[Mortality from cardiovascular diseases in three Brazilian states from 1980 through 2002].
OBJECTIVE
To evaluate and compare adult mortality from diseases of the circulatory system (CDs), especially ischemic heart disease (IHD) and cerebrovascular disease (CVD), from 1980 through 2002 in the Brazilian states of Rio de Janeiro, Rio Grande do Sul, and São Paulo and their capital cities (respectively Rio de Janeiro, Porto Alegre, and São Paulo), taking into account the impact of deaths due to ill-defined causes on mortality rates.


METHODS
We estimated mortality rates (crude and adjusted by age and sex) from CDs overall and from IHD and CVD among individuals aged 20 years or older. These rates were weighted with a portion of the deaths from ill-defined or unknown causes, in the same proportion as deaths from CDs, IHD, and CVD in relation to deaths overall, excluding deaths from ill-defined causes. Using linear regression models, we also estimated the mean values of and annual differences in the weighted adjusted mortality rates. The reference population was that of the state of Rio de Janeiro in 2000.


RESULTS
The annual decline in the weighted adjusted mortality rates from CDs ranged from -13.1 per 100,000 individuals in the state of Rio de Janeiro to -8.7 per 100,000 in the city of São Paulo. For IHD, the annual declines were greatest in the city of Rio de Janeiro (-5.0 per 100,000) and the state of Rio de Janeiro (-4.5 per 100,000), and smallest in the state of Rio Grande do Sul (-2.8 per 100,000) and the city of São Paulo (-2.7 per 100,000). With CVD, the range that was found extended from -6.5 per 100,000 in the state of Rio de Janeiro to -2.9 per 100,000 in the city of Porto Alegre.


CONCLUSIONS
The decreases in weighted adjusted mortality rates from CDs, IHD, and CVD occurred after 1980, so it is unlikely that the declines resulted from controlling risk factors or from the practice of myocardial revascularization. The decreases might be related to a period of strong economic development preceding the declines, which translated into improved living conditions and reduced exposure to infections in the perinatal period and childhood.
Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro (RJ), Brazil. glaucia@mls.com.br
Gláucia M M de
GM
Oliveira
Carlos H
CH
Klein
Nelson A de
NA
Souza e Silva
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000401:mortality; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality; D012959:Socioeconomic Factors