Ethnicity and cardiovascular mortality in Brazil: a call for papers

Abstract

THE CHALLENGE OF ETHNICITY/RACE/SKIN COLOR AND HEALTH OUTCOMESDespite the consensus that age, sex, parental history, hypertension, dyslipidemia, smoking and diabetes are risk factors for cardiovascular diseases, 1 race, ethnicity or skin color always bring an anthropological debate into biology. 2 First, there are different views about the meaning of race according to culture and country. Second, the potential influence of genetic background is blurred by differential distribution of the proportions of formal education and income according to race/ethnicity/skin color. Third, considering that the foundation of racially admixed societies, such as most of the countries in the Americas, was based on subjugation of the indigenous populations and imported slavery of Africans, the presence of racism and discrimination cannot be neglected as one point in the causal pathway of cardiovascular diseases according to race/ethnicity/skin color. Fortunately, the emergence of molecular biology and genomics is opening up a new road towards understanding the influence of race on several diseases. Although the terms "race" and "skin color" are very popular, we will prefer "ethnicity" because it encompasses biology, culture, language and religion, thereby revealing health behavior and beliefs. 3 THE BRAZILIAN PATTERN OF CARDIOVASCULAR MORTALITY ACCORDING TO ETHNICITYThe Brazilian national census of 2010 was the first to assess self-reported race. In that year, 99.5% of the respondents completed the section on race/skin color. The census showed that 47.8% of the population self-reported as white, 43.1% mixed or brown, 7.6% black, 1.1% Asian and 0.4% indigenous. On the other hand, recording mortality on death certificates according to race or skin color was established in Brazil in 1996. The lowest proportion of leaving race blank on the death certificate form (6.4%) and the lowest proportion of deaths due to unknown causes (7.0%) occurred in 2010. Thus, 2010 was the best year for calculating death rates according to race without using predicted values for the population. Taking into consideration the aim of reducing premature mortality due to non-communicable diseases, 4 we evaluated the ageadjusted cardiovascular death rate according to race in Brazil in 2010 ( Table 1).

Caracterização epidemiológica dos óbitos no Brasil por macrorregião de 2016 a 2018

“…Há variabilidade na autoclassificação étnica das pessoas e, como em outros países, também no Brasil a identidade racial não é fixa nem imutável e sua validade e confiabilidade são limitadas (ARAÚJO et al, 2009;CAMPOS, ESTANISLAU, 2016;CHOR, 2013). Até o Censo 2010, havia pouca informação sobre a mortalidade relacionada à cor/raça, sendo necessário, na época, aplicar um procedimento metodológico adicional para realizar a estimativa (CAMPOS et al, 2017;LOTUFO, 2015).…”