RESUMEN
BACKGROUND: Cardiovascular disease accounts for about one-third of all premature deaths (ie, age < 70) in Cuba. Yet, the relevance of major risk factors, including systolic blood pressure (SBP), diabetes, and body-mass index (BMI), to cardiovascular mortality in this population remains unclear. METHODS: In 1996-2002, 146,556 adults were recruited from the general population in five areas of Cuba. Participants were interviewed, measured (height, weight and blood pressure) and followed up by electronic linkage to national death registries until Jan 1, 2017; in 2006-08, 24,345 participants were resurveyed. After excluding all with missing data, cardiovascular disease at recruitment, and those who died in the first 5 years, Cox regression (adjusted for age, sex, education, smoking, alcohol and, where appropriate, BMI) was used to relate cardiovascular mortality rate ratios (RRs) at ages 35-79 years to SBP, diabetes and BMI; RR were corrected for regression dilution to give associations with long-term average (ie, 'usual') levels of SBP and BMI. RESULTS: After exclusions, there were 125,939 participants (mean age 53 [SD12]; 55% women). Mean SBP was 124 mmHg (SD15), 5% had diabetes, and mean BMI was 24.2 kg/m2 (SD3.6); mean SBP and diabetes prevalence at recruitment were both strongly related to BMI. During follow-up, there were 4112 cardiovascular deaths (2032 ischaemic heart disease, 832 stroke, and 1248 other). Cardiovascular mortality was positively associated with SBP (>=120 mmHg), diabetes, and BMI (>=22.5 kg/m2): 20 mmHg higher usual SBP about doubled cardiovascular mortality (RR 2.02, 95%CI 1.88-2.18]), as did diabetes (2.15, 1.95-2.37), and 10 kg/m2 higher usual BMI (1.92, 1.64-2.25). RR were similar in men and in women. The association with BMI and cardiovascular mortality was almost completely attenuated following adjustment for the mediating effect of SBP. Elevated SBP (>=120 mmHg), diabetes and raised BMI (>=22.5 kg/m2) accounted for 27%, 14%, and 16% of cardiovascular deaths, respectively. CONCLUSIONS: This large prospective study provides direct evidence for the effects of these major risk factors on cardiovascular mortality in Cuba. Despite comparatively low levels of these risk factors by international standards, the strength of their association with cardiovascular death means they nevertheless exert a substantial impact on premature mortality in Cuba.
Asunto(s)
Enfermedades Cardiovasculares , Diabetes Mellitus , Adulto , Anciano , Presión Sanguínea , Índice de Masa Corporal , Cuba/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
OBJECTIVE: Evaluate the degree of integrity of the Cuban statistical registry of maternal deaths and the quality of the classification of the causes of death included in that registry. METHODS: We analyzed the information of all Cuban women who died in fertile age in 2013 according to the continuous mortality registry of the Directorate of Medical Records and Health Statistics of the Ministry of Public Health of Cuba (MINSAP), regardless of the main cause of death informed. Four research groups (national, expert, provincial and health units), each with defined functions, applied four forms to establish if the women had been pregnant in the year prior to death, to reassess whether the cases corresponded to a maternal death and, in that case, to review the classification. RESULTS: Deaths of 2 731 women of reproductive age notified in Cuba in 2013 were assessed. Of them, the cause of death of 2 711 (99.3%) was conclusive and, of these, 97 (3.6%) had had a pregnancy in the year prior to death. We found 50 maternal deaths (one more than in the continuous registry) for a 2% error and an adjustment factor of 1.02. Of the 97 deaths studied, only 4 cases were reclassified: 2 maternal deaths and 1 death related to pregnancy, delivery and puerperium, according to the continuous registry, which were reclassified as direct deaths; and 1 death considered non- maternal by the continuous registry that was reclassified as late maternal death, for a 95.9% concordance. CONCLUSIONS: The information on maternal deaths included in the MINSAP's continuous mortality registry has a high level of integrity. The quality of the classification of maternal deaths in this registry is high; reclassification of causes of death is uncommon.
OBJETIVOS: Avaliar o grau de integridade do registro estatístico cubano de óbitos maternos e a qualidade da classificação das causas de óbito incluídas nesse registro. MÉTODOS: Analisamos a informação de todas as mulheres cubanas que morreram em idade fértil em 2013 de acordo com o histórico de mortalidade contínua da Diretoria de Registros Médicos e Estatísticas de Saúde do Ministério da Saúde Pública de Cuba (MINSAP), independentemente da causa básica da morte consignada. Quatro grupos de pesquisa (nacional, especialistas, provincial e unidades de saúde), com funções definidas, aplicaram quatro formas para determinar se houve gravidez no ano anterior à morte, reavaliam se os casos corresponderam a uma morte materna e, em nesse caso, rever a classificação. RESULTADOS: Foram investigadas as 2 731 mulheres falecidas de idade reprodutiva notificadas em Cuba em 2013, das quais as causas de morte de 2 711 (99,3%) foram conclusivas e, destas, 97 (3,6%) tiveram gravidez no ano anterior à morte. Encontramos 50 mortes maternas (uma mais do que no registro contínuo) por erro de 2% e um fator de ajuste de 1,02. Das 97 mortes estudadas, apenas 4 casos foram reclassificados: 2 mortes maternas e 1 morte relacionada à gravidez, parto e puerpério, de acordo com o registro contínuo, que foram reclassificadas como mortes diretas, e 1 morte considerada não materna pelo registro contínuo que foi reclassificada como morte materna tardia, para uma concordância de 95,9%. CONCLUSÕES: A informação sobre mortes maternas incluída no registro de mortalidade contínua do MINSAP tem alto nível de integridade. A qualidade da classificação das mortes maternas neste registro é alta; a reclassificação das causas de morte é pouco frequente.
