Cardiovascular and Cancer Death Rates in the Brazilian Population Aged 35 to 74 Years, 1996-2017

Mansur, Antonio de Padua; Favarato, Desiderio

doi:10.36660/abc.20200233

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Arquivos Brasileiros de Cardiologia

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Original Article • Arq. Bras. Cardiol. 117 (2) • Aug 2021 • https://doi.org/10.36660/abc.20200233 copy

Cardiovascular and Cancer Death Rates in the Brazilian Population Aged 35 to 74 Years, 1996-2017

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Cardiovascular diseases (CVD) and cancer are the main causes of death worldwide. These diseases share many risk factors. Control of traditional risk factors for CVD was associated with lower incidence of cancers.

Objective:

To analyze CVD and cancer mortality rate trends in Brazilian population aged 35-74 years from 1996 to 2017.

Methods:

Crude and age-adjusted death rate trends were analyzed for all causes of death, CVD, and cancer. Data were obtained from mortality database of the Ministry of Health. Joinpoint Regression Program performed analysis of trends and adjustments in death rates. The degree of changes was determined by the average annual percent change (AAPC). Level of statistical significance was set at p <0.05.

Results:

Mortality from all causes of death (AAPC=-1.6%; p<0.001), CVD (AAPC=-2.3; p<0.001), ischemic heart disease (IHD) (AAPC=-1.6; p<0.001) and stroke (AAPC=-3.7; p<0.001) declined. Same trends were observed for CVD (p<0.001) in men and women. Death rates from all causes of cancer (AAPC=-0.1; p=0.201), in men (AAPC=-0.1; p=0.193) and in women (AAPC=-0.1; p=0,871) remained unchanged. In 2002, mortality from cancer exceeded the sum of deaths from IHD and stroke. If trends continue, cancer mortality will also exceed mortality from CVD by 2024. In women, death rates from breast, lung and colon cancer increased, and from cervical and gastric cancers decreased. In men, mortality from lung, stomach and esophagus cancer decreased, and from prostate cancer remained unchanged.

Conclusion:

CVD are currently the leading cause of death in Brazil, but death rates from cancer will exceed those from CVD in a few years.

Keywords:
Cardiovascular Diseases/mortality; Epidemiology; Mortality; Brazil; Stroke; Neoplasms; Myocardial Ischemia

General population	1996	2017	% change	AAPC(%)	99%CI		p
All causes of deaths	1032.24	744.67	–28	–1.6	–1.8	–1.4	<0.000
Cardiovascular disease	342.85	211.94	–38	–2.3	–2.5	–2.1	<0.001
Ischemic Heart disease	111.46	79.19	–29	–1.6	–1.8	–1.5	<0.001
Stroke	85.5	38.6	–55	–3.7	–3.9	–3.5	<0.001
Ischemic heart disease + stroke	196.96	117.78	–40	–2.4	–2.6	–2.2	<0.001
Cancer	166.13	166.37	0	–0.1	–0.4	0.1	0.2
Men
All causes of death	1327.36	964.96	–27	–1.6	–1.8	–1.3	<0.000
Cardiovascular disease	421.96	272.35	–35	–2.1	–2.3	–1.9	<0.001
Ischemic Heart disease	150.23	110.52	–26	–1.5	–1.7	–1.3	<0.001
Stroke	102.9	49.13	–52	–3.5	–3.7	–3.3	<0.001
Ischemic heart disease + stroke	253.13	159.65	–37	–2.2	–2.4	–2	<0.001
Cancer	194.36	187.29	–3.7	–0.3	–0.5	–0.1	<0.001
Women
All causes of death	764.76	548.76	–28	–1.7	–1.9	–1.5	<0.000
Cardiovascular disease	270.84	159.26	–41	–2.5	–2.8	–2.3	<0.001
Ischemic Heart disease	76.25	51.63	–32	–1.9	–2.1	–1.7	<0.001
Stroke	69.81	29.66	–57	–3.9	–4.2	–3.7	<0.001
Ischemic heart disease + stroke	146.07	81.29	–44	–2.8	–3	–2.5	<0.001
Cancer	141.23	149.38	5.8	0.1	–0.1	0.3	0.4

