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Cardiovascular Mortality in Brazil During the COVID-19 Pandemic: A Comparison between Underlying and Multiple Causes of Death

34 Pages Posted: 21 Oct 2022

See all articles by Luisa Campos Caldeira Brant

Luisa Campos Caldeira Brant

Federal University of Minas Gerais (UFMG) - Faculty of Medicine

Pedro C. Pinheiro

Federal University of Minas Gerais (UFMG) - Faculty of Medicine

Luiz G. Passaglia

Federal University of Minas Gerais (UFMG) - Faculty of Medicine

Maria F. M. Souza

Federal University of Minas Gerais (UFMG) - Faculty of Medicine

Deborah C. Malta

Federal University of Minas Gerais (UFMG) - Departamento de Enfermagem Materno Infantil e Saúde Pública

Antonio L. P. Ribeiro

University College London - Institute of Health Informatics; State University of Montes Claros

Bruno R. Nascimento

Federal University of Minas Gerais (UFMG) - Faculty of Medicine

More...

Abstract

Introduction: The Covid-19 pandemic has differentially impacted cardiovascular disease (CVD) mortality worldwide. We evaluated the impact of the Covid-19 pandemic on CVD mortality in Brazil, a large middle-income country, comparing underlying (UC) and multiple causes (MC) of death.

Methods: Ecological, time series study analysing the age-standardized death rates for CVD, from epidemiological week 10/2020 to 39/2021, using data from the Mortality Information System (SIM-SUS). CVD was defined using ICD-10 coding, if reported as UC or MC of death (UC + other causes of any line in death certification). Observed and expected (mean for 2017–2019) data were compared. Risk ratios (RiR) and 95% confidence intervals (CI) were calculated.

Results: Age-standardized mortality rate for CVD as UC of death was 165.8 (95%CI 165.4-166.3)/100,000 inhabitants, similar to expected (165.6/100,000, 95%CI 165.2-166.1, RiR=1.00). There was increased out-of-hospital mortality (RiR=1.18; 95%CI 1.17-1.19) and deaths of ill-defined causes (RiR=1.43; 95%CI 1.42-1.44). The increase in out-of-hospital deaths was more pronounced in the North (RiR=1.33; 95%CI 1.30-1.36), region with less resilient health system. Conversely, as MC of death, there was a 10% increase in CVD mortality (observed: 243.2 (CI95% 242.7-243.7), expected: 221.6 (95%CI 221.1 – 222.1)/100,000), noticeably out-of-hospital (19%). Greater increases also occurred in the North and Central West regions (RiR=1.16; 95%CI 1.15-1.18), among men (RiR=1.11; 95%CI 1.11-1.12) and individuals ³60 years (RiR=1.11; 95%CI 1.10-1.11).

Conclusions: During the pandemic, mortality rates for CVD as MC of death increased in Brazil, whereas UC did not change. Higher out-of-hospital mortality, misclassification, and competing causes of death may explain this pattern.

Funding: BRN is partially supported by CNPq (312382/2019-7), the Edwards
Lifesciences Foundation and FAPEMIG (APQ-000627-20). DCM is partially financed
by CNPq (310177/2020-0). The Brazilian Ministry of Health funds the present project.
AB is supported by the National Institute for Health Research (NIHR), British Medical
Association, AstraZeneca, and UK Research and Innovation, and Trustee of the South
Asian Health Foundation and of Long Covid SOS. ALPR is partially funded by CNPq
(310679/2016-8 and 465518/2014-1), FAPEMIG (PPM-00428-17 and RED-00081-16)
and CAPES (88887.507149/2020-00).

Declaration of Interest: None to declare.

Keywords: Covid-19, cardiovascular diseases, mortality, Brazil

Suggested Citation

Brant, Luisa Campos Caldeira and Pinheiro, Pedro C. and Passaglia, Luiz G. and Souza, Maria F. M. and Malta, Deborah C. and Ribeiro, Antonio L. P. and Nascimento, Bruno R., Cardiovascular Mortality in Brazil During the COVID-19 Pandemic: A Comparison between Underlying and Multiple Causes of Death. Available at SSRN: https://ssrn.com/abstract=4254868 or http://dx.doi.org/10.2139/ssrn.4254868

Luisa Campos Caldeira Brant (Contact Author)

Federal University of Minas Gerais (UFMG) - Faculty of Medicine ( email )

Pedro C. Pinheiro

Federal University of Minas Gerais (UFMG) - Faculty of Medicine ( email )

Luiz G. Passaglia

Federal University of Minas Gerais (UFMG) - Faculty of Medicine ( email )

Maria F. M. Souza

Federal University of Minas Gerais (UFMG) - Faculty of Medicine ( email )

Deborah C. Malta

Federal University of Minas Gerais (UFMG) - Departamento de Enfermagem Materno Infantil e Saúde Pública ( email )

Antonio L. P. Ribeiro

University College London - Institute of Health Informatics ( email )

State University of Montes Claros ( email )

Bruno R. Nascimento

Federal University of Minas Gerais (UFMG) - Faculty of Medicine ( email )