Medición de la mortalidad de pacientes internados por enfermedad cardiovascular mediante el desarrollo de un algoritmo de inteligencia artificial / Measurement of mortality during hospitalization due cardiovascular disease through the development of an artificial intelligence algorithm

Introducción: determinar la causa de muerte de los pacientes internados con enfermedad cardiovascular es de suma importancia para poder tomar medidas y así mejorar la calidad su atención y prevenir muertes evitables. Objetivos: determinar las principales causas de muerte durante la internación por enfermedades cardiovasculares. Desarrollar y validar un algoritmo para clasificar automáticamente a los pacientes fallecidos durante la internación con enfermedades cardiovasculares Diseño del estudio: estudio exploratorio retrospectivo. Desarrollo de un algoritmo de clasificación. Resultados: del total de 6161 pacientes, el 21,3% (1316) se internaron por causas cardiovasculares; las enfermedades cerebrovasculares representan el 30,7%, la insuficiencia cardíaca el 24,9% y las enfermedades cardíacas isquémicas el 14%. El algoritmo de clasificación según motivo de internación cardiovascular vs. no cardiovascular alcanzó una precisión de 0,9546 (IC 95%: 0,9351-0,9696). El algoritmo de clasificación de causa específica de internación cardiovascular alcanzó una precisión global de 0,9407 (IC 95%: 0,8866-0,9741). Conclusiones: la enfermedad cardiovascular representa el 21,3% de los motivos de internación de pacientes que fallecen durante su desarrollo. Los algoritmos presentaron en general buena performance, particularmente el de clasificación del motivo de internación cardiovascular y no cardiovascular y el clasificador según causa específica de internación cardiovascular. (AU)

Introduction: determining the cause of death of hospitalized patients with cardiovascular disease is of the utmost importance in order to take measures and thus improve the quality of care of these patients and prevent preventable deaths. Objectives: to determine the main causes of death during hospitalization due to cardiovascular diseases.To development and validate a natural language processing algorithm to automatically classify deceased patients according to their cause for hospitalization. Design: retrospective exploratory study. Development of a natural language processing classification algorithm. Results: of the total 6161 patients in our sample who died during hospitalization, 21.3% (1316) were hospitalized due to cardiovascular causes. The stroke represent 30.7%, heart failure 24.9%, and ischemic cardiac disease 14%. The classification algorithm for detecting cardiovascular vs. Non-cardiovascular admission diagnoses yielded an accuracy of 0.9546 (95% CI 0.9351, 0.9696), the algorithm for detecting specific cardiovascular cause of admission resulted in an overall accuracy of 0.9407 (95% CI 0.8866, 0.9741). Conclusions: cardiovascular disease represents 21.3% of the reasons for hospitalization of patients who die during hospital stays. The classification algorithms generally showed good performance, particularly the classification of cardiovascular vs non-cardiovascular cause for admission and the specific cardiovascular admission cause classifier. (AU)

Tendência da mortalidade das doenças cardiovasculares, nas capitais brasileiras, no período entre 1990 e 2018 / Trends in mortality from cardiovascular diseases in brazilian capitals between 1990 and 2018

As doenças cardiovasculares (DCV) são a principal causa de morte no Brasil e no mundo. As doenças isquêmicas do coração (DIC) e doenças cerebrovasculares (DCBV) estão entre as dez principais causas de mortes no Brasil. A análise de tendência da mortalidade por DCV permite definir populações prioritárias para intervenções, elaborar e avaliar ações em saúde pública. Nesse sentido, o objetivo do estudo foi analisar a tendência da mortalidade por DIC e DCBV nas 27 capitais brasileiras, no período de 1990 a 2018. Trata-se de um estudo ecológico de série temporal, os dados de óbitos foram obtidos através do Sistema de Informações sobre Mortalidade (SIM). Buscando corrigir problemas na qualidade da informação dos registros de óbito do SIM, realizou-se a correção dos óbitos referentes aos dados com sexo e/ou faixa etária ignorada e aos óbitos registrados com causas "mal definidas". As taxas de mortalidade por DIC e DBCV foram padronizadas pelo método direto, tomando-se como população padrão a população do Brasil no ano de 2010. A análise de tendência da mortalidade por DIC e DCBV para a população total, homens e mulheres foi realizada utilizando o modelo de regressão de Poisson. Os resultados mostraram tendência de redução da mortalidade por DCBV tanto para a população total como para homens e mulheres em todas as capitais brasileiras. Vitória, capital da região Sudeste, apresentou a maior redução da taxa de mortalidade total por DCBV dentre todas as capitais brasileiras, -5,6% ao ano (IC95%: -6,0; -5,1%). No entanto, Macapá, capital da região Norte, teve a menor dentre todas as capitais -1,7% ao ano (IC95%: -2,7; -0,7%). Paras as DIC foi observada tendência de redução da mortalidade tanto para a população total como para homens e mulheres nas capitais das regiões Sul, Sudeste e para a maioria das capitais da região Centro-Oeste. As capitais das regiões Norte e Nordeste apresentaram uma variabilidade na tendência da mortalidade por DIC. Conclui-se que as capitais das regiões Sul e Sudeste apresentaram as maiores reduções da tendência da mortalidade por DIC e DCBV. Os achados desse estudo são importantes para prover informações mais detalhadas buscando auxiliar a gestão local na promoção de políticas de saúde pública, planejamento de estratégias e elaboração de medidas e ações em saúde.

Cardiovascular diseases (CVD) are the leading cause of death in Brazil and worldwide. Ischemic heart diseases (IHD) and cerebrovascular diseases (CBVD) are among Brazil's ten main causes of death. The trend analysis of mortality from CVD allows defining priority populations for interventions, designing and evaluating public health actions. In this sense, the study's objective was to analyze the mortality trend from IHD and CBVD in the 27 Brazilian capitals from 1990 to 2018. This is an ecological time-series study with the Mortality Information System (SIM) data. Seeking to correct the quality of the information in the SIM death records, the correction of deaths referring to data with anonymous sex and age group and deaths recorded with "ill-defined" causes was carried out. IHD and CBVD mortality rates were standardized by the direct method, using the population of Brazil in 2010 as the standard population. Trend analysis of IHD and CBVD mortality for the total population, men and women, was performed using the Poisson regression model. The results showed a reduction in the trend of mortality from CBVD for both the total population and for men and women in all Brazilian capitals. Vitória, the capital of the Southeast region, showed the greatest reduction in the total mortality rate from CVD among all Brazilian capitals, -5.6% per year (95%CI: -6.0; -5.1%). However, Macapá, the capital of the North region, had the lowest among all capitals -1.7% per year (95%CI: -2.7; -0.7%). For IHD, a decrease in the mortality trend was observed both for the total population and for men and women in the capitals of the South and Southeast regions and most capitals of the Center-West region. The capitals of the North and Northeast regions showed variability in the trend of IHD mortality. In conclusion, the capitals of the South and Southeast regions showed the greatest reductions in the mortality trend due to IHD and CBVD. The findings of this study are essential to provide more detailed information to assist local management in promoting public health policies, planning strategies, and designing health measures and actions.