	Cardiovascular disease						Cancer
Age group	1996	2017	% change	AAPC(%)	99%CI		1996	2017	% change	AAPC(%)	99%CI
35 – 39	47,62	26,36	–45	–2.5^* * p<0.001	–2.8	–2.2	26,64	25,65	–4	–0.3^* * p<0.001	–0.5	–0.1
40 – 44	88,85	49,41	–44	–2.8^* * p<0.001	–3.0	–2.7	49,73	43,99	–12	–0.9^* * p<0.001	–1.0	–0.7
45 – 49	153,2	87,01	–43	–2.8^* * p<0.001	–3.1	–2.6	86,77	76,26	–12	–0.9^* * p<0.001	–1.2	–0.6
50 – 54	245,94	146,86	–40	–2.7^* * p<0.001	–3.0	–2.4	135,69	130,53	–4	–0.5^* * p<0.001	–0.8	–0.2
55 – 59	394,94	229,14	–42	–2.5^* * p<0.001	–2.9	–2.2	212,25	209,39	–1	–0.1	–0.4	0.2
60 – 64	614,22	383,33	–38	–2.2^* * p<0.001	–2.4	–2.0	306,56	316,44	3	0.1	–0.1	0.2
65 – 69	936,57	599,92	–36	–2.1^* * p<0.001	–2.3	–1.9	431,34	441,09	2	0.1	–0.1	0.3
70 – 74	1449,9	952,99	–34	–2.0^* * p<0.001	–2.2	–1.8	566,21	610,74	8	0.2	–0.0	0.4
Men
35 – 39	57,21	32,28	–44	–2.4^* * p<0.001	–2.8	–2.1	21,47	18,25	–15	–1.0^* * p<0.001	–1.2	–0.8
40 – 44	109,8	60,55	–45	–2.8^* * p<0.001	–3.1	–2.6	44,29	34,95	–21	–1.5^* * p<0.001	–1.7	–1.2
45 – 49	188,97	106,62	–44	–2.8^* * p<0.001	–3.1	–2.6	87,5	68,5	–22	–1.5^* * p<0.001	–1.9	–1.1
50 – 54	188,97	106,62	–44	–2.8^* * p<0.001	–3.1	–2.6	146,38	130,76	–11	–0.8^* * p<0.001	–1.1	–0.4
55 – 59	501,07	302,72	–40	–2.4^* * p<0.001	–2.7	–2.1	248,35	226,81	–9	–0.3	–0.7	0.0
60 – 64	775,24	501,75	–35	–2.0^* * p<0.001	–2.3	–1.8	377,57	374,18	–1	–0.1	–0.3	0.1
65 – 69	1151	777,83	–32	–1.9^* * p<0.001	–2.0	–1.7	541,39	541,7	0	–0.1	–0.3	0.1
70 – 74	1715,4	1207,8	–30	–1.7^* * p<0.001	–1.9	–1.4	725,44	779,78	7	0.2	–0.0	0.5
Women
35 – 39	38,45	20,5	–47	–2.6^* * p<0.001	–3.0	–2.3	31,52	32,98	5	0.2	–0.1	0.5
40 – 44	68,57	38,54	–44	–2.9^* * p<0.001	–3.1	–2.7	54,91	52,82	–4	–0.4^* * p<0.001	–0.6	–0.3
45 – 49	118,44	68,14	–42	–2.8^* * p<0.001	–3.1	–2.6	86,06	83,7	–3	–0.4^* * p<0.001	–0.7	–0.0
50 – 54	118,44	68,14	–42	–2.8^* * p<0.001	–3.1	–2.6	125,55	130,31	4	–0.2	–0.6	0.1
55 – 59	296,71	161,73	–45	–2.7^* * p<0.001	–3.1	–2.4	179,35	193,43	8	0.2	–0.1	0.5
60 – 64	468,94	278,6	–41	–2.5^* * p<0.001	–2.7	–2.3	243,39	265,39	9	0.3^* * p<0.001	0.1	0.5
65 – 69	748,39	449,47	–40	–2.4^* * p<0.001	–2.6	–2.1	336,33	356,04	6	0.3^* * p<0.001	0.1	0.5
70 – 74	1218,50	751,48	–38	–2.4^* * p<0.001	–2.6	–2.1	430,65	477,05	11	0.2	–0.1	0.4

