Consistent declining trends in stroke mortality in Brazil: mission accomplished?

Abstract

Stroke is the second leading cause of death in Brazil and worldwide 1 and trends in stroke mortality rates may be analyzed as a proxy of social economic differences among countries and regions. A systematic review of population-based studies showed a divergent, statistically significant difference trend in stroke incidence rates, from 1970 to 2008. It was observed a 42% decrease in stroke incidence in high income countries in contrast to a more than 100% increase in this incidence in middle and low income countries 2 . There is a ten-fold difference in mortality rates for stroke between the most-affected and the less-affected countries. Moreover, national per capita income has been pointed out as the strongest predictor of stroke mortality even after adjusting for cardiovascular risk factors 3 . In Brazil, there is evidence of declining mortality from stroke in São Paulo since the 1970s 4 and all over the country since the 1980s 5 , but the magnitude of the mortality rates and its decline, as well as the differences among the regions of the country need to be better investigated. From 1979 to 1996, among Brazilian adults aged 30 or more years old, despite the high values, the age-adjusted death rate for stroke dropped significantly (p<0.001) from 200 to 164 deaths/100,000 population in men and from 168 to 130 deaths/100,000 population in women ABstrACtStroke mortality rates are declining in Brazil, but diferences among regions need to be better investigated. The age-adjusted stroke mortality trends among adults (30-69 years-old) from Brazilian regions were studied between 1996 and 2011. Method: Data were analyzed after: 1) reallocation of deaths with non-registered sex or age; 2) redistribution of garbage codes and 3) underreporting correction. A linear regression model with autoregressive errors and a state space model were fitted to the data, aiming the estimation of annual trends at every point in time. Results: Although there were high values, a steady decrease of rates was observed. The decreasing trends among all regions were statistically significant, with higher values of decline among the Northeast and Northern regions, where rates were the highest. Conclusion: Standardized methodology use is mandatory for correct interpretation of mortality estimates. Although declining, rates are still extremely high and efforts must be made towards prevention of stroke incidence, reduction of case-fatality rates and prevention of sequelae.Key-words: stroke; mortality rate; health inequalities. resumo Objetivos: As taxas de mortalidade por acidente vascular encefálico (AVE) estão em declínio no Brasil, mas diferenças entre as regiões precisam ser melhor investigadas. Foram analisadas as tendências de mortalidade por AVE ajustadas por idade em adultos (30-69 anos) de regiões do Brasil, entre 1996 e 2011. Método: Análise realizada após realocação dos óbitos sem registro de sexo ou idade; redistribuição de códigos mal definidos e correção do subregistro. Modelos de regressão linear e de espaço de estados foram utilizad...

Doença cerebrovascular no Brasil de 1990 a 2015: Global Burden of Disease 2015

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