Comportamiento de la cardiopatía isquémica en una unidad de cuidados intensivos / Characteristics of ischemic heart disease in an intensive care unit

Introducción: La cardiopatía isquémica es frecuente, tiene diversas formas de manifestarse y predomina entre las enfermedades que motivan el ingreso de pacientes a unidades de emergencias, y que causan ingresos hospitalarios. Objetivo: Profundizar en el conocimiento de los pacientes con cardiopatía isquémica en una unidad de cuidados intensivos municipal. Método: Se realizó un estudio descriptivo y transversal, de 528 pacientes que ingresaron en la Unidad de Cuidados Intensivos del Hospital General Docente Orlando Pantoja Tamayo, Contramaestre, Santiago de Cuba, con diagnóstico de cardiopatías isquémicas, desde enero de 2016 hasta junio de 2019. Las variables utilizadas fueron: grupo de edades, sexo, diagnostico al ingreso, antecedentes patológicos personales, estadía y estado al egreso. Se utilizó el porcentaje para resumir la información, así como el test chi cuadrado para identificar asociación estadística. Resultados: Hubo predominio del sexo masculino y edades entre 60-70 y 36-59 años, fueron más frecuentes el infarto agudo de miocardio y la combinación de 3 o más factores de riesgo. El mayor número de fallecimientos se ocurrió en los primeros 3 días de admitidos y en pacientes con ventilación mecánica invasiva. Conclusiones: El comportamiento de las enfermedades cardiovasculares continúa siendo un gran problema de salud, aparece en edades cada vez más tempranas. En casos severos la mortalidad puede ocurrir en las primeras 72 h(AU)

Introduction: Ischemic heart disease is frequent, has different manifestation forms, and predominates among diseases leading to patient admission into emergency units and hospital admissions in general. Objective: To deepen the knowledge of patients with ischemic heart disease in a municipal intensive care unit. Method: A descriptive and cross-sectional study was carried out of 528 patients who were admitted into the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital in Contramaestre Municipality, Santiago de Cuba, with a diagnosis of ischemic heart disease, from January 2016 to June of 2019. The variables used were age group, sex, diagnosis at admission, personal pathological history, hospital stay, and status at discharge. We used percentage to summarize the information, as well as the chi-square test to identify statistical association. Results: There was a predominance of males and ages between 60-70 and 36-59 years. Acute myocardial infarction and the combination of three or more risk factors were more frequent. The highest number of deaths occurred in the first three days after admission and among patients with invasive mechanical ventilation. Conclusions: The characteristics of cardiovascular diseases continues to be a major health concern, as long as they are appearing at increasingly earlier ages. In severe cases, mortality can occur in the first seventy-two hours(AU)

Mortality Trends from Cardiovascular Diseases in the State of Bahia, Brazil, between 2000 and 2015

Abstract Background: Mortality from cardiovascular diseases has reduced in Brazil in recent decades, but this phenomenon is not clear in the northeast region of the country. Objectives: To describe the mortality trends from cardiovascular disease in Bahia from 2000-2015, in total population and by sex and age groups, and by specific causes (ischemic heart disease, cerebrovascular diseases, rheumatic heart disease and heart failure). Methods: This was a time series study. Data were obtained from SIM-DATASUS and IBGE, and the 10th revision of the ICD used for disease classification. Mortality rates (per 100,000 inhabitants) were calculated from total cardiovascular disease and specific causes, by sex and age groups. Direct standardization was used to adjust for age, using the population of 2010 as reference. Linear regression models estimated percentage variation. The significance level of 5% was adopted. Results: In Bahia, crude mortality rates from cardiovascular disease increased in the period; however, after standardization by age, mortality rates became stable for the total and female populations, with a slight reduction for the male population. An increase in mortality rates from cardiovascular disease was found in the elderly groups. For ischemic heart disease, a progressive increase in adjusted mortality rates was observed: 43%, 24% and 29% for the total, male, and female population, respectively. There was a progressive reduction in crude and age-standardized mortality rates from heart failure in all groups, a modest reduction in age-adjusted mortality rates from cerebrovascular diseases, and a slight reduction in age-standardized mortality rate from rheumatic heart disease, especially in the subgroup <40 years. Conclusions: Mortality from cardiovascular disease in Bahia did not follow the decreasing trend of other Brazilian states, especially in relation to ischemic heart disease, which showed an increase in mortality rates.

Coronary artery bypass graft surgery improves survival without increasing the risk of stroke in patients with ischemic heart failure in comparison to percutaneous coronary intervention: a meta-analysis with 54, 173 patients

Abstract Objective: To evaluate whether there is any difference on the results of patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in the setting of ischemic heart failure (HF). Methods: Databases (MEDLINE, Embase, Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Literatura Latino-americana e do Caribe em Ciências da Saúde [LILACS], and Google Scholar) were searched for studies published until February 2019. Main outcomes of interest were mortality, myocardial infarction, repeat revascularization, and stroke. Results: The search yielded 5,775 studies for inclusion. Of these, 20 articles were analyzed, and their data were extracted. The total number of patients included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR 0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in the PCI group. The HR for stroke showed no statistically significant difference between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237; P=0.459). Conclusion: This meta-analysis found that CABG surgery remains the best option for patients with ischemic HF, without increase in the risk of stroke.

