A Reappraisal of Stroke Mortality Trends in Brazil (1979–2009)

Lotufo, Paulo A.; Goulart, Alessandra Carvalho; Fernandes, Tiótrefis Gomes; Benseñor, Isabela M.

doi:10.1111/j.1747-4949.2011.00757.x

Cited by 47 publications

(52 citation statements)

References 18 publications

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“…From 2005 to 2007, the annual average of ill-defined codes for Brazilian Capitals were very high: 31.8% of code I64.0 (stroke not specified as hemorrhagic or ischemic), 25.2 % as code I61.9 (non-specified intracerebral hemorrhage) and 11.6% as code I67.8 (other cerebrovascular diseases) 24 . A reappraisal of stroke mortality trends in Brazil between 1979 and 2009 showed that mortality are declining in the country for all strokes subtypes, although these estimates did not considered quality differences on registry, redistribution due to garbage codes or ill-defined diseases 25 .…”

Section: Discussionmentioning

confidence: 99%

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

Passos

Ishitani

Franco

et al. 2016

Arq. Neuro-Psiquiatr.

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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...

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Section: Discussionmentioning

confidence: 99%

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

Passos

Ishitani

Franco

et al. 2016

Arq. Neuro-Psiquiatr.

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“…Reductions in stroke mortality over the last 20 years were greatest in the two wealthiest regions and least in the poorest regions. 34 The burden of stroke risk factors, and in particular, hypertension, has been characterized as a partial consequence of social determinants, including socioeconomic inequality and perceived discrimination. These are structural factors underlying global health inequalities that exceed the expected influence of access to health services.…”

Section: Poverty: a Global Risk Factor For Strokementioning

confidence: 99%

Targeting stroke risk and improving outcomes in patients with atrial fibrillation in Latin America

Stambler

Scazzuso

2016

Sao Paulo Med. J.

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“…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 .…”

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confidence: 99%

“…, Deborah Carvalho Malta 4,5 , Paulo A. Lotufo 1,2 Stroke mortality in Brazil has been reported the highest in South America for both genders 1 . 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 .…”

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confidence: 99%

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

Benseñor

Goulart

Szwarcwald

et al. 2015

Arq. Neuro-Psiquiatr.

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There is scarce data about prevalence of stroke in Brazil. The National Health Survey (PNS) is a community-based epidemiological survey, with a nationally representative sample to assess the absolute numbers with respective prevalence rates of stroke and post-stroke disabilities. It was estimated 2,231.000 stroke and 568,000 stroke cases with severe disabilities. The point prevalences was 1.6% and 1.4% in men and women, respectively. The prevalences of post-stroke disabilities were 29.5% for men and 21.5% for women. Stroke prevalence rates increased with aging, low education level, among people living in urban areas with no difference according to self-reported skin color. The degree of post-stroke disability was not statistically different according to sex, race, education level or living area. This new data from PNS show high stroke prevalence rates especially in older individuals without formal education and urban dweller, but the degree of stroke disability was not determined by the sociodemographic characteristics of the Brazilian population.

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A Reappraisal of Stroke Mortality Trends in Brazil (1979–2009)

Abstract: Stroke mortality rates are declining in Brazil for all stroke subtypes.

Cited by 47 publications

References 18 publications

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

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

Targeting stroke risk and improving outcomes in patients with atrial fibrillation in Latin America

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

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