Trends in prevalence, mortality, and morbidity associated with high systolic blood pressure in Brazil from 1990 to 2017: estimates from the "Global Burden of Disease 2017" (GBD 2017) study.

BACKGROUND: Hypertension remains the leading risk factor for cardiovascular disease (CVD) worldwide, and its impact in Brazil should be assessed in order to better address the issue. We aimed to describe trends in prevalence and burden of disease attributable to high systolic blood pressure (HSBP) among Brazilians ≥ 25 years old according to sex and federal units (FU) using the Global Burden of Disease (GBD) 2017 estimates. METHODS: We used the comparative risk assessment developed for the GBD study to estimate trends in attributable deaths and disability-adjusted life-years (DALY), by sex, and FU for HSBP from 1990 to 2017. This study included 14 HSBP-outcome pairs. HSBP was defined as ≥ 140 mmHg for prevalence estimates, and a theoretical minimum risk exposure level (TMREL) of 110-115 mmHg was considered for disease burden. We estimated the portion of deaths and DALYs attributed to HSBP. We also explored the drivers of trends in HSBP burden, as well as the correlation between disease burden and sociodemographic development index (SDI). RESULTS: In Brazil, the prevalence of HSBP is 18.9% (95% uncertainty intervals [UI] 18.5-19.3%), with an annual 0.4% increase rate, while age-standardized death rates attributable to HSBP decreased from 189.2 (95%UI 168.5-209.2) deaths to 104.8 (95%UI 94.9-114.4) deaths per 100,000 from 1990 to 2017. In spite of that, the total number of deaths attributable to HSBP increased 53.4% and HSBP raised from 3rd to 1st position, as the leading risk factor for deaths during the period. Regarding total DALYs, HSBP raised from 4th in 1990 to 2nd cause in 2017. The main driver of change of HSBP burden is population aging. Across FUs, the reduction in the age-standardized death rates attributable to HSBP correlated with higher SDI. CONCLUSIONS: While HSBP prevalence shows an increasing trend, age-standardized death and DALY rates are decreasing in Brazil, probably as results of successful public policies for CVD secondary prevention and control, but suboptimal control of its determinants. Reduction was more significant in FUs with higher SDI, suggesting that the effect of health policies was heterogeneous. Moreover, HSBP has become the main risk factor for death in Brazil, mainly due to population aging.

Variations and particularities in cardiovascular disease mortality in Brazil and Brazilian states in 1990 and 2015: estimates from the Global Burden of Disease. / Variações e diferenciais da mortalidade por doença cardiovascular no Brasil e em seus estados, em 1990 e 2015: estimativas do Estudo Carga Global de Doença.

OBJECTIVE:: To analyze variations and particularities in mortality due to cardiovascular disease (CVD) in Brazil and in Brazilian states, in 1990 and 2015. METHODS:: We used data compiled from the Global Burden of Disease (GBD) 2015, obtained from the database of the Mortality Information System (SIM) of the Brazilian Ministry of Health. Correction of the sub-registry of deaths and reclassification of the garbage codes were performed using specific algorithms. The cardiovascular causes were subdivided into 10 specific causes. Age-standardized CVD mortality rates - in 1990 and 2015 - were analyzed according to sex and Brazilian state. RESULTS:: Age-standardized CVD mortality rate decreased from 429.5 (1990) to 256.0 (2015) per 100,000 inhabitants (40.4%). The proportional decrease was similar in both sexes, but death rates in males were substantially higher. The reduction of age-standardized mortality rate was more significant for rheumatic heart disease (44.5%), ischemic cardiopathy (43.9%), and cerebrovascular disease (46.0%). The decline in mortality was markedly different across states, being more pronounced in those of the southeastern and southern regions and the Federal District, and more modest in most states in the north and northeast regions. CONCLUSION:: Age-standardized CVD mortality has declined in Brazil in recent decades, but in a heterogeneous way across states and for different specific causes. Considering the burden magnitude and the Brazilian population aging, policies to prevent and manage CVD should continue to be prioritized.