Trend of mortality from ischemic heart disease and influenza vaccination in older adults in São Paulo / Tendência da mortalidade por doenças isquêmicas do coração e a vacinação contra influenza em idosos em São Paulo

Abstract The aim of the present study was to analyze the mortality trend due to ischemic heart disease (IHD) among older adults, identify changes in the trend and determine the correlation with influenza vaccine coverage (2000 to 2012) in the state of São Paulo between 1980 and 2012. An ecological time series study was conducted involving secondary data from Brazilian information systems. Linear and polynomial regression models as well as joinpoint regression were used to estimate the trends. Pearson's correlation coefficient was used to evaluate the correlation between age-standardized mortality coefficients and vaccine coverage. A decreasing tendency in mortality due to IHD occurred in both sexes, higher mortality rates were found for males and greater reductions were found in the period after the vaccination campaigns. However, no statistically significant changes occurred in the year coinciding with or near the onset of the campaigns. In the overall sample, no evidence of a linear correlation was found between the mortality coefficients and vaccination coverage. Other factors directly associated with morbidity and mortality due to ischemic heart disease may have influenced the trend.

Resumo O objetivo deste artigo é analisar a tendência dos coeficientes de mortalidade por doenças isquêmicas do coração (DIC) nos idosos no estado de São Paulo, entre 1980 e 2012, identificar mudanças na tendência e verificar a relação entre as coberturas da vacinação contra influenza e os referidos coeficientes de mortalidade. Trata-se de um estudo ecológico de série temporal, realizado com dados secundários do Sistema de Informação sobre Mortalidade (SIM), do Instituto Brasileiro de Geografia e Estatística (IBGE) e do Sistema de Informações do Programa Nacional de Imunização. Para análise dos dados, utilizaram-se técnicas de correlação, modelos de regressão linear, polinomial e joinpoint regression. Observou-se tendência de queda dos coeficientes de mortalidade por DIC em ambos os sexos, sobremortalidade masculina e redução mais expressiva dos coeficientes no período após a intervenção vacinal. As mudanças estatisticamente significativas encontradas nas tendências não ocorreram em ano coincidente ou próximo do início das campanhas. Para o total de idosos, não foi constatada correlação linear entre os coeficientes de mortalidade e as coberturas vacinais. Outros fatores associados à morbimortalidade dos idosos por DIC podem ter influenciado na tendência.

Caracterización clínica epidemiológica de la diabetes mellitus en dos áreas de salud. Municipio Cárdenas. 2017 / Clinico-epidemiological characterization of diabetes mellitus in two health areas. Municipality of Cardenas. 2017

RESUMEN Introducción: la diabetes mellitus es un trastorno metabólico caracterizado por hiperglucemia crónica con alteraciones en los carbohidratos, grasas y proteínas. Las tasas de morbimortalidad han aumentado al igual que la obesidad, constituye un problema de salud en el mundo, Cuba y la provincia de Matanzas. Objetivo: realizar una caracterización clínica epidemiológica de la diabetes mellitus tipo 2 en dos áreas de salud, conocer las variables e identificar las barreras para una posterior intervención. Materiales y métodos: se realizó un estudio epidemiológico descriptivo- transversal a 750 diabéticos tipo 2 mayores de 18 años en dos áreas de salud. Se realizaron encuestas, procesándose en el programa Epi-Info, obteniéndose la frecuencia de las variables, y las diferencias estadísticas significativas entre variables de las dos aéreas de salud, utilizándose el valor de p < 0,05 % y el Chi2. Resultados: el promedio de edad fue de 62,2 años, predominio del sexo femenino y color de la piel blanca. La hipertensión arterial y la obesidad fueron las enfermedades más asociadas, y el tabaquismo, la ingestión de bebidas alcohólicas y azucaradas, y la no realización de ejercicios físicos fueron los factores asociados más relevantes. Los medicamentos más utilizados fueron la glibenclamida y la metformina. Conclusiones: la diabetes mellitus es la primera causa de fracaso renal en el mundo occidental, siendo la insuficiencia renal una de las complicaciones crónicas más graves de esta enfermedad. Entre las principales causas de muerte de esta enfermedad son las complicaciones macrovasculares, manifestadas clínicamente como cardiopatía isquémica, insuficiencia cardíaca, la enfermedad vascular cerebral y la insuficiencia arterial periférica.

ABSTRACT Introduction: diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia with alterations in carbohydrates, fats and proteins. Morbi-mortality rates have increased as have done obesity, being a health problem in the world, Cuba and the province of Matanzas. Objective: to carry out clinical-epidemiological characterization of type 2 diabetes mellitus in two health areas, knowing the variables and identifying the barriers for a subsequent intervention. Materials and methods: a cross-sectional descriptive study was carried out in 750 type-2 diabetic patients over 18 years in two health areas. Surveys were made and processed in Epi-Info program, showing significant statistic differences among variables of both health areas; p < 0,05 % value and Chi2 were used. Results: the average age was 62.2 years, predominating female sex and white skin color. The most commonly associated diseases were arterial hypertension and obesity; smoking and drinking alcoholic and sugar-sweetened beverages and sedentary life were the most relevant associated factors. The most commonly used medications were glibenclamide and metformin. Conclusions: diabetes is the first cause of renal failure in the Western world, being renal insufficiency one of the most serious chronic complications of this disease. The main causes of death of this disease are macro vascular complications clinically manifested as ischemic heart disease, heart failure, cerebra-vascular disease and peripheral arterial insufficiency.

Características de la mortalidad por enfermedad isquémica del corazón en Costa Rica de 1970 al 2014 / Characteristics of mortality due to ischemic heart disease in Costa Rica from 1970 to 2014

Resumen Objetivo: Actualizar algunos aspectos importantes de la epidemiología descriptiva de la enfermedad isquémica del corazón (EIC) en Costa Rica durante el periodo 1970-2014. Métodos: Se obtuvieron las tasas de mortalidad por EIC en dos periodos. De 1930 al año 1969 y luego, para un análisis más específico, de 1970 al 2014, utilizando promedios móviles y quinquenios, a partir de datos del Instituto Nacional de Estadística y del Centro Centroamericano de Población, para analizarlos en relación con edad, sexo, ubicación geográfica y aporte porcentual a la mortalidad general. También se obtuvo información para determinar la carga de la enfermedad, en este caso mediante años de vida ajustados por discapacidad, años de vida perdidos y años de vida perdidos por discapacidad. Resultados: Se apreció ascenso de las tasas en la población general y con mayor empuje en la población de 35 a 74 años, hasta el quinquenio 1995-1999, a partir del cual se inicia un descenso que aparentemente se detiene durante el quinquenio 2010-2014 (ambos sexos: r = 0.9964, r2 = 0.9928, β = —2.4950, p = 0.04; hombres: r = 0.9994, r2 = 0.9988, β = —2.770, p = 0.02; mujeres: r = 0.9896, r2 = 0.9793, β = —2.4950, p = 0.07). Las tasas más altas se presentan en las provincias del centro del país. Predomina durante todo el periodo en el sexo masculino y representa en promedio el 14% de la mortalidad general. Conclusión: La mortalidad por EIC está en fase de disminución, pero el aumento de la obesidad y el sobrepeso en el país amenaza con frenar dicha tendencia, al menos durante el último quinquenio.

