Academic journal article Demographic Research

The Relation between Cardiovascular Mortality and Development: A Study of Small Areas in Brazil, 2001-2015

Academic journal article Demographic Research

The Relation between Cardiovascular Mortality and Development: A Study of Small Areas in Brazil, 2001-2015

Article excerpt


Deaths from cardiovascular diseases (CVD) are increasing and CVD is the leading cause of death worldwide; that is, more people die annually from CVDs than from any other cause (Franco et al. 2011; Lozano et al. 2012; Roth et al. 2015, 2017a, 2017b). In the last twenty-seven years the estimated number of deaths from CVDs increased from approximately 12.0 million in 1990 to 17.8 million in 2017. These numbers represent around 25.6% and 31.8% of all global deaths, respectively (Global Burden of Disease Collaborative Network 2019). In recent years, Lopez and Aidar (2019) have observed a slowdown in the rate of decline in CVD mortality in high-income countries. This pattern and these recent changes are a combination of several factors, such as population growth, aging, education, behavior, climate, access to health services, epidemiologic changes in CVD, and income (GDP) (Timæ us 1993; Lopez, Caselli, and Valkonen 1995; Lopez et al. 2006a, 2006b; Vallin and Meslé 2004; Jerrett et al. 2005; Marmot 2010; WHO 2014; Roth et al. 2015; Baptista and Queiroz 2019; Lopez and Aidar 2019).

According to the World Health Organization (WHO) (2016), over three-quarters of deaths from CVD take place in low- and middle-income countries (Franco et al. 2011), like Brazil. While the number of deaths from CVD in Brazil increased from 258,338.97 in 1990 to 388,268.09 in 2017, the percentage has remained fairly stable, 28.89% and 28.78%, respectively (Global Burden of Disease Collaborative Network 2019). However, despite CVD being the main cause of mortality in Brazil (Lotufo 2019), CVD mortality rates are not uniformly distributed within the country (Borges 2017; Baptista, Queiroz, and Rigotti 2018; Baptista and Queiroz 2019). Brazil is marked by important regional disparities resulting from socioeconomic inequality and limited access to health services (Souza et al. 2018).

Due to heterogeneity in both the spatial distribution of deaths from cardiovascular disease and regional socioeconomic conditions in Brazil, the goal of this paper is to investigate the relationship between CVD mortality and gross domestic product (GDP) per capita in the adult population (over 30 years of age), by sex, in Brazilian microregions from 2001 to 2015. This is an attempt to advance the recent study by Baptista and Queiroz (2019), who investigate the spatial pattern of deaths from CVD across small areas in Brazil by performing a spatial analysis of CVD mortality, identifying regions with high levels of mortality, and showing how they have changed over recent periods of time. The results show temporal clockwise change in the concentration of high-high regions (where there is a high level of CVD mortality not only in the region but also in the neighborhood) from the South to the Northeast. Baptista and Queiroz (2019) speculate that these changes may be related to socioeconomic and cultural factors. Following their study, in this paper we aim to investigate associated factors that may explain recent changes in mortality by cardiovascular disease. More specifically, we study the relationship between changes in CVD mortality and a measure of income (GDP) over time and space.

Income, often expressed as gross domestic product (GDP) per capita, is one of the most widely used socioeconomic predictors of mortality/health, and this relationship has been widely discussed in the literature (Preston 1975; Murray and Lopez 1997; Berger and Messer 2002; Mackenbach et al. 2004; Subramanian and Kawachi 2006; James et al. 2012). We introduce an adapted bivariate choropleth map using software R to investigate the temporal and spatial relationship between CVD mortality and GDP per capita in Brazil.

2.Data and methods

2.1 Data source and level of analysis

We use cause-specific mortality from cardiovascular disease from the Tenth Revision of the International Classification of Diseases (ICD-10), Chapter IX, publicly available in the Sistema de Informaçöes sobre Mortalidade (SIM), DATASUS. …

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