General population	1996	2017	% change	AAPC(%)	99%CI
35 – 39	462,36	289,21	–37	–1.8^* * p<0.001	–2.0	–1.6
40 – 44	577,73	363,58	–37	–2.0^* * p<0.001	–2.2	–1.9
45 – 49	757,12	499,16	–34	–2.0^* * p<0.001	–2.2	–1.7
50 – 54	1029,54	730,39	–29	–1.8^* * p<0.001	–2.1	–1.6
55 – 59	1487,2	1062,17	–29	–1.7^* * p<0.001	–1.9	–1.4
60 – 64	2137,66	1614,4	–24	–1.5^* * p<0.001	–1.7	–1.3
65 – 69	3118,78	2374,82	–24	–1.5^* * p<0.001	–1.7	–1.3
70 – 74	4550,93	3605,81	–21	–1.4^* * p<0.001	–1.7	–1.1
Men
35 – 39	462,36	289,21	–37	–2.0^* * p<0.001	–2.2	–1.8
40 – 44	577,73	363,58	–37	–2.2^* * p<0.001	–2.3	–2.0
45 – 49	757,12	499,16	–34	–2.0^* * p<0.001	–2.3	–1.7
50 – 54	1029,54	730,39	–29	–1.8^* * p<0.001	–2.1	–1.5
55 – 59	1487,2	1062,17	–29	–1.6^* * p<0.001	–2.0	–1.3
60 – 64	2137,66	1614,4	–24	–1.4^* * p<0.001	–1.7	–1.1
65 – 69	3118,78	2374,82	–24	–1.4^* * p<0.001	–1.6	–1.1
70 – 74	4550,93	3605,81	–21	–1.2^* * p<0.001	–1.5	–0.9
Women
35 – 39	180,12	125,12	–30	–1.5^* * p<0.001	–1.8	–1.2
40 – 44	260,07	178,54	–31	–1.8^* * p<0.001	–2.0	–1.6
45 – 49	388,86	267,28	–31	–1.9^* * p<0.001	–2.1	–1.6
50 – 54	568,95	400,78	–30	–1.9^* * p<0.001	–2.2	–1.6
55 – 59	855,6	599,49	–30	–1.7^* * p<0.001	–2.0	–1.4
60 – 64	1273,52	928,53	–27	–1.6^* * p<0.001	–1.8	–1.4
65 – 69	1951,63	1408,09	–28	–1.6^* * p<0.001	–1.8	–1.4
70 – 74	3031,34	2257,57	–25	–1.6^* * p<0.001	–1.8	–1.3