Abstract Objective: To update some important aspects of the descriptive epidemiology of ischemic heart (EIC) disease in Costa Rica during the period 1970-2014. Methods: EIC death rates were obtained in two periods: from 1930 to 1969 and then, for a more specific analysis, from 1970 to 2014, using moving and five-year averages, based on data from the Instituto Nacional de Estadística and the Centro Centroamericano de Población, to analyze them according to age, sex, geographical location and percentage contribution to the general mortality. Information was also obtained to determine the burden of the disease, in this case through Years of Adjusted Life for Disability, Years of Life Lost and Years of Life lost due to Disability. Results: There was a rise in rates in the general population, with greater momentum in the population from 35 to 74 years, up to the five-year period 1995-1999, after which a decline began that apparently stopped during the five-year period 2010-2014 (both sexes: r = 0.9964, r2 = 0.9928, β = -2.4950, p 0.04; men: r = 0.9994, r2 = 0.9988, β = -2.770, p = 0.02; women: r = 0.9896, r2 = 0.9793, β = -2.4950, p = 0.07). The highest rates occur in the provinces of the center of the country. It predominates during the whole period in the male sex and represents on average 14% of the general mortality. Conclusions: Mortality due to EIC is in a phase of decline but the increase in obesity and overweight in the country threatens to slow down this trend, at least during the last five years.

Control de la hipertensión arterial y la prevención secundaria reduce la cardiopatía isquémica. Objetivo alcanzable / Arterial hypertension control and secondary prevention reduce ischemic hearth disease. An aim with in reach

RESUMEN El control de la hipertensión arterial resulta la medida más efectiva para lograr disminuir la mortalidad total. Una propuesta de actualidad para alcanzar ese propósito es la implementación de regímenes de tratamiento estandarizados, asociados a la prevención secundaria de la cardiopatía isquémica. En este sentido es importante el acceso del paciente a los medicamentos, el trabajo en equipo y la vigilancia del control de la presión arterial y del progreso de los pacientes que reciben el tratamiento, para ello el monitoreo y la evaluación son elementos fundamentales.

ABSTRACT The arterial hypertension control is the most effective measure to reach the decrease of the total mortality. A current proposal to reach this goal is the implementation of standardized treatment regimes, associated to the secondary prevention of the ischemic heart disease. In this sense it is important the access of the patient to the medicines, the team work and the surveillance of the arterial pressure control and the progress of the patients receiving treatment, for what monitoring and assessment are main elements.

Up to 15-Year Survival of Men and Women after Percutaneous Coronary Intervention Paid by the Brazilian Public Healthcare System in the State of Rio de Janeiro, 1999-2010 / Sobrevida em até 15 Anos de Homens e Mulheres após Intervenção Coronariana Percutânea Paga pelo Sistema Único de Saúde no Estado do Rio de Janeiro, 1999-2010

Abstract Background: Percutaneous coronary intervention (PCI) is the most frequently used invasive therapy for ischemic heart disease (IHD). Studies able to provide information about PCI's effectiveness should be conducted in a population of real-world patients. Objectives: To assess the survival rate of IHD patients treated with PCI in the state of Rio de Janeiro (RJ). Methods: Administrative (1999-2010) and death (1999-2014) databases of dwellers aged ≥ 20 years old in the state of RJ submitted to one single PCI paid by the Brazilian public healthcare system (SUS) between 1999 and 2010 were linked. Patients were grouped as follows: 20-49 years old, 50-69 years old and ≥ 70 years old, and PCI in primary PCI, with stent and without stent placement (bare metal stent). Survival probabilities in 30 days, one year and 15 years were estimated by using the Kaplan-Meier method. Cox hazards regression models were used to compare risks among sex, age groups and types of PCI. Test results with a p-value < 0.05 were deemed statistically significant. Results: Data of 19,263 patients (61 ± 11 years old, 63.6% men) were analyzed. Survival rates of men vs. women in 30 days, one year and 15 years were: 97.3% (97.0-97.6%) vs. 97.1% (96.6-97.4%), 93.6% (93.2-94.1%) vs. 93.4% (92.8-94.0%), and 55.7% (54.0-57.4%) vs. 58.1% (55.8-60.3%), respectively. The oldest age group was associated with lower survival rates in all periods. PCI with stent placement had higher survival rates than those without stent placement during a two-year follow-up. After that, both procedures had similar survival rates (HR 0.91, 95% CI 0.82-1.00). Conclusions: In a population of real-world patients, women had a higher survival rate than men within 15 years after PCI. Moreover, using a bare-metal stent failed to improve survival rates after a two-year follow-up compared to simple balloon angioplasty.

Resumo Fundamento: A intervenção coronariana percutânea (ICP) é o tratamento invasivo mais frequentemente realizado na doença isquêmica do coração (DIC). Estudos capazes de prover informação sobre a sua efetividade são importantes. Objetivo: Avaliar a sobrevida em até 15 anos de pacientes submetidos a ICP no estado do Rio de Janeiro (ERJ). Métodos: Bases de dados administrativas (1999-2010) e de óbitos (1999-2014) dos residentes com idade ≥ 20 anos do ERJ submetidos a uma única ICP paga pelo Sistema Único de Saúde (SUS) entre 1999-2010 foram relacionadas. Os pacientes foram agrupados em 20-49, 50-69 ou ≥ 70 anos, e as ICP em primária (ICP-P), sem stent (ICP-SS) e com stent convencional (ICP-CS). As probabilidades de sobrevida em 30 dias, um ano e 15 anos foram estimadas pelo método de Kaplan-Meier. Modelos de regressão de risco de Cox foram utilizados para comparar riscos entre sexo, faixas etárias e tipos de ICP. Resultados dos testes com um valor de p < 0,05 foram considerados estatisticamente significativos. Resultados: Foram analisados os dados de 19.263 pacientes (61±11 anos, 63,6% homens). A sobrevida de homens vs. mulheres em 30 dias, um ano e 15 anos foram: 97,3% (97,0-97,6%) vs. 97,1% (96,6-97,4%), 93,6% (93,2-94,1%) vs. 93,4% (92,8-94,0%), e 55,7% (54,0-57,4%) vs. 58,1% (55,8-60,3%), respectivamente. Idade ≥ 70 anos foi associada à menor taxa de sobrevida em todos os períodos. A ICP-CS foi associada a uma sobrevida maior do que a ICP-SS até dois anos de acompanhamento, e após este período ambos os procedimentos apresentaram taxas de sobrevida semelhantes (HR 0,91, IC 95% 0,82-1,00). Conclusões: Mulheres apresentaram maiores taxas de sobrevida em 15 anos após ICP, e o uso de stent convencional não esteve associado a um aumento de sobrevida em longo prazo.

