Impact of social vulnerability on cardiovascular mortality trends in Brazil before and after the COVID-19 pandemic
A Ferreira Pena Maciel, G Moraes de Oliveira, T Salim, P Blanco Villela, G Xexeo, C Lima, M Marques, J MarquesAbstract
Introduction
Cardiovascular diseases (CVD) remain the leading cause of mortality in Brazil, yet the influence of social vulnerability on temporal mortality trends, particularly across prepandemic, pandemic, and post-pandemic COVID-19 periods, remains insufficiently understood.
Purpose
To analyze mortality trends for CVD, Ischemic Heart Disease (IHD), and Cerebrovascular Diseases (CBVD) in Brazil from 2000 to 2023, identifying regional patterns and their association with the Social Vulnerability Index (SVI).
Methods
An ecological time-series study was conducted using the Information Technology Department of the Brazilian Unified Health System (DATASUS/MS) data for individuals aged ≥20 years. Mortality rates per 100,000 inhabitants were calculated and compared across three periods: pre-pandemic (2000–2019), pandemic (2020–2021), and post-pandemic (2022–2023). Temporal variation was assessed using the Variability Index (VI). SVI values for Brazilian states were obtained from the Institute for Applied Economic Research and correlated with mortality trends.
Results
A total of 8,076,774 CVD deaths, 2,426,539 IHD deaths, and 2,328,869 CBVD deaths were recorded. National mortality decreased during the pandemic but increased in the post-pandemic period, particularly for IHD (5.7%) and CBVD (4.5%). The North and Northeast regions exhibited increases during the pandemic, notably in Amapá and Roraima. States with higher social vulnerability exhibited higher mortality rates, greater temporal variability, and more pronounced reversal of trends. Women demonstrated disproportionately increased mortality in several states.
Conclusion
The COVID-19 pandemic amplified pre-existing cardiovascular health inequalities in Brazil. Social vulnerability was strongly associated with increased CVD mortality, especially in the North and Northeast. These findings highlight the need for public policies prioritizing vulnerable territories and high-risk social groups, including targeted strategies for women.Picture 1-Mortality Rate and Quartile