Variações e diferenciais da mortalidade por doença cardiovascular no Brasil e em seus estados, em 1990 e 2015: estimativas do Estudo Carga Global de Doença / Variations and particularities in cardiovascular disease mortality in Brazil and Brazilian states in 1990 and 2015: estimates from the Global Burden of Disease

RESUMO: Objetivo: Analisar as variações e os diferenciais da mortalidade por doenças cardiovasculares (DCV) no Brasil e em seus estados, em 1990 e 2015. Métodos: Foram utilizados os dados de mortalidade compilados pelo Global Burden of Disease (GBD) 2015, obtidos da base de dados do Sistema de Informação sobre Mortalidade do Ministério da Saúde. Foram realizadas a correção do sub-registro de óbitos e a reclassificação dos códigos garbage por meio de algoritmos específicos. As causas cardiovasculares foram subdivididas em 10 causas específicas. As taxas de mortalidade - dos anos 1990 e 2015 - foram padronizadas pela idade, de acordo com o sexo e o estado brasileiro. Resultados: A taxa de mortalidade por DCV padronizada por idade caiu de 429,5 (1990) para 256,0 (2015) a cada 100 mil habitantes (40,4%). A redução proporcional foi semelhante em ambos os sexos, mas as taxas em homens são substancialmente mais altas do que nas mulheres. A redução da taxa padronizada por idade foi mais acentuada para a doença cardíaca reumática (44,5%), cardiopatia isquêmica (43,9%) e doença cerebrovascular (46,0%). A queda na mortalidade diferiu marcadamente entre os estados, sendo mais acentuada nos estados das regiões Sudeste e Sul do país e no Distrito Federal, e atenuada nos estados do Norte e Nordeste. Conclusão: A mortalidade por DCV padronizada por idade reduziu no Brasil nas últimas décadas, porém de forma heterogênea entre os estados e para diferentes causas específicas. Considerando a magnitude da carga de doença e o envelhecimento da população brasileira, as políticas de enfrentamento das DCV devem ser priorizadas.

ABSTRACT: Objective: To analyze variations and particularities in mortality due to cardiovascular disease (CVD) in Brazil and in Brazilian states, in 1990 and 2015. Methods: We used data compiled from the Global Burden of Disease (GBD) 2015, obtained from the database of the Mortality Information System (SIM) of the Brazilian Ministry of Health. Correction of the sub-registry of deaths and reclassification of the garbage codes were performed using specific algorithms. The cardiovascular causes were subdivided into 10 specific causes. Age-standardized CVD mortality rates - in 1990 and 2015 - were analyzed according to sex and Brazilian state. Results: Age-standardized CVD mortality rate decreased from 429.5 (1990) to 256.0 (2015) per 100,000 inhabitants (40.4%). The proportional decrease was similar in both sexes, but death rates in males were substantially higher. The reduction of age-standardized mortality rate was more significant for rheumatic heart disease (44.5%), ischemic cardiopathy (43.9%), and cerebrovascular disease (46.0%). The decline in mortality was markedly different across states, being more pronounced in those of the southeastern and southern regions and the Federal District, and more modest in most states in the north and northeast regions. Conclusion: Age-standardized CVD mortality has declined in Brazil in recent decades, but in a heterogeneous way across states and for different specific causes. Considering the burden magnitude and the Brazilian population aging, policies to prevent and manage CVD should continue to be prioritized.

Healthy behavior among Brazilian young adults.