Mortalidad por enfermedades isquémicas del corazón en Ecuador, 2001-2016: estudio de tendencias / Mortality due to ischemic heart disease in Ecuador 2001- 2016: a time trend study

Background: Ischemic Heart Disease (IHD) is the leading cause of mortality worldwide. Aim: To analyze the evolution of mortality by IHD in Ecuador, from 2001 to 2016. Material and Methods: Analysis of Ecuador death registries elaborated by the National Statistics and Census Institute. Specific and age-adjusted mortality rates were calculated for the 2001-2016 period in Ecuador. The annual percent change (APC) and the average annual percent change (AAPC) were estimated. Changes in trends were located through joinpoint regression analysis. Results: From 2001 to 2016 there were 46,133 deaths due to IHD in Ecuador, of which 60% (n = 27,489) corresponded to men. In the joinpoint regression analysis, the crude mortality rates for IHD reported an increase in the AAPC of 4.0% (2001-2016, 95% CI: 1.5 - 6.6). Rates adjusted for age increased with an AAPC of 3.2% (2001-2016, 95% CI: 0.7 - 5.8). Conclusions: Mortality due to ischemic heart disease increased in Ecuador in the period 2001-2016. Two marked periods were observed, one with a decrease followed by a significant increase, in both sexes and all age groups.

Correlação entre fatores clínicos e educacionais e atraso na chegada ao hospital no infarto agudo do miocárdio / Corelation between clinical and educational factors and delayed hospital arrival in myocardial infarction

Background: Acute myocardial infarction is one of the main causes of morbidity and mortality in the world, and one of the factors with the greatest prognostic impact is early specialist care, but there are still many factors that delay patient's arrival at the hospital. Objective: To correlate social, educational, cognitive and clinical factors with time to hospital arrival after the onset of acute myocardial infarction's first symptoms. Methods: Time interval to search for medical care was measured by patient's report of the onset of infarction's first symptoms and hospital admission verified through electronic medical data of the emergency service. The correlation between delta-T and other variables was performed through Kendall's correlation. Values of p < 0.05 were considered statistically significant. Results: There was no correlation between delta-T and scholarity, or between delta - T and Mini Mental State Examination performance, as well as no association between the presence of hypertension, diabetes mellitus, dyslipidemia, family history, sedentary lifestyle or smoking with arrival time at the hospital. Comparisons between delta-T and marital status were also not statistically significant. Transfer from another health service and city of origin were the most determinant delay factors in our population's arrival at the hospital. Conclusion: The present study suggests that, in our population, educational, social and cognitive factors are not directly related to the delay in arriving at the hospital

Fundamentos: O infarto agudo do miocárdio se configura como uma das principais causas de morbimortalidade no mundo, e um dos fatores de maior impacto prognóstico é o atendimento especializado precoce, porém ainda existem inúmeros fatores que retardam a chegada do paciente até o hospital. Objetivo: Correlacionar fatores sociais, educacionais, cognitivos e clínicos com o tempo para a chegada no hospital após os primeiros sintomas de infarto agudo do miocárdio. Métodos: O tempo para a busca de atendimento médico foi mensurado entre o início dos primeiros sintomas de infarto relatado pelo paciente e o registro da admissão hospitalar em prontuário eletrônico do serviço de emergência. A correlação entre o delta T e outras variáveis foi verificada por meio da correlação de Kendall. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Não houve correlação entre delta T e escolaridade, e nem entre delta T e desempenho no Mini-Exame do Estado Mental, assim como não houve associação entre a presença de hipertensão arterial sistêmica, diabetes melito, dislipidemia, sedentarismo, história familiar ou tabagismo com o tempo de chegada no hospital. Comparações entre delta T e estado civil também não foram estatisticamente significativas. A transferência de outro serviço de saúde e a região de procedência foram os fatores que mais determinaram atraso no atendimento especializado de nossa população. Conclusão: Fatores educacionais, sociais e cognitivos não estiveram diretamente relacionados ao atraso na chegada ao hospital

Correlation between Clinical and Educational Factors and Delayed Hospital Arrival in Myocardial Infarction

Acute myocardial infarction is one of the main causes of morbidity and mortality in the world, and one of the factors with the greatest prognostic impact is early specialist care, but there are still many factors that delay patient's arrival at the hospital. Objective: To correlate social, educational, cognitive and clinical factors with time to hospital arrival after the onset of acute myocardial infarction's first symptoms. Methods: Time interval to search for medical care was measured by patient's report of the onset of infarction's first symptoms and hospital admission verified through electronic medical data of the emergency service. The correlation between delta-T and other variables was performed through Kendall's correlation. Values of p < 0.05 were considered statistically significant. Results: There was no correlation between delta-T and scholarity, or between delta - T and Mini Mental State Examination performance, as well as no association between the presence of hypertension, diabetes mellitus, dyslipidemia, family history, sedentary lifestyle or smoking with arrival time at the hospital. Comparisons between delta-T and marital status were also not statistically significant. Transfer from another health service and city of origin were the most determinant delay factors in our population's arrival at the hospital. Conclusion: The present study suggests that, in our population, educational, social and cognitive factors are not directly related to the delay in arriving at the hospital

Burden of ischemic heart disease mortality attributable to physical inactivity in Brazil

