The slowdown in the reduction rate of premature mortality from cardiovascular diseases puts the Americas at risk of achieving SDG 3.4: A population trend analysis of 37 countries from 1990 to 2017

Abstract

Cardiovascular diseases (CVD) are leading causes of mortality and morbidity in the Americas, resulting in substantial negative economic and social impacts. This study describes the trends and inequalities of CVD burden in the Americas to guide programmatic interventions and health system responses. We examined the CVD burden trends by age, sex, and countries between 1990 and 2017 and quantified social inequalities in CVD burden across countries. In 2017, CVD accounted for 2 million deaths in the Americas, 29% of total deaths. Age‐standardized DALY rates caused by CVD declined by −1.9% (95% uncertainty interval, −2.0 to −1.7) annually from 1990 to 2017. This trend varied with a striking decreasing trend over the interval 1994‐2003 (annual percent change (APC) −2.4% [−2.5 to 2.2]) and 2003‐2007 (APC −2.8% [−3.4 to −2.2]). This was followed by a slowdown in the rate of decline over 2007‐2013 (APC −1.83% [−2.1 to −1.6]) and a stagnation during the most recent period 2013‐2017 (APC −0.1% [−0.5 to 0.3]). The social inequality in CVD burden along the socio‐demographic gradient across countries decreased 2.75‐fold. The CVD burden and related social inequality have both substantially decreased in the Americas since 1990, driven by the reduction in premature mortality. This trend occurred in parallel with the improvement in the socioeconomic development and health care of the region. The deceleration and stagnation in the rate of improvement of CVD burden and persistent social inequality pose major challenges to reduce the CVD burden and the achievement of the United Nations’ Sustainable Development Goals Target 3.4.

Trend analysis of disability adjusted life years due to cardiovascular diseases: results from the global burden of disease study 2019

“…For instance, Martinez et al reported a descending trend of CVD YLD in the United States between 1990 and 2017. They also stated that rheumatic heart disease (RHD) had the sharpest downward slope among different types of cardiovascular diseases [ 11 ]. A worldwide study by Zimmerman et al indicated that the global YLD of congenital heart disease (CHD) had a relatively stable pattern between 1990 and 2017.…”

Premature mortality due to non-communicable diseases in Brazilian municipalities estimated for the three-year periods of 2010 to 2012 and 2015 to 2017

“…National research has shown, as well as the present study, that the greatest temporal reduction has occurred in the rates of premature mortality due to cardiovascular diseases 10 . Authors suggest that the decline in mortality rates for this group of causes observed in Brazil is a result of smoking control measures and the expansion of access to primary care 27 , however studies have been pointing to a deceleration in the trajectory of reduction in mortality rates due to NCDs in Brazil 31,36 and even an increase after 2015 10 . The increase in the prevalence of risk factors such as hypertension and overweight, associated with the decrease in eating healthy foods and physical activity 27 , the fiscal austerity measures established in recent years in Brazil 37 and, currently, the health crisis imposed by the COVID-19 pandemic represent challenges to the progression of the trend of reducing mortality due to NCDs.…”

State of birth and cardiovascular disease mortality: Multilevel analyses of the National Longitudinal Mortality Study

“…Cardiovascular disease (CVD) is the number one underlying cause of death in the United States, directly contributing to almost 660,000 deaths in 2019 ( Roth et al, 2018 ). Despite continued advances in public health and medicine, recent data suggest that the decline of CVD mortality may have plateaued in the US ( Martinez et al, 2020 ; Wilmot et al, 2015 ). This stagnating decline in CVD mortality, rather than the rising “deaths of despair”, has been credited as the main reason why life expectancy in the US has stalled/declined in recent years ( Mehta et al, 2020 ).…”