Mortality Due to Acute Myocardial Infarction in Brazil from 1996 to 2016: 21 Years of Disparities in Brazilian Regions

Ferreira, Letícia de Castro Martins; Nogueira, Mário Círio; Carvalho, Marilia Sá; Teixeira, Maria Teresa Bustamante

doi:10.36660/abc.20190438

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Brasil

Arquivos Brasileiros de Cardiologia

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Original Article • Arq. Bras. Cardiol. 115 (5) • Nov 2020 • https://doi.org/10.36660/abc.20190438 copy

Mortality Due to Acute Myocardial Infarction in Brazil from 1996 to 2016: 21 Years of Disparities in Brazilian Regions

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Acute myocardial infarction (AMI), the leading cause of death in Brazil, has presented regional disparities in mortality rate time trends in recent years. Previous time trend studies did not correct for cause-of-death garbage codes, which may have skewed the estimates.

Objective:

To analyze regional and gender-based inequalities in the AMI mortality trend in Brazil from 1996-2016.

Methods:

A 21-year time series study (1996-2016). Data are from the Mortality Information System and population estimates from the Brazilian Institute of Geography and Statistics. Corrections of deaths due to ill-defined causes of death, garbage codes, and underreporting were made. The time series broken down by major geographic regions, gender, capital cities, and other municipalities was analyzed using the linear regression technique segmented by Jointpoint. Statistical significance level was set at 5%.

Results:

In the period, mortality decreased more sharply in women (−2.2%; 95% CI: −2.5; −1.9) than in men (−1.7%; 95% CI: - 1.9; −1.4) and more in the capital cities (−3.8%; 95% CI: - 4.3; −3.3) than in other municipalities (−1.5%; 95% CI: - 1.8; −1.3). Regional inequalities were observed, with an increase for men living in other municipalities of the North (3.3; 95% CI: 1.3; 5.4) and Northeast (1.3%; 95% CI: 1.0; 1.6). Statistical significance level was set at 5%. Mortality rates after corrections showed a significant difference in relation to the estimates without corrections, mainly due to the redistribution of garbage codes.

Conclusions:

Although AMI-related mortality has decreased in Brazil in recent years, this trend is uneven by region and gender. Correcting the numbers of deaths is essential to obtaining more reliable estimates.

Keywords:
Myocardial Infarction; Epidemiology; Mortality; Time Series Studies; Myocardial Ischemia

Region	Location	Year	Standardized rates				% Changes
Region	Location	Year	Not corrected	Correction 1	Correction 2	Correction 3	% Change 1	% Change 2	% Change 3	Total % change
Brazil	Capital cities	1996	79.1	82.9	127.1	127.1	5	53	0	61
		2016	42.7	43.7	65.2	65.2	2	49	0	53
		Dif%	−46	−47	−49	−49
	Other municipalities	1996	52.9	64.3	105.4	116.5	21	64	11	120
		2016	53.6	56.2	85.6	89.4	5	52	4	67
		Dif%	1	−12	−19	−23
North	Capital cities	1996	50.1	57.6	98.7	98.7	15	71	0	97
		2016	38.1	40.9	62.7	62.7	7	53	0	64
		Dif%	−24	−29	−36	−36
	Other municipalities	1996	22.5	37.6	57.7	83.4	67	54	45	271
		2016	51.4	55.4	83.1	97.7	8	50	18	90
		Dif%	129	47	44	17
Northeast	Capital cities	1996	56.0	59.1	105.5	105.5	6	79	0	88
		2016	42.5	43.8	63.8	63.8	3	46	0	50
		Dif%	−24	−26	−40	−40
	Other municipalities	1996	25.4	47.5	68.4	87.9	87	44	28	246
		2016	60.2	64.6	95.7	104.2	7	48	9	73
		Dif%	137	36	40	19
Central West	Capital cities	1996	52.4	55.2	99.5	99.5	5	80	0	90
		2016	38.5	38.8	54.1	54.1	1	39	0	41
		Dif%	−27	−30	−46	−46
	Other municipalities	1996	46.6	54.8	105.2	120.4	18	92	14	158
		2016	54.4	55.6	83.1	90.0	2	49	8	66
		Dif%	17	2	−21	−25
Southeast	Capital cities	1996	91.7	95.7	140.1	140.1	4	46	0	53
		2016	46.4	47.2	72.5	72.5	2	54	0	56
		Dif%	−49	−51	−48	−48
	Other municipalities	1996	66.4	74.0	128.0	134.0	11	73	5	102
		2016	47.9	50.4	79.7	81.8	5	58	3	71
		Dif%	−28	−32	−38	−39
South	Capital cities	1996	91.9	92.2	130.3	130.3	0	41	0	42
		2016	32.3	32.8	44.1	44.1	2	34	0	37
		Dif%	−65	−64	−66	−66
	Other municipalities	1996	78.4	86.7	136.4	141.9	11	57	4	81
		2016	44.1	45.4	74.2	76.9	3	63	4	74
		Dif%	−44	−48	−46	−46