ABSTRACT OBJECTIVE To analyze if the burden of ischemic heart disease mortality trend attributed to physical inactivity in Brazil differs from the global estimates. METHODS Databases from the Global Burden of Disease Study for Brazil, Brazilian states, and global information were used. We estimated the summary exposure value for physical inactivity, the total number of deaths, and the age-standardized death rates for ischemic heart disease attributed to physical inactivity in the years 1990 and 2015, and the population-attributable fraction. Data were presented according to sex. RESULTS The Brazilian population was found to have a risk of exposure to physical inactivity varying between 70.4% for men and 75.7% for women in the year of 1990. This risk of exposure was similar in 2015. In men, the mortality rate from ischemic heart disease attributed to physical inactivity decreased in 2015 by approximately 24% around the world and 45% in Brazil. For women, this decrease was in 31% around the world and 45% in Brazil. The states of Southern and Southeastern Brazil presented lower mortality rates due to ischemic heart disease attributed to physical inactivity. If physical inactivity were eliminated in Brazil, mortality from ischemic heart disease would be reduced by 15.8% for men and 15.2% for women. CONCLUSIONS Over 25 years, the risk of exposure to physical inactivity in Brazil did not change and was high compared to global estimates. The decrease in ischemic heart disease mortality results from the improvement of health services in Brazil and the control of other risk factors. Approximately 15% of deaths from ischemic heart disease in Brazil could be avoided if people met the recommendations for physical activity.

Green spaces and mortality due to cardiovascular diseases in the city of Rio de Janeiro / Espaços verdes e mortalidade por doenças cardiovasculares no município do Rio de Janeiro

ABSTRACT OBJECTIVE Investigate the association between exposure to green spaces and mortality from ischemic heart and cerebrovascular diseases, and the role of socioeconomic status in this relationship, in the city of Rio de Janeiro, Brazil. METHODS Ecological study, with the census tracts as unit of analysis. This study used data from deaths due to ischemic heart and cerebrovascular diseases among residents aged over 30 years, from 2010 to 2012. Exposure to green was estimated using the Normalized Difference Vegetation Index based on satellite images. The associations between exposure to green spaces and mortality rates due to ischemic heart and cerebrovascular diseases, standardized by gender and age, were analyzed using conditional autoregressive models, adjusted for the density of light and heavy traffic routes, pollution proxy, and by the socioeconomic situation, measured by the Social Development Index. Analyzes stratified by socioeconomic levels were also carried out, given by the tertiles of the Social Development Index. RESULTS Among the greener sectors, with a Normalized Difference Vegetation Index above the third quartile, the reduction in mortality due to ischemic heart disease was 6.7% (95%CI 3.5-9.8) and cerebrovascular was 4.7% (95%CI 1.2-8.0). In the stratified analysis, the protective effect of green spaces on ischemic heart disease mortality was observed among the greenest sectors of all strata, and it was higher for those with a lower socioeconomic level (8.6%, 95%CI 1.8-15.0). In the case of mortality due to cerebrovascular diseases, the protective effect was verified only for the greenest sectors of the lowest socioeconomic level (9.6%, 95%CI 2.3-16.5). CONCLUSIONS Mortality rates for ischemic heart and cerebrovascular diseases are inversely associated with exposure to green spaces when controlling socioeconomic status and air pollution. The protective effect of green spaces is greater among the tracts of lower socioeconomic level.

RESUMO OBJETIVO Investigar a associação entre a exposição aos espaços verdes e a mortalidade por doenças isquêmicas do coração e cerebrovasculares, e o papel do nível socioeconômico nessa relação, no município do Rio de Janeiro, Brasil. MÉTODOS Estudo ecológico, tendo os setores censitários como unidade de análise. Foram utilizados os dados de óbitos por doenças isquêmicas do coração e cerebrovasculares, entre residentes com idade acima de 30 anos, ocorridos de 2010 a 2012. A exposição ao verde foi estimada por meio do Índice de Vegetação por Diferença Normalizada, baseado em imagens de satélite. As associações entre a exposição aos espaços verdes e a taxas de mortalidade por doenças isquêmicas do coração e cerebrovasculares, padronizadas por sexo e idade, foram analisadas por meio de modelos condicionais autorregressivos, ajustados pelas densidades de vias de tráfego leve e pesado, proxy de poluição, e pela situação socioeconômica, mensurada pelo Índice de Desenvolvimento Social. Também foram realizadas análises estratificadas por níveis socioeconômicos, dados pelos tercis do Índice de Desenvolvimento Social. RESULTADOS Entre os setores mais verdes, com Índice de Vegetação por Diferença Normalizada acima do terceiro quartil, a redução da mortalidade por doenças isquêmicas do coração foi de 6,7% (IC95% 3,5-9,8) e por cerebrovascular foi de 4,7% (IC95% 1,2-8,0). Na análise estratificada, o efeito protetor dos espaços verdes na mortalidade por doenças isquêmicas do coração foi observado entre os setores mais verdes de todos os estratos, sendo maior para os de menor nível socioeconômico (8,6%; IC95% 1,8-15,0). No caso da mortalidade por doenças cerebrovasculares, o efeito protetor foi verificado apenas para os setores mais verdes do nível socioeconômico mais baixo (9,6%; IC95% 2,3-16,5). CONCLUSÕES As taxas de mortalidade por doenças isquêmicas do coração e cerebrovasculares são inversamente associadas à exposição aos espaços verdes, controlando o nível socioeconômico e a poluição do ar. O efeito protetor dos espaços verdes é maior entre os setores de nível socioeconômico mais baixo.

Prognostic Value of Coronary Flow Reserve Obtained on Dobutamine Stress Echocardiography and its Correlation with Target Heart Rate / Valor Prognóstico da Reserva de Fluxo Coronariano Obtida Durante o Ecocardiograma sob Estresse com Dobutamina e sua Correlação com a Frequência Cardíaca Alvo

Abstract Background: Normal coronary flow velocity reserve (CFVR) (≥ 2) obtained in the left anterior descending coronary artery (LAD) from transthoracic echocardiography is associated with a good prognosis, but there is no study correlating CFVR with submaximal target heart rate (HR). Objective: To evaluate the prognostic value of CFVR obtained in the LAD of patients with preserved (>50%) left ventricular ejection fraction (LVEF) who completed a dobutamine stress echocardiography (DSE), considering target HR. Methods: Prospective study of patients with preserved LVEF and CFVR obtained in the LAD who completed DSE. In Group I (GI = 31), normal CFVR was obtained before achieving target HR, and, in Group II (GII = 28), after that. Group III (G III=24) reached target HR, but CFVR was abnormal. Death, acute coronary insufficiency, coronary intervention, coronary angiography without further intervention, and hospitalization were considered events. Results: In 28 ± 4 months, there were 18 (21.6%) events: 6% (2/31) in GI, 18% (5/28) in GII, and 46% (11/24) in GIII. There were 4 (4.8%) deaths, 6 (7.2%) coronary interventions and 8 (9.6%) coronary angiographies without further intervention. In event-free survival by regression analysis, GIII had more events than GI (p < 0.001) and GII (p < 0.045), with no difference between GI and GII (p = 0.160). After adjustment, the only difference was between GIII and GI (p = 0.012). Conclusion: In patients with preserved LVEF and who completed their DSE, normal CFVR obtained before achieving target HR was associated with better prognosis.

