Data from Brazil and GBD
Data used in the present document have four different sources: (a) the Brazilian Mortality and Hospital Information Systems, provided by the government; (b) the GBD 2019 estimates;¹ (c) the systematic review of the literature with emphasis on the publications of the last 10 years; (d) the health care utilization costs, based on the reimbursement tables from the Public Health System, adjusted for inflation and reported in both original currency units (Reais or US dollars in a specific year) and international dollars. The international dollars were converted to PPP adjusted to US$ 2019 (Int$ 2019) using the Campbell and Cochrane Economics Methods Group and the Evidence for Policy and Practice Information and Coordinating Centre cost converter.² More details on the methodology used can be obtained in the previous version of this Statistics,³ and a better explanation on how mortality rate estimates can vary depending on the source used (mortality information system or GBD datasets) can be seen elsewhere.⁴
As expected, different or discordant metrics are sometimes presented for a single condition, considering that studies may have distinct methodologies or were conducted in different time periods, locations, and age ranges. These differences are unavoidable, and their possible reasons are always discussed in this document. Since many studies cover a long period of time and life expectancy increased in Brazil in the last decades, we used age-standardized rates, i.e., a weighted average of the age-specific rates per 100 000 persons, in which the weights are the proportions of people in the corresponding age groups of a standard population. The GBD age-standardization uses a global age pattern, although other sources may have used different reference populations. For most studies, race/skin color was used according to the IBGE definition, i.e., white, black, brown, yellow (oriental), and indigenous.
Cardiovascular disease is still responsible for nearly one third of deaths in Brazil and affects disproportionally the most vulnerable stratum of the population, which has marked difficulties in accessing high quality health care. ⁵, ⁶ To have representative, reliable and extensive national data on CVD, risk behaviors and factors is an obligatory step towards overcoming these inequalities and providing the best possible CV care to all Brazilians. This study gathers this information, essential to individual care and to plan the next steps of health policy in Brazil.⁷ In addition, it points out gaps in the knowledge to be filled with further studies. We all aspire for people to live longer and better. Knowing more about CV statistics to help tackle CVD is a good start to this goal.
1. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, Bonny A, Brauer M, Brodmann M, Cahill TJ, Carapetis J, Catapano AL, Chugh SS, Cooper LT, Coresh J, Criqui M, DeCleene N, Eagle KA, Emmons-Bell S, Feigin VL, Fernández-Solà J, Fowkes G, Gakidou E, Grundy SM, He FJ, Howard G, Hu F, Inker L, Karthikeyan G, Kassebaum N, Koroshetz W, Lavie C, Lloyd-Jones D, Lu HS, Mirijello A, Temesgen AM, Mokdad A, Moran AE, Muntner P, Narula J, Neal B, Ntsekhe M, Moraes de Oliveira G, Otto C, Owolabi M, Pratt M, Rajagopalan S, Reitsma M, Ribeiro ALP, Rigotti N, Rodgers A, Sable C, Shakil S, Sliwa-Hahnle K, Stark B, Sundström J, Timpel P, Tleyjeh IM, Valgimigli M, Vos T, Whelton PK, Yacoub M, Zuhlke L, Murray C, Fuster V; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982-3021. doi: 10.1016/j.jacc.2020.11.010.
2. Shemilt I, Thomas J, Morciano M. A Web-Based Tool for Adjusting Costs to a Specific Target Currency and Price Year. Evid. Policy. 2010;6(1):51-9. doi:10.1332/174426410X482999.
3. Oliveira GMM, Brant LCC, Polanczyk CA, Biolo A, Nascimento BR, Malta DC, Souza MFM, Soares GP, Xavier GF Jr, Machline-Carrion MJ, Bittencourt MS, Pontes Neto OM, Silvestre OM, Teixeira RA, Sampaio RO, Gaziano TA, Roth GA, Ribeiro ALP. Cardiovascular Statistics - Brazil 2020. Arq Bras Cardiol. 2020;115(3):308-439. doi: 10.36660/abc.20200812.
4. Malta DC, Teixeira R, Oliveira GMM, Ribeiro ALP. Cardiovascular Disease Mortality According to the Brazilian Information System on Mortality and the Global Burden of Disease Study Estimates in Brazil, 2000-2017. Arq Bras Cardiol. 2020;115(2):152-160. doi: 10.36660/abc.20190867.
5. Castro MC, Massuda A, Almeida G, Menezes-Filho NA, Andrade MV, Noronha KVMS, Rocha R, Macinko J, Hone T, Tasca R, Giovanella L, Malik AM, Werneck H, Fachini LA, Atun R. Brazil's Unified Health System: The First 30 Years and Prospects for the Future. Lancet. 2019;394(10195):345-56. doi: 10.1016/S0140-6736(19)31243-7.
6. Ribeiro ALP, Duncan BB, Brant LCC, Lotufo PA, Mill JG, Barreto SM. Cardiovascular Health in Brazil: Trends and Perspectives. Circulation. 2016;133(4): 422-33. doi: https://doi.org/10.1161/CIRCULATIONAHA.114.008727.
7. Ribeiro ALP, Oliveira GMM. Toward a Patient-Centered, Data-Driven Cardiology. Arq Bras Cardiol. 2019;112(4):371-3. doi: 10.5935/abc.20190069.