Region	Location	Year	Standardized rates				% Changes
Region	Location	Year	Not corrected	Correction 1	Correction 2	Correction 3	% Changes 1	% Changes 2	% Changes3	Total % changes
Brazil	Capital cities	1996	145.4	153.0	205.1	205.1	5	34	0	41
		2016	86.0	88.9	117.5	117.5	3	32	0	37
		Dif%	−41	−42	−43	−43
	Other municipalities	1996	86.5	105.2	150.2	167.3	22	43	11	93
		2016	89.4	95.8	131.7	138.4	7	37	5	55
		Dif%	3	−9	−12	−17
North	Capital	1996	88.6	105.5	154.5	154.5	19	46	0	74
		2016	85.3	92.7	123.3	123.3	9	33	0	44
		Dif%	−4	−12	−20	−20
	Other municipalities	1996	37.5	62.8	85.9	122.8	68	37	43	228
		2016	88.3	96.7	131.2	153.6	10	36	17	74
		Dif%	136	54	53	25
Northeast	Capital	1996	101.2	107.1	160.6	160.6	6	50	0	59
		2016	84.9	88.0	119.3	119.3	4	36	0	41
		Dif%	−16	−18	−26	−26
	Other municipalities	1996	39.9	71.8	95.8	123.9	80	33	29	210
		2016	104.2	113.7	152.6	166.4	9	34	9	60
		Dif%	161	58	59	34
Central West	Capital	1996	79.0	84.6	136.6	136.6	7	61	0	73
		2016	79.5	80.9	99.9	99.9	2	23	0	26
		Dif%	1	−4	−27	−27
	Other municipalities	1996	82.9	99.8	154.1	172.8	20	54	12	109
		2016	95.8	99.7	134.5	146.0	4	35	8	52
		Dif%	16	0	−13	−16
Southeast	Capital	1996	174.7	182.5	235.9	235.9	4	29	0	35
		2016	92.9	95.8	128.0	128.0	3	34	0	38
		Dif%	−47	−48	−46	−46
	Other municipalities	1996	118.5	134.1	195.1	206.1	13	46	6	74
		2016	88.5	94.7	129.9	133.2	7	37	3	50
		Dif%	−25	−29	−33	−35
South	Capital	1996	164.6	165.6	208.9	208.9	1	26	0	27
		2016	67.1	68.5	82.3	82.3	2	20	0	23
		Dif%	−59	−59	−61	−61
	Other municipalities	1996	134.4	149.4	203.7	204.8	11	36	1	52
		2016	83.4	86.7	120.7	121.3	4	39	0	45
		Dif%	−38	−42	−41	−41

	North		Northeast		Central West		Southeast		South		Total
Year	M	F	M	F	M	F	M	F	M	F	M	F	General
1996	883	813	4865	5117	1670	1501	14198	15996	4429	5140	26045	28567	54612
1997	911	797	5056	5175	1816	1696	13429	15240	4181	4881	25393	27789	53182
1998	972	898	5547	5540	1758	1594	13342	15350	4507	5221	26126	28603	54729
1999	1043	863	5379	5367	1827	1492	12632	14569	4098	4691	24979	26982	51961
2000	1046	821	5402	5431	1674	1511	12138	13859	4157	4837	24417	26459	50876
2001	1194	919	5677	5678	1770	1566	11931	13603	3926	4563	24498	26329	50827
2002	1103	900	5783	6109	1963	1668	11649	13821	3915	4784	24413	27282	51695
2003	1184	1002	5871	6141	1974	1623	12100	14002	4047	4703	25176	27471	52647
2004	1183	935	6484	6644	1967	1700	12798	14552	4196	4864	26628	28695	55323
2005	1248	1051	6915	7299	2092	1649	12642	14131	4019	4712	26916	28842	55758
2006	1329	1008	8210	8463	2104	1870	13354	15142	4009	4939	29006	31422	60428
2007	1420	1111	8469	8733	2129	1830	13486	15326	4316	5161	29820	32161	61981
2008	1454	1205	8541	8888	2125	1849	13784	15670	4379	5207	30283	32819	63102
2009	1464	1182	8538	9017	2107	1868	13588	15727	4464	5223	30161	33017	63178
2010	1551	1237	8300	8616	2179	1965	14372	16825	4464	5394	30866	34037	64903
2011	1587	1405	8784	9292	2128	1907	14522	17280	4649	5834	31670	35718	67388
2012	1611	1369	8583	9038	2155	2072	14340	16909	4514	5302	31203	34690	65893
2013	1699	1428	8923	9437	2199	1994	14720	16875	4873	5556	32414	35290	67704
2014	1737	1458	8609	9238	2197	2085	14589	17028	4709	5564	31841	35373	67214
2015	1843	1506	9006	9925	2191	2045	15143	18112	4810	5615	32993	37203	70196
2016	1866	1586	9200	9829	2013	1770	16496	18841	5260	6063	34835	38089	72924

