Race, gender and stroke subtypes mortality in São Paulo, Brazil

Abstract

-Stroke mortality rates have a discrepant distribution according to socioeconomic variables as social exclusion in Brazil. Recently, data from race has been available from the official health statistics considering five categories: White, Mixed, Black, Asian and Native. We addressed in the city of São Paulo, Brazil, an analysis of cerebrovascular mortality according to race (excluding Asian and Native due to small number of events) and gender during 1999-2001 for people aged 30 to 79 years-old. For all cerebrovascular diseases, age-adjusted mortality rates (x 100,000) for men were higher for Black (150.2), intermediate for Mixed (124.2) and lower for White (104.5) people. These gradient patterns were similar for all stroke subtypes, except for subarachnoideal hemorrhage in which no differences were detected. For women, the rates were lower compared to men and the same pattern was observed among Black (125.4), Mixed (88.5) and White (64.1) women. Compared to White men, the risk ratio of Black men was 1.4. However, compared to White women, the risk ratio for Black women was 2.0. Concluding, there is a significant gradient of stroke mortality according to race, mainly among women.KEY WORDS: cerebrovascular diseases, race, gender, mortality.Raça, gênero e mortalidade por subtipos da doença cerebrovascular em São paulo, brasil RESUMO -As taxas de mortalidade pela doença cerebrovascular apresentam distribuição diferenciada de acordo com variáveis socioeconômicas. Informação sobre raça é nova no sistema de informação de mortalidade do Ministério da Saúde. Na cidade de São Paulo foi verificada entre três categoria de raça -branca, parda e negra -a taxa específica de mortalidade nos anos de 1999-2001 para pessoas entre 30 e 79 anos. Para o conjunto das doenças cerebrovasculares as taxas de mortalidade ajustadas para idade (x 100.000) para homens foram maiores entre os negros (150,2), intermediária para os pardos (124,2) e menor para brancos (104,5). Esse gradiente foi o mesmo para todos os subtipos, excluindo a hemorragia subaracnoídea. Para as mulheres, as taxas foram menores quando comparada aos homens e, o mesmo padrão foi observado para negras (125,4), pardas (88,5) e brancas (64,1). A razão de risco para homens negros quando comparado aos brancos foi 1.4, mas entre as mulheres negras e as brancas foi o

Prevalence of stroke and associated disability in Brazil: National Health Survey - 2013

“…In contrast to the results presented here, the prevalence of stroke according to self-reported race/skin color was similar in all categories. Mortality studies show higher mortality in Black due to the higher prevalence of hypertension in this population, as well, factors associated with worse socioeconomic status in this subset 6 . However, Judd et al showed in the Reasons for Geographic and Racial Study Differences in Stroke (REGARDS), which evaluated stroke in high-risk areas in the United States, that the proportion of deaths from late post-stroke complications was higher in Whites, indicating a higher survival rate compared to brown or black individuals 19 .…”

“…Although stroke deaths have declined in the last decades 2,3 , recent mortality data also reveal cerebrovascular disease as the third cause of premature death after coronary heart disease and homicides 4 . However, the decrease in stroke mortality is not equally distributed across the country and it occurs mainly on the poorest areas of the country and among Blacks 5,6,7 . Compared to previous mortality studies 8 , there are few studies evaluating the prevalence of stroke in Brazil according to sociodemographic characteristics 9,10,11,12 .…”

Cardiovascular Health in Brazil

“…Based on reported race in the death certificates, the age-standardized premature CVD and stroke death rates are higher in blacks than in mixed race and white persons ( Figure IA in the online-only Data Supplement). 34 Since 1996, the relative rate of decline of agestandardized premature CVD death rates has been higher in women (-3.0%/y) than in men (-2.5%/y, P<0.001, Figure IB in the online-only Data Supplement), and this pattern was also observed for coronary heart disease (women, -2.2%/y; men, -1.4%/y, P<0.001) and for stroke (women, -3.6%/y; men, -3.3%/y, P=0.002). Figure IC in the online-only Data Supplement shows mortality trends from 1996 to 2011 in the 3 areas of Sao Paulo city classified by their geographically defined mean household income.…”

Validation of a stroke symptom questionnaire for epidemiological surveys

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] The impact of cerebrovascular diseases matters not only because of the burden of death [1][2][3][4][5][6][7][8] and the costs of hospitalizations, 9 but also because of the late effects from the disease, such as the degree of motor disabilities, post-stroke depression, reduced cognitive function and, consequently, the reduced quality of life among stroke survivors and their caregivers. [10][11][12] However, mortality data has a natural limitation; classical prevalence surveys 13 are relatively expensive; and incidence-based population studies [14][15][16] are only suitable for small and middle-size towns.…”