Mortalidade cardiovascular e desigualdades sociais no município de São Paulo, Brasil, 1996-1998 e 2008-2010

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Abstract

avaliar diferenças na mortalidade por doença isquêmica do coração (DIC) e doenças cerebrovasculares (DCBV) em áreas geográficas com características socioeconômicas distintas, no município de São Paulo, em 1996 a 1998 e 2008 a 2010.

MÉTODOS:

foram estudados óbitos da população acima de 20 anos e indicadores sociais agregados em cinco áreas territoriais; foram calculadas razões de mortalidade padronizadas (RMP) pelo método indireto e razão de risco de mortalidade (RRM) entre áreas, estimada por regressão de Poisson e teste de tendência.

RESULTADOS:

comparando-se as áreas com menor e maior exclusão, a RRM para DIC em 2008-2010 foi de 1,38 (IC_95%: 1,22-1,55), entre homens e 1,61 (IC_95%: 1,42-1,83) entre mulheres; observou-se a associação da DCBV com exclusão social em ambos os sexos e nos dois períodos (p<0,01).

CONCLUSÃO:

houve aumento do risco da mortalidade por DIC e DCBV, acompanhando o declínio das condições sociais nas áreas geográficas estudadas.

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Most cited references 40

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Neighborhood of residence and incidence of coronary heart disease.

A. V. Diez Roux, S Merkin, D Arnett … (2001)

Where a person lives is not usually thought of as an independent predictor of his or her health, although physical and social features of places of residence may affect health and health-related behavior. Using data from the Atherosclerosis Risk in Communities Study, we examined the relation between characteristics of neighborhoods and the incidence of coronary heart disease. Participants were 45 to 64 years of age at base line and were sampled from four study sites in the United States: Forsyth County, North Carolina; Jackson, Mississippi; the northwestern suburbs of Minneapolis; and Washington County, Maryland. As proxies for neighborhoods, we used block groups containing an average of 1000 people, as defined by the U.S. Census. We constructed a summary score for the socioeconomic environment of each neighborhood that included information about wealth and income, education, and occupation. During a median of 9.1 years of follow-up, 615 coronary events occurred in 13,009 participants. Residents of disadvantaged neighborhoods (those with lower summary scores) had a higher risk of disease than residents of advantaged neighborhoods, even after we controlled for personal income, education, and occupation. Hazard ratios for coronary events in the most disadvantaged group of neighborhoods as compared with the most advantaged group--adjusted for age, study site, and personal socioeconomic indicators--were 1.7 among whites (95 percent confidence interval, 1.3 to 2.3) and 1.4 among blacks (95 percent confidence interval, 0.9 to 2.0). Neighborhood and personal socioeconomic indicators contributed independently to the risk of disease. Hazard ratios for coronary heart disease among low-income persons living in the most disadvantaged neighborhoods, as compared with high-income persons in the most advantaged neighborhoods were 3.1 among whites (95 percent confidence interval, 2.1 to 4.8) and 2.5 among blacks (95 percent confidence interval, 1.4 to 4.5). These associations remained unchanged after adjustment for established risk factors for coronary heart disease. Even after controlling for personal income, education, and occupation, we found that living in a disadvantaged neighborhood is associated with an increased incidence of coronary heart disease.

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Differences between socioeconomic groups in mortality from and risk factors for cardiovascular diseases have been reported in many countries. We have made a comparative analysis of these inequalities in the United States and 11 western European countries. The aims of the analysis were (1) to compare the size of inequalities in cardiovascular disease mortality between countries, and (2) to explore the possible contribution of cardiovascular risk factors to the explanation of between-country differences in inequalities in cardiovascular disease mortality. Data on ischaemic heart disease, cerebrovascular disease and total cardiovascular disease mortality by occupational class and/or educational level were obtained from national longitudinal or unlinked cross-sectional studies. Data on smoking, alcohol consumption, overweight and infrequent consumption of fresh vegetables by occupational class and/or educational level were obtained from national health interview or multipurpose surveys and from the European Union's Eurobarometer survey. Age-adjusted rate ratios for mortality were correlated with age-adjusted odds ratios for the behavioural risk factors. In all countries mortality from cardiovascular diseases is higher among persons with lower occupational class or lower educational level. Within western Europe, a north-south gradient is apparent, with relative and absolute inequalities being larger in the north than in the south. For ischaemic heart disease, but not for cerebrovascular disease, an even more striking north-south gradient is seen, with some 'reverse' inequalities in southern Europe. The United States occupy intermediate positions on most indicators. Inequalities in cardiovascular disease mortality are associated with inequalities in some risk factors, especially cigarette smoking and excessive alcohol consumption. Socioeconomic inequalities in cardiovascular disease mortality are a major public health problem in most industrialized countries. Closing the gap between low and high socioeconomic groups offers great potential for reducing cardiovascular disease mortality. Developing effective methods of behavioural risk factor reduction in the lower socioeconomic groups should be a top priority in cardiovascular disease prevention. Copyright 2000 The European Society of Cardiology.

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Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world.

F Levi (2002)

To analyse trends in mortality from coronary heart disease (CHD) and cerebrovascular disease (CVD) over the period 1965 to 1998 in the European Union, other European countries, the USA, and Japan. Data were derived from the World Health Organization database. In the European Union, CHD mortality in men rose from 146/100 000 in 1965-9 to 163/100 000 in 1975-9 and declined thereafter to 99/100 000 in 1995-8 (-39%). In women, the fall was from 70 to 45/100 000 (-36%). A > 55% decline in CVD was registered in both sexes. In eastern Europe, mortality from both CHD and CVD rose up to the early 1990s but has declined over the past few years in Poland and the Czech Republic. In the Russian Federation during 1995-8, mortality rates from CHD reached 330/100 000 men and 154/100 000 women and mortality rates from CVD were 203/100 000 men and 150/100 000 women-that is, they were among the highest rates worldwide. In the USA and Japan, long term trends were favourable for both CHD and CVD. Trends in mortality from CHD and CVD were favourable in several developed areas of the world, but there were major geographical differences. In a few eastern European countries, mortality from CHD and CVD remains exceedingly high.