwanga WN; General and Specialized Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, BRA., Elamin A; Medicine, National University, Khartoum, SDN., Eshete FD; General Surgery, Jimma University, Jimma, ETH., El Husseini N; Medicine, Beirut Arab University, Beirut, LBN., El Ghazzawi AA; Medicine, Beirut Arab University, Beirut, LBN., Patel VK; Medicine, St. George's University, West Indies, GRD., Pessôa BL; General and Specialized Surgery, Universidade Federal Fluminense, Niteroi, BRA., Tolentino J; General and Specialized Surgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, BRA., Mesquita ET; Clinical Medicine, Universidade Federal Fluminense, Niteroi, BRA.
Jazyk: angličtina
Zdroj: Cureus [Cureus] 2023 Sep 24; Vol. 15 (9), pp. e45845. Date of Electronic Publication: 2023 Sep 24 (Print Publication: 2023).
DOI: 10.7759/cureus.45845
Abstrakt: Background Cerebrovascular disease is the second leading cause of death and the third leading cause of disability following heart disease. In 2019, there were over 101 million people living with a stroke and 12.2 million incidents of stroke globally. For the past three decades, stroke has remained the leading cause of death in Brazil, causing over 100,000 fatalities annually, along with numerous functional impairments among those who survive. The Brazilian healthcare system has witnessed notable advancements in the last decade, including the establishment of additional hospitals and a rise in the count of healthcare professionals specializing in cardiovascular and neurological surgery. However, there exists a gap in the research landscape for continuous comprehensive studies aimed at exploring the evolving mortality rates related to cerebrovascular diseases, of which the last one included data up to 2019. This study aimed to address this gap by meticulously analyzing the trends in cerebrovascular disease mortality in Brazil from 2000 to 2021, for the variables age, sex, state of residence, and geographic region. Methods This is a descriptive, ecological, and time series study. Nationwide data for annual cerebrovascular mortality from Brazil were used for the period 2000-2021. Age-adjusted mortality rates (AAMRs) by direct standardization, encompassing people above 20 years of age, were calculated and expressed per 100,000 persons. Mortality trends were assessed using joinpoint regression analysis by calculating the annual percentage change (APC) and its corresponding 95% confidence interval (CI) across categories of age, sex, and state and region of residence. Results The mortality rates decreased for the sex categories over the analyzed years. The AAMR for the categories decreased as follows: males and females (95 deaths/100,000 to 52 deaths/100,000 inhabitants), males (108 deaths/100,000 to 63 deaths/100,000 inhabitants), and females (83 deaths/100,000 to 44 deaths/100,000 inhabitants). The most substantial reduction in AAMR for males occurred in the 30-39-year age group (APC: -4.10), while the smallest decline was observed in the 20-29-year age group (APC: -1.44). All five macro-regions demonstrated statistically significant and downward AAPC values in mortality rates. The south and midwest regions decreased at a stable rate, as denoted by the same APC and AAPC values (-4.05 and -3.11, respectively). The north and northeast regions exhibited an increase in AAMR, followed by a decrease (APC: 0.68 to -1.42 and 2.63 to -2.35, respectively). Conclusions Our comprehensive analysis revealed a downward trend in cerebrovascular disease mortality rates across diverse demographic groups and macro-regions. Females experienced a more substantial reduction compared to males. Despite higher mortality rates among individuals aged 50 and above, all age groups displayed a marked decrease. The continuous decline can be attributed to policy interventions aimed at enhancing healthcare delivery, increased awareness, and healthier diets and lifestyles. With regard to the macro-regions, the regions in the southern zone demonstrated a more significant decrease as compared to the northern part. In Brazil, a more significant decline in cerebrovascular disease mortality rates could be achieved through increased focus on prevention measures and efforts toward mitigating disparities and inequalities between macro-regions.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright © 2023, McBenedict et al.)
Databáze: MEDLINE