OBJECTIVE: To estimate the prevalence and factors associated to healthy behavior among young adults. METHODS: A total of 14,193 respondents aged 18-29 years who participated in the system Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL--Telephone-Based Surveillance of Risk and Protective Factors for Chronic Diseases) carried out in 27 Brazilian capitals in 2006 were studied. Healthy behavior was defined as non-smoking, reported regular physical activity and intake of fruits and vegetables five days or more a week. Data analysis was based on prevalence ratios estimated using Poisson regression. RESULTS: The prevalence of healthy young adults was 8.0%; 39.6% reported two healthy behaviors, 45.3% one; and 7.0% none. In the multivariate analysis, healthy behavior was more commonly seen among those aged 25-29 years with 9 or more years of schooling and who reported engaging in physical activities near home. Inverse associations were found with non-white skin color, consumption of whole milk and fatty meat or poultry, being on a diet, and poor self-perception of health status. CONCLUSIONS: Young adults who show fewer healthy behaviors perceive their health as poor, which suggests that these behaviors negatively affect their own health perception. Positive associations with higher schooling, white skin color, and living near physical activity facilities indicate social inequalities in access to healthy behaviors.

Comportamento saudável entre adultos jovens no Brasil / Comportamiento saludable entre adultos jóvenes en Brasil, 2006 / Healthy behavior among Brazilian young adults

OBJETIVO: Estimar a prevalência de características associadas a comportamentos saudáveis em jovens. MÉTODOS: Foram analisados dados de 14.193 indivíduos com idades entre 18 e 29 anos, referentes ao sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL), realizado nas 27 capitais brasileiras em 2006. Foi considerado saudável quem não fuma, pratica atividade física regular e consome frutas/hortaliças cinco ou mais dias na semana. Foi analisada associação entre comportamento saudável com variáveis sociodemográficas e indicadores de saúde. A análise dos dados baseou-se na razão de prevalência obtida por regressão de Poisson. RESULTADOS: A prevalência de jovens saudáveis foi de 8,0 por cento; 39,6 por cento relataram dois comportamentos saudáveis, 45,3 por cento relataram um, e 7,0 por cento nenhum. Na análise multivariada, o comportamento saudável foi mais freqüente entre participantes com 25-29 anos, escolaridade maior que nove anos de estudo e que relataram haver local para praticar esportes próximo à residência. A freqüência de comportamento saudável foi significativamente menor entre participantes que relataram cor de pele parda ou preta, consumo de leite integral e de carne vermelha ou frango com gordura, estar em dieta e autopercepção da saúde como ruim. ...

OBJECTIVE: To estimate the prevalence and factors associated to healthy behavior among young adults. METHODS: A total of 14,193 respondents aged 18-29 years who participated in the system Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (VIGITEL - Telephone-Based Surveillance of Risk and Protective Factors for Chronic Diseases) carried out in 27 Brazilian capitals in 2006 were studied. Healthy behavior was defined as non-smoking, reported regular physical activity and intake of fruits and vegetables five days or more a week. Data analysis was based on prevalence ratios estimated using Poisson regression. RESULTS: The prevalence of healthy young adults was 8.0 percent; 39.6 percent reported two healthy behaviors, 45.3 percent one; and 7.0 percent none. In the multivariate analysis, healthy behavior was more commonly seen among those aged 25-29 years with 9 or more years of schooling and who reported engaging in physical activities near home. Inverse associations were found with non-white skin color, consumption of whole milk and fatty meat or poultry, being on a diet, and poor self-perception of health status...

The increase of diabetes mortality burden among Brazilian adults.

OBJECTIVE: To estimate diabetes-related deaths among Brazilian adults between 1999 and 2003 and to investigate demographic factors associated with reporting diabetes as an associated cause of death. METHODS: All deaths with diabetes as the underlying or associated cause were identified using the Brazilian Mortality Data System. Analysis was performed by sex, age, year, state of residence, and place of death. Mortality rates were age standardized by the 2000 Brazilian population. FINDINGS: A total of 237 946 deaths (8.8%) were related to diabetes; in 4.2% of deaths it was the underlying cause and in 4.6% it was an associated cause. Between 1999 and 2003, age-standardized mortality rates for diabetes as the underlying cause increased 14% among males and 9% among females, while mortality with diabetes as an associated cause increased 22% and 28%, respectively. Diabetes appeared more often as an associated cause in death certificates among older individuals and in those residing in São Paulo State; it appeared less often as an associated cause among women, brown- and black-skinned populations, and in deaths occurring outside hospitals. Cardiovascular diseases accounted for 54.5% of the underlying causes of death when diabetes was an associated cause. CONCLUSION: Diabetes was related to almost 9% of the deaths in the South and Southeast regions of Brazil. Mortality from diabetes is increasing, especially deaths with diabetes as an associated cause. The probability of having diabetes as the underlying cause of death is greater among women and nonwhite individuals. Our results reinforce the importance of using multiple causes of death to monitor diabetes, because half the individuals with the disease will die of another cause, especially cardiovascular diseases.

