Name: Juliana Bottoni de Souza
Type: PhD thesis
Publication date: 26/02/2021

Namesort descending Role
Jose Geraldo Mill Advisor *

Examining board:

Namesort descending Role
Adauto Emmerich Oliveira Internal Examiner *
Adelmo Inacio Bertolde External Examiner *
Deborah Carvalho Malta External Examiner *
Eliana Zandonade Co advisor *
Jose Geraldo Mill Advisor *
Maria del Carmen Bisi Molina Internal Examiner *
Romildo Luiz Monteiro Andrade External Alternate *
Valéria Valim Cristo Internal Alternate *

Summary: Cardiovascular diseases (CVD) are the leading cause of death in Brazil and
worldwide contributing to about 30% of all deaths. Individually, myocardial infarction
(MI) and vascular brain disease (VBD) are the most common events that lead to
cardiovascular death. Although they are serious diseases, CVD can be prevented if
the classic risk factors (smoking, dyslipidemia, hypertension and diabetes, among
others) are controlled. In recent decades, there has been a trend towards reduction
of the mortality rate due to CVD in Brazil. However, there are no studies detailing
how these rates have been performing in Espírito Santo (ES) State since, being a
state with a small population (about 2% in relation to Brazil), its trends may not be
reflected in the global analysis of the Brazilian figures and southeast region (WHERE
ES is included). In this study we analyzed cardiovascular mortality in the ES from
2006 to 2016. Mortality rates were standardized for age either for total as for
premature cardiovascular deaths (30 to 69 years). The profile of death trends due to
MI and VBD in the same period and territories was also investigated. We also
evaluated the association of total and premature cardiovascular deaths in ES cities
with the Human Development Index for each municipality (HDIM). We observed that
CVD mortality rates are decreasing in Brazil, southeast region and ES. The rate of
reduction in total and premature deaths was higher in ES than in the southeast and in
Brazil. Decline rates, however, have stabilized from 2012 onwards in the three
segments analyzed. Premature deaths stand out in the study, representing 40% in
ES, 39.7% in Brazil and 41.2% in the southeast. We also observed a negative
correlation between the HDIM values for ES municipalities and their mortality rates,
with emphasis on income and education components. Therefore, our study suggest
that such differences can be due both to different impacts of primary care on
cardiovascular health or on the capacity of the health system to attend to acute
cardiovascular events with the highest contribution to mortality. The results of this
study show that, even in decline, there are important differences between
municipalities inside ES. Considering that such municipalities share similar
sociodemographic characteristics our study points out that inequalities in the
attention to cardiovascular diseases in similar cities and regions can be ascribed to

important differences of mortality rates. Special attention of the health system is
necessary to attenuate such differences.

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