巴西在 COVID-19 大流行期间的心血管死亡率：根本死因与多种死因的比较。

Cardiovascular mortality in Brazil during the COVID-19 pandemic: a comparison between underlying and multiple causes of death.

机构信息

School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Telehealth Center, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

出版信息

Public Health. 2023 Nov;224:131-139. doi: 10.1016/j.puhe.2023.08.027. Epub 2023 Sep 28.

DOI:10.1016/j.puhe.2023.08.027

PMID:37776607

Abstract

OBJECTIVES

The COVID-19 pandemic has differentially impacted cardiovascular disease (CVD) mortality worldwide. Causes of death misclassification may be one of the reasons. We evaluated the impact of the pandemic on CVD mortality in Brazil, comparing underlying causes (UCs) and multiple causes (MCs) of death.

STUDY DESIGN

Ecological time-series study.

METHODS

An ecological, time-series study was conducted analysing age-standardised death rates for CVD, from epidemiological week (EW) 10/2020 to 39/2021, using data from the Mortality Information System, Brazil. CVD was defined using the International Classification of Diseases (ICD-10) coding, if reported as UC or MC of death. Observed and expected data (mean for the same EW, 2017-2019) were compared. Risk ratios (RiRs) were analysed, and 95% confidence intervals (CIs) were calculated.

RESULTS

Age-standardised mortality rate for CVD as UC of death was 165.8 (95%CI: 165.4-166.3) per 100,000 inhabitants, similar to what was expected (165.6/100,000, 95%CI: 165.2-166.1, RiR = 1.00). There was increased out-of-hospital mortality (RiR = 1.18; 95%CI: 1.17-1.19) and deaths of ill-defined causes (RiR = 1.43; 95%CI: 1.42-1.44). The increase in out-of-hospital deaths was more pronounced in the North (RiR = 1.33; 95%CI 1.30-1.36) region, with a less resilient health system. Conversely, as MCs of death, there was a 10% increase in CVD mortality (observed: 243.2 [95%CI: 242.7-243.7], expected: 221.6 [95%CI: 221.1-222.1] per 100,000). An increase also occurred in the North and Central West regions (RiR = 1.16; 95%CI: 1.15-1.18), among men (RiR = 1.11; 95%CI: 1.11-1.12) and individuals aged ≥60 years (RiR = 1.11; 95%CI: 1.10-1.11).

CONCLUSIONS

During the pandemic, mortality rates for CVD as MCs of death increased in Brazil, whereas as UC mortality rates did not change. Higher out-of-hospital mortality, misclassification, and competing causes of death may explain this pattern.

摘要

目的

COVID-19 大流行在全球范围内对心血管疾病（CVD）死亡率产生了不同影响。死因分类错误可能是其中一个原因。我们评估了大流行对巴西 CVD 死亡率的影响，比较了根本死因（UC）和多种死因（MC）的死亡情况。

研究设计

生态时间序列研究。

方法

采用生态时间序列研究，分析了 2020 年第 10 周至 2021 年第 39 周期间，来自巴西死亡率信息系统的年龄标准化 CVD 死亡率数据。CVD 使用国际疾病分类（ICD-10）编码定义，如果报告为 UC 或 MC 死因。将观察到的数据与预期数据（同一周的平均值，2017-2019 年）进行比较。分析风险比（RiR），并计算 95%置信区间（CI）。

结果

作为 UC 死因的 CVD 年龄标准化死亡率为 165.8（95%CI：165.4-166.3）/100,000 居民，与预期值（165.6/100,000，95%CI：165.2-166.1，RiR=1.00）相似。出现了更多的院外死亡（RiR=1.18；95%CI：1.17-1.19）和不明原因死亡（RiR=1.43；95%CI：1.42-1.44）。院外死亡的增加在北部（RiR=1.33；95%CI 1.30-1.36）地区更为明显，该地区的医疗体系弹性较差。相反，作为 MC 死因，CVD 死亡率增加了 10%（观察：243.2[95%CI：242.7-243.7]，预期：221.6[95%CI：221.1-222.1]/100,000）。北部和中西部地区也出现了增长（RiR=1.16；95%CI：1.15-1.18），男性（RiR=1.11；95%CI：1.11-1.12）和≥60 岁人群（RiR=1.11；95%CI：1.10-1.11）也是如此。