Resumo Fundamento: A reserva de velocidade de fluxo coronariano (RVFC) adequada (≥ 2) obtida na artéria descendente anterior (ADA) através do ecocardiograma transtorácico associa-se a bom prognóstico, mas não há estudo correlacionando-a com a frequência cardíaca (FC) alvo (submáxima). Objetivo: Avaliar o valor prognóstico da RVFC obtida na ADA de pacientes com fração de ejeção do ventrículo esquerdo (FEVE) preservada (>50%) e ecocardiograma sob estresse com dobutamina (EED) concluído, considerando a FC alvo submáxima. Métodos: studo prospectivo de pacientes com FEVE preservada e RVFC obtida na ADA durante EED concluído. No Grupo I (GI=31), a RVFC adequada foi obtida antes de se atingir a FC alvo, e no Grupo II (G II=28), após. O Grupo III (G III=24) atingiu a FC alvo, mas a RVFC foi inadequada. Foram considerados eventos: óbito, insuficiência coronariana aguda, intervenção coronariana, coronariografia sem intervenção subsequente e internamento hospitalar. Resultados: Em 28 ± 4 meses, ocorreram 18 (21,6%) eventos, sendo 6% (2/31) no GI, 18% (5/28) no GII e 46% (11/24) no GIII. Foram 4 (4,8%) óbitos, 6 (7,2%) intervenções coronarianas e 8 (9,6%) coronariografias sem intervenção subsequente. Na sobrevida livre de eventos pela análise de regressão, GIII apresentou mais eventos do que GI (p < 0,001) ou GII (p < 0,045), não havendo diferença entre GI e GII (p = 0,160). Após o ajustamento, foi mantida a diferença apenas entre GIII e GI (p = 0,012). Conclusão: Em pacientes com FEVE preservada e EED concluído, a RVFC adequada obtida antes da FC alvo associou-se ao melhor prognóstico.

Estimación de la carga global de enfermedad en Colombia 2012: nuevos aspectos metodológicos / Estimation of the global burden of disease in Colombia-2012: new methodological aspects

RESUMEN La nueva metodología de carga global de enfermedad (GBD, 2010) resulta difícil de reproducir completamente en Colombia. En este trabajo se presentan los resultados de utilización parcial de esta metodología para estimar los años perdidos por muerte prematura (APMP) y los vividos con discapacidad (AVD). La redistribución de códigos inútiles produce incrementos importantes en las causas de muerte, que es preferible a un análisis de causas de muerte con un 15,6 % de códigos inútiles que aportarían poca o ninguna información estadística. La cardiopatía isquémica, eventos cerebrovasculares y la cardiopatía hipertensiva causan el mayor riesgo de mortalidad (164,2 muertes por 100 000). Las agresiones por arma de fuego y objeto cortante, las lesiones auto-infligidas y las provocadas por vehículos de tres y cuatro ruedas, causan el mayor riesgo de APMP (34,3 APMP por 1000). Enfermedades de piel como la dermatitis, eritemas, la pediculosis y la pitiriasis, causan el mayor riesgo de AVD (51,3 AVD por 1000). Este grupo de enfermedades de la piel también resultan la principal causa de AVISAs Totales (51,4 AVISAs Totales por 1000). Los departamentos con las tasas más elevadas de mortalidad y APMP para las causas del grupo I (enfermedades transmisibles) son Guainía, Amazonas, Vaupés, Cauca, Vichada, Putumayo, Nariño, Chocó, Córdoba, La Guajira, Guaviare y Caquetá, que están entre los de más baja cobertura de la mortalidad.(AU)

ABSTRACT The new methodology applying for burden of disease study (GBD 2010) is difficult to completely reproduce in Colombia. This paper presents the results of partial use of this methodology to estimate the components years lost due to premature death (YLLs) and lived with disability (YLDs). Redistribution of useless codes produces significant increases in some causes of death, which are preferable to deal with an analysis of causes of death with 15,6 % of useless codes that would provide little or no statistical information. Ischemic heart disease, cerebrovascular and hypertensive heart disease events cause the highest risk of mortality rate (164,2 per 100,000). Assaults by firearms and sharp objects, self-inflicted injuries and those caused by motorcycles and four-wheeled vehicles on the road, are the first cause of YLLs per 1000 (34,3). Skin diseases such as dermatitis, erythemas, burns on exposure to sunlight, pediculosis and pityriasis, cause the greatest risk of YLDs per 1000 (51,3). This group of skin diseases are also the leading cause of DALYs per 1000 (51,4). The departments with the highest rates of mortality and YLLs for Group I (communicable diseases) are Guainía, Amazonas, Vaupés, Cauca, Vichada, Putumayo, Nariño, Chocó, Cordoba, La Guajira, Guaviare y Caquetá and with the lower mortality coverage.(AU)

Principais causas da mortalidade masculina e os anos potenciais de vida perdidos por estes agravos / Principales causas de mortalidad masculina y los años potenciales de vida perdidos debido a estos agravios / Main causes of male mortality and potential years of life lost due to those diseases

RESUMO Esta pesquisa teve como objetivo descrever o perfil da mortalidade masculina de Cuiabá-MT entre os anos de 2002-2012 segundo as principais causas de mortalidade masculina e os anos potenciais de vida perdidos (APVP) por esta população. Trata-se de um estudo ecológico, realizado a partir de 5.135 registros de óbitos de homens com idades entre 20 e 59 anos, residentes em Cuiabá-MT. A análise descritiva foi feita através da frequência absoluta e relativa dos dados e cálculo dos Indicadores de Saúde. Dentre os resultados, destacam-se as mortes em decorrência de causas violentas e doenças crônicas e degenerativas, além da mortalidade precoce, expressa pela grande perda de APVP na população de 20 a 29 anos de idade. Diante deste panorama, ressalta-se a necessidade de ações conjuntas entre seguimentos da sociedade, agentes públicos e agentes de saúde no sentido de promover a mudança deste cenário através de ações educativas com intuito de fomentar a redução da mortalidade com a sensibilização da população masculina em relação aos comportamentos de risco como a violência e a direção perigosa, bem como a adoção de hábitos mais saudáveis.