RESUMEN
RESUMEN Objetivos Evaluar el grado de integridad del registro estadístico cubano de muertes maternas y la calidad de la clasificación de las causas de muerte recogidas en ese registro. Métodos Se analizó la información de todas las cubanas fallecidas en edad fértil en el año 2013 según el registro continuo de mortalidad de la Dirección de Registros Médicos y Estadísticas de Salud del Ministerio de Salud Pública de Cuba (MINSAP), independientemente de la causa básica de muerte consignada. Cuatro grupos de investigación (nacional, de expertos, provincial y de unidades de salud), con funciones definidas, aplicaron cuatro formularios para determinar si hubo embarazo en el año previo a la defunción, reevaluar si los casos correspondían a una muerte materna y, en ese caso, revisar la clasificación. Resultados Se investigaron las 2 731 mujeres fallecidas en edad reproductiva notificadas en Cuba en el 2013; de ellas las causas de muerte de 2 711 (99,3%) resultaron concluyentes y, de estas, 97 (3,6%) habían tenido un embarazo en el año previo a la defunción. Se encontraron 50 muertes maternas (una más que en el registro continuo) para 2% de error y un factor de ajuste de 1,02. De las 97 muertes estudiadas, solo se reclasificaron 4 casos: 2 muertes maternas y 1 muerte relacionada con el embarazo, el parto y el puerperio, según el registro continuo, que se reclasificaron como muertes directas, y 1 muerte considerada no materna por el registro continuo que se reclasificó como muerte materna tardía, para una concordancia de 95,9%. Conclusiones La información sobre las muertes maternas recogida en el registro continuo de mortalidad del MINSAP tiene un alto nivel de integridad. La calidad de la clasificación de las muertes maternas en ese registro es elevada, al existir muy pocos cambios en la reclasificación de las causas de muerte.
ABSTRACT Objective Evaluate the degree of integrity of the Cuban statistical registry of maternal deaths and the quality of the classification of the causes of death included in that registry. Methods We analyzed the information of all Cuban women who died in fertile age in 2013 according to the continuous mortality registry of the Directorate of Medical Records and Health Statistics of the Ministry of Public Health of Cuba (MINSAP), regardless of the main cause of death informed. Four research groups (national, expert, provincial and health units), each with defined functions, applied four forms to establish if the women had been pregnant in the year prior to death, to reassess whether the cases corresponded to a maternal death and, in that case, to review the classification. Results Deaths of 2 731 women of reproductive age notified in Cuba in 2013 were assessed. Of them, the cause of death of 2 711 (99.3%) was conclusive and, of these, 97 (3.6%) had had a pregnancy in the year prior to death. We found 50 maternal deaths (one more than in the continuous registry) for a 2% error and an adjustment factor of 1.02. Of the 97 deaths studied, only 4 cases were reclassified: 2 maternal deaths and 1 death related to pregnancy, delivery and puerperium, according to the continuous registry, which were reclassified as direct deaths; and 1 death considered non- maternal by the continuous registry that was reclassified as late maternal death, for a 95.9% concordance. Conclusions The information on maternal deaths included in the MINSAP's continuous mortality registry has a high level of integrity. The quality of the classification of maternal deaths in this registry is high; reclassification of causes of death is uncommon.
RESUMO Objetivos Avaliar o grau de integridade do registro estatístico cubano de óbitos maternos e a qualidade da classificação das causas de óbito incluídas nesse registro. Métodos Analisamos a informação de todas as mulheres cubanas que morreram em idade fértil em 2013 de acordo com o histórico de mortalidade contínua da Diretoria de Registros Médicos e Estatísticas de Saúde do Ministério da Saúde Pública de Cuba (MINSAP), independentemente da causa básica da morte consignada. Quatro grupos de pesquisa (nacional, especialistas, provincial e unidades de saúde), com funções definidas, aplicaram quatro formas para determinar se houve gravidez no ano anterior à morte, reavaliam se os casos corresponderam a uma morte materna e, em nesse caso, rever a classificação. Resultados Foram investigadas as 2 731 mulheres falecidas de idade reprodutiva notificadas em Cuba em 2013, das quais as causas de morte de 2 711 (99,3%) foram conclusivas e, destas, 97 (3,6%) tiveram gravidez no ano anterior à morte. Encontramos 50 mortes maternas (uma mais do que no registro contínuo) por erro de 2% e um fator de ajuste de 1,02. Das 97 mortes estudadas, apenas 4 casos foram reclassificados: 2 mortes maternas e 1 morte relacionada à gravidez, parto e puerpério, de acordo com o registro contínuo, que foram reclassificadas como mortes diretas, e 1 morte considerada não materna pelo registro contínuo que foi reclassificada como morte materna tardia, para uma concordância de 95,9%. Conclusões A informação sobre mortes maternas incluída no registro de mortalidade contínua do MINSAP tem alto nível de integridade. A qualidade da classificação das mortes maternas neste registro é alta; a reclassificação das causas de morte é pouco frequente.