	Ischemic heart disease						Stroke
	1996	2017	% change	AAPC(%)	99%CI		1996	2017	% change	AAPC(%)	99%CI
35 – 39	13.29	8.07	–39	–1,7^* * p<0.001	–2,2	–1,2	7,75	2,59	–67	–4.6^* * p<0.001	–5.1	–4.1
40 – 44	26.61	17.66	–34	–2,1^* * p<0.001	–2,4	–1,8	16,41	6,07	–63	–5.0^* * p<0.001	–5.3	–4.7
45 – 49	49.47	32.99	–33	–2,1^* * p<0.001	–2,3	–1,9	32,28	10,93	–66	–5.3^* * p<0.001	–5.5	–5.0
50 – 54	81.50	58.58	–28	–1,9^* * p<0.001	–2,2	–1,6	55,99	19,51	–65	–5.1^* * p<0.001	–5.3	–4.8
55 – 59	134.79	93.00	–31	–1,7^* * p<0.001	–2	–1,4	94,01	35,01	–63	–4.5^* * p<0.001	–4.7	–4.3
60 – 64	211.01	151.31	–28	–1,5^* * p<0.001	–1,7	–1,3	149,57	67,34	–55	–3.8^* * p<0.001	–4.0	–3.6
65 – 69	307.56	223.24	–27	–1,5^* * p<0.001	–1,6	–1,3	247,26	122,81	–50	–3.3^* * p<0.001	–3.5	–3.1
70 – 74	443.13	326.20	–26	–1,6^* * p<0.001	–1,8	–1,3	415,42	220,28	–47	–2.9^* * p<0.001	–3.1	–2.7
Men
35 – 39	18,95	11,53	–39	–1,8^* * p<0.001	–2.3	–1.2	8,16	2,91	–64	–4.5^* * p<0.001	–5.1	–4.0
40 – 44	39,03	25,05	–36	–2,3^* * p<0.001	–2.7	–2.0	18,52	6,59	–64	–5.1^* * p<0.001	–5.5	–4.8
45 – 49	70,45	46,04	–35	–2,2^* * p<0.001	–2.5	–2.0	36,38	11,75	–68	–5.4^* * p<0.001	–5.7	–5.0
50 – 54	117,12	84,66	–28	–1,8^* * p<0.001	–2.1	–1.6	64,97	23,53	–64	–5.0^* * p<0.001	–5.3	–4.7
55 – 59	188,45	134,54	–29	–1,6^* * p<0.001	–1.9	–1.3	116,25	44,08	–62	–4.5^* * p<0.001	–4.7	–4.2
60 – 64	287,28	212,78	–26	–1,3^* * p<0.001	–1.6	–1.0	186,52	87,85	–53	–3.7^* * p<0.001	–3.9	–3.5
65 – 69	403,3	307,46	–24	–1,2^* * p<0.001	–1.4	–1.0	305,16	160,48	–47	–3.1^* * p<0.001	–3.3	–2.8
70 – 74	556,69	439,34	–21	–1,1^* * p<0.001	–1.3	–0.9	495,87	285,93	–42	–2.6^* * p<0.001	–2.8	–2.4
Women
35 – 39	7,92	4,65	–41	–1.8^* * p<0.001	–2.5	–1.0	7,35	2,28	–69	–4.7^* * p<0.001	–5.2	–4.1
40 – 44	14,76	10,44	–29	–1.8^* * p<0.001	–2.1	–1.4	14,4	5,57	–61	–4.8^* * p<0.001	–5.2	–4.5
45 – 49	29,43	20,46	–30	–1.9^* * p<0.001	–2.2	–1.5	28,36	10,13	–64	–5.1^* * p<0.001	–5.5	–4.7
50 – 54	47,72	34,04	–29	–1.9^* * p<0.001	–2.3	–1.5	47,48	15,73	–67	–5.2^* * p<0.001	–5.6	–4.8
55 – 59	85,91	54,97	–36	–1.8^* * p<0.001	–2.5	–1.2	73,75	26,7	–64	–4.6^* * p<0.001	–4.9	–4.3
60 – 64	143,16	96,96	–32	–1.9^* * p<0.001	–2.1	–1.7	143,16	96,96	–32	–4.0^* * p<0.001	–4.2	–3.8
65 – 69	224,89	152,05	–32	–1.8^* * p<0.001	–2.1	–1.6	197,26	90,97	–54	–3.6^* * p<0.001	–3.9	–3.3
70 – 74	346,44	236,73	–31	–2.1^* * p<0.001	–2.3	–1.8	346,93	168,36	–51	–3.2^* * p<0.001	–3.5	–2.9

Men	1996	2017	% change	AAPC(%)	99%CI
Lung	35.55	27.78	–22	–1.3^* * p<0.001	–1.6	–1.1
Gastric	25.88	15.83	–39	–2.2^* * p<0.001	–2.5	–2.0
Prostate	15.51	15.64	1	–0.2	–0.4	0.1
Esophagus	15.73	13.24	–16	–0.8^* * p<0.001	–1.0	–0.5
Colon	6.69	9.26	38	1.5^* * p<0.001	1.3	1.8
Women
Breast	24.44	28.01	15	0.4^* * p<0.001	0.2	0.6
Lung	11.50	17.80	55	1.9^* * p<0.001	1.6	2.2
Cervix	11.22	10.91	–3	–0.9^* * p<0.001	–1.3	–0.6
Gastric	10.22	6.95	–32	–1.6^* * p<0.001	–1.9	–1.4
Colon	6.40	8.20	28	1.0^* * p<0.001	0.8	1.3

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[1] Mailing Address: Antonio de Padua Mansur• Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Av. Dr. Enéas C. Aguiar, 44. Postal Code 05403-000, São Paulo, SP – Brazil. E-mail: apmansur@yahoo.com