RESUMEN Esta investigación tuvo como objetivo describir el perfil de la mortalidad masculina de Cuiabá-MT, Brasil, entre los años de 2002-2012, según las principales causas de mortalidad masculina y los años potenciales de vida perdidos (APVP) por esta población. Se trata de un estudio ecológico, realizado a partir de 5.135 registros de óbitos de hombres con edades entre 20 y 59 años, residentes en Cuiabá-MT, Brasil. El análisis descriptivo fue hecho a través de la frecuencia absoluta y relativa de los datos y cálculo de los Indicadores de Salud. Entre los resultados, se destacan las muertes debido a causas violentas y enfermedades crónicas y degenerativas, además de la mortalidad precoz, expresada por la gran pérdida de los APVP en la población de 20 a 29 años de edad. Ante este panorama, se resalta la necesidad de acciones conjuntas entre segmentos de la sociedad, agentes públicos y agentes de salud en el sentido de promover el cambio de este escenario a través de acciones educativas con el objetivo de fomentar la reducción de la mortalidad con la sensibilización de la población masculina con relación a los comportamientos de riesgo como la violencia y la conducción temeraria, así como la adopción de hábitos más saludables.

ABSTRACT The objective of this study was to describe the male mortality rate of Cuiabá-MT between the years 2002-2012 according to the main causes of male mortality and the years of potential life lost (YPLL) by that population. This is an ecological study, based on 5,135 death records of men aged 20 to 59 years old, living in Cuiabá-MT. The descriptive analysis occurred through the absolute and relative frequencies of data and calculation of the Health Indicators. Among the results, deaths due to violent causes and chronic and degenerative diseases stand out, in addition to the early mortality, expressed by the large loss of YPLL in the population from 20 to 29 years of age. In view of this panorama, there is need for actions in conjunction with all segments of society, public and health agents for the effort to promote the change of that scenario through educational actions aiming at encouraging the reduction of mortality with the sensitization of the male population regarding risk behaviors such as violence and dangerous management, as well as the adoption of healthier habits.

Proportional Mortality due to Heart Failure and Ischemic Heart Diseases in the Brazilian Regions from 2004 to 2011 / Mortalidade Proporcional por Insuficiência Cardíaca e Doenças Isquêmicas do Coração nas Regiões do Brasil de 2004 a 2011

Abstract Background: Heart failure (HF) and ischemic heart diseases (IHD) are important causes of death in Brazil. Objective: To assess proportional mortality (PM) due to HF and IHD as underlying causes stratified by sex and age groups in the Brazilian geoeconomic regions from 2004 to 2011. Methods: Data from death certificates were obtained in the DATASUS site under the following International Statistical Classification of Diseases and Related Health Problems codes, 10th Revision: 1) from chapter IX: I20 to I24 for acute IHD, I25 for chronic IHD, and I50 for HF; and 2) from chapter XVIII, for ill-defined causes (IDC). Results: Proportional mortality due to HF increased with age in both sexes and all regions, the highest percentages being found among elderly women. Among men, the highest percentages were observed in the West-Central region up to the ninth decade, but, among the eldest individuals, the highest percentages were identified in the Southern region. Among women, the regions did not differ up to the age group of 70-79 years, although the West-Central region took the lead from 50 to 79 years; however, from the age of 80 years on, the Southern region showed the highest PM due to HF. Proportional mortality due to acute IHD in all Brazilian regions and in both sexes increased up to the age group of 60-69 years, from which it decreased. Among men, the Southeastern region had the highest percentages in the age group of 50-59 years, while women had lower PM due to acute IHD than men in all regions. In both sexes, PM due to chronic IHD increased with age in the Southern and Southeastern regions, which did not happen in the others, while the Southern region had the highest rate of all regions for all age groups. Conclusions: Regional differences were more prominent at more advanced ages, especially when deaths due to IDC were excluded.

Resumo Fundamento: Insuficiência cardíaca (IC) e doenças isquêmicas do coração (DIC) são importantes causas de morte no Brasil. Objetivo: Avaliar a mortalidade proporcional (MP) por IC e DIC, como causas básicas, estratificada por sexo e faixa etária nas regiões brasileiras de 2004 a 2011. Métodos: As informações das declarações de óbito foram obtidas no site do DATASUS, codificadas conforme a Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, 10ª Revisão: 1) do Capítulo IX: I20 a I24 para DIC aguda, I25 para DIC crônica, e I50 para IC; e 2) do Capítulo XVIII, para causas mal definidas (CMD). Resultados: A MP por IC aumentou com a idade nos dois sexos e em todas as regiões, as mais altas porcentagens sendo encontradas entre as mulheres mais idosas. Entre os homens, as mais altas porcentagens foram observadas na região Centro-Oeste até a nona década; entre os mais idosos, porém, as mais altas porcentagens foram identificadas na região Sul. Entre as mulheres, as regiões não diferiram até a faixa etária de 70-79 anos, embora a região Centro-Oeste tenha liderado dos 50 aos 79 anos; entretanto, a partir dos 80 anos, a região Sul apresentou a mais alta MP por IC. Em todas as regiões brasileiras e nos dois sexos, a MP por DIC aguda aumentou até a faixa etária de 60-69 anos, a partir da qual diminuiu. Entre os homens, a região Sudeste apresentou as mais altas porcentagens na faixa etária de 50-59 anos, enquanto as mulheres tiveram menor MP por DIC aguda em comparação aos homens em todas as regiões. Nos dois sexos, a MP por DIC crônica aumentou com a idade nas regiões Sul e Sudeste, mas não nas demais, enquanto a região Sul apresentou a mais alta MP entre todas as regiões para todas as faixas etárias. Conclusões: Diferenças regionais foram mais marcantes nas idades mais avançadas, especialmente quando excluídas as mortes por CMD.