Region	1996	2016	% Difference
Brazil	149.86	104.35	−43.6
North	107.05	112.48	4.8
Northeast	107.42	121.30	11.4
Central West	135.32	100.47	−34.7
Southeast	172.93	102.92	−68.0
South	168.74	91.14	−85.1

Region	Municipality	Gender	Trend 1			Trend 2			Trend 3			Trend 4
			Period	APC	IC95%	Period	APC	IC95%	Period	APC	IC 95%	Period	APC	IC95%
Brazil	Capital cities	F	1996 to 2010	−4.1	−4.7; −3.6	2010 to 2016	−1.1	−3.2; + 1.0
	Capital cities	M	1996 to 2010	−3.5	−4.0; −3.1	2010 to 2016	−1.2	−3.0; +0.6
	Other municipalities	F	1996 to 2016	−1.4	−1.7; −1.1
	Other municipalities	M	1996 to 2016	−1	−1.3; −0.8
	All	Both	1996 to 2016	−1.9	−1.7; −2.2
North	Capital cities	F	1996 to 2006	−5.1	−6.6; −3.6	2006 to 2016	0.9	−0.7; 2.5
	Capital cities	M	1996 to 1999	0.6	−5.6; 7.2	1999 to 2002	−10.8	−23.0; 3.4	2002 to 2016	0.5	0.0; 1.0
	Other municipalities	F	1996 to 2016	0.20	−0.3; 0.7
	Other municipalities	M	1996 to 2005	1.3	0.3; 2.3	2005 to 2010	−1.8	−5.5; 2.0	2010 to 2016	3.3	1.3;5.4
	All	Both	1996 to 2010	−0.8	−1.3; −0.2	2010 to 2016	2.4	0.2; 4.7
Northeast	Capital cities	F	1996 to 2000	−5.3	−9.1; −1.2	2000 to 2016	−2.0	−2.5; −1.6
	Capital cities	M	1996 to 2016	−1.6	−2.0; −1.3
	Other municipalities	F	1996 to 2002	0.60	−1.0; +2.2	2002 to 2006	5.20	0.2;10.5	2006 to 2010	−3.0	−7.6; +1.8	2010 to 2016	0.5	−1.1; 2.1
	Other municipalities	M	1996 to 2016	1.30	1.0; 1.6
	All	Both	1996 to 2003	0.0	−1.2; 1.3	2003 to 2006	5.2	−4.0; 15.3	2006 to 2010	−2.8	−7.2; 1.8	2010 to 2016	1.0	−0.6; 2.6
Central West	Capital cities	F	1996 to 2016	−2.8	−3.3; −2.2
	Capital cities	M	1996 to 2016	−1.7	−2.1; −1.2
	Other municipalities	F	1996 to 2016	−1.8	−2.2; −1.3
	Other municipalities	M	1996 a 2016	−1.0	−1.4; −0.6
	All	Both	1996 to 2016	−1.7	−2.1; −1.2
Southeast	Capital cities	F	1996 to 2010	−4	−5.0; −3.8	2010 to 2016	−0.6	−2.8;1.6
	Capital cities	M	1996 to 2001	−5.7	−8.1; −3.2	2001 to 2016	−2.9	−2.5; −3.3
	Other municipalities	F	1996 to 2001	−5.2	−7.5 - 2.8	2001 to 2005	0.10	−5.5; 6.2	2005 to 2008	−6.4	−17.5 6.1	2008 to 2016	−0.9	0.2; −2.1
	Other municipalities	M	1996 to 2016	−2.3	−2.6; −1.9
	All	Both	1996 to 2009	−3.3	−3.9; −2.7	2009 to 2016	−1.3	−2.9; 0.4
South	Capital cities	F	1996 to 2016	−5.8	−6.2; −5.4
	Capital cities	M	1996 to 2016	−5.2	−5.5; −4.8
	Other municipalities	F	1996 to 2016	−3.4	−3.8; −3.0
	Other municipalities	M	1996 to 2016	−2.9	−3.3; −2.5
	All	Both	1996 to 2016	−3.4	−3.8; −3.0

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[1] Mailing Address: Letícia de Castro Martins Ferreira • Faculdade de Medicina da Universidade Federal de Juiz de Fora - Avenida Eugênio Nascimento, s/nO. Postal Code 36038-330, Dom Bosco, Juiz de Fora, MG - Brazil E-mail: leticiacmferreira@gmail.com