Mortality from Diseases of the Circulatory System in Brazil and its Relationship with Social Determinants Focusing on Vulnerability

Abstract

Background: Deaths from diseases of the circulatory system (DCS) and ischemic heart diseases (IHD) are declining, but slowly in developing countries, emphasizing its probable relationship with determinants of social vulnerability. Objectives: To analyze the temporal progression of mortality rates of DCS and IHD from 1980 to 2019 and the association of the rates with the Municipal Human Development Index (MHDI) and Social Vulnerability Index (SVI) in Brazil. Methods: We estimated the crude and standardized mortality rates of DCS and IHD and analyzed the relationship between the obtained data and the MHDI and SVI. Data on deaths and population were obtained from the DATASUS. The MHDI and the SVI of each federative unit were extracted from the websites Atlas Brasil and Atlas da Vulnerabilidade Social, respectively. Results: The age-standardized mortality rates of DCS and IHD showed a downward trend nationwide, which was unequal across the federative units. There was an inversely proportional relationship between the standardized mortality rates of DCS and IHD and the MHDI. The downward mortality trend was observed when the indices were greater than 0.70 and 0.75, respectively. The SVI was directly proportional to the standardized mortality rates of DCS and IHD. An upward mortality trend was observed with an SVI greater than 0.35.Conclusions: Social determinants represented by the MHDI and the SVI were related to mortality from DCS and IHD across the Brazilian federative units. The units with most development and least social inequalities had the lowest mortality from these causes. The most vulnerable die the most.