The increase of diabetes mortality burden among Brazilian adults

OBJECTIVE: To estimate diabetes-related deaths among Brazilian adults between 1999 and 2003 and to investigate demographic factors associated with reporting diabetes as an associated cause of death. METHODS: All deaths with diabetes as the underlying or associated cause were identified using the Brazilian Mortality Data System. Analysis was performed by sex, age, year, state of residence, and place of death. Mortality rates were age standardized by the 2000 Brazilian population. FINDINGS: A total of 237 946 deaths (8.8 percent) were related to diabetes; in 4.2 percent of deaths it was the underlying cause and in 4.6 percent it was an associated cause. Between 1999 and 2003, age-standardized mortality rates for diabetes as the underlying cause increased 14 percent among males and 9 percent among females, while mortality with diabetes as an associated cause increased 22 percent and 28 percent, respectively. Diabetes appeared more often as an associated cause in death certificates among older individuals and in those residing in São Paulo State; it appeared less often as an associated cause among women, brown- and black-skinned populations, and in deaths occurring outside hospitals. Cardiovascular diseases accounted for 54.5 percent of the underlying causes of death when diabetes was an associated cause. CONCLUSION: Diabetes was related to almost 9 percent of the deaths in the South and Southeast regions of Brazil. Mortality from diabetes is increasing, especially deaths with diabetes as an associated cause. The probability of having diabetes as the underlying cause of death is greater among women and nonwhite individuals. Our results reinforce the importance of using multiple causes of death to monitor diabetes, because half the individuals with the disease will die of another cause, especially cardiovascular diseases.

OBJETIVOS: Estimar las muertes relacionadas con la diabetes en adultos brasileños entre 1999 y 2003 y analizar los factores demográficos asociados con el informe de la diabetes como causa asociada de muerte. MÉTODOS: Se identificaron todas las muertes en que la diabetes fue la causa principal o asociada, a partir del Sistema Brasileño de Datos de Mortalidad. El análisis se realizó según el sexo, la edad, el año, el estado de residencia y el lugar de muerte. Las tasas de mortalidad se estandarizaron por la edad según la población brasileña en 2000. RESULTADOS: En total, 237 946 muertes (8,8 por ciento) estuvieron relacionadas con la diabetes; en 4,2 por ciento de las muertes, la diabetes fue la causa principal y en 4,6 por ciento fue una causa asociada. Entre 1999 y 2003, las tasas de mortalidad estandarizadas según la edad para las muertes en que la diabetes fue la causa principal aumentaron 14 por ciento en hombres y 9 por ciento en mujeres, mientras que la mortalidad con la diabetes como causa asociada aumentó a 22 por ciento y 28 por ciento, respectivamente. La diabetes apareció más frecuentemente como causa asociada en los certificados de defunción de la personas de mayor edad y en los que residían en el Estado de São Paulo, mientras que fue menos frecuente en mujeres, negros y mestizos y cuando la muerte ocurrió fuera de los hospitales. Las enfermedades cardiovasculares fueron la causa principal de 54,5 por ciento de las muertes en las que la diabetes se consideró como causa asociada. CONCLUSIONES: La diabetes estuvo relacionada con casi 9 por ciento de las muertes ocurridas en las regiones sur y suroriental de Brasil. La mortalidad por diabetes está en aumento, especialmente cuando la diabetes figura como causa asociada de muerte. La probabilidad de tener diabetes como causa principal de muerte es mayor en mujeres y en personas que no son blancas. Estos resultados confirman la importancia de utilizar la información de las múltiples...