Abstract 13664: Cardiovascular Mortality in Brazil During the COVID-19 Pandemic: Comparison Between Underlying and Multiple Causes of Death

Abstract

Introduction: COVID-19 has impacted cardiovascular disease (CVD) mortality worldwide due to avoidance of healthcare, health system collapse, and the direct CV effects, but detailed data from Brazil are still scarce. We aimed to evaluate the impact of COVID-19 pandemic on CVD mortality, stratified by age, sex and region of Brazil, comparing underlying (UC) and multiple causes (MC) of death. Methods: Ecological, time series study analysing CVD age-standardized death rates, from epidemiological weeks (EW) 10/2020 to 11/2021, using data from the Mortality Information System (SIM-SUS). CVD was defined as in ICD-10 Chapter IX, and considered if reported as UC or MC of death (UC + other causes reported in any line of death certificate) in separate analyses. Observed was compared to expected data (mean for the same EW of 2017-2019). Risk ratios (RiR) were analysed and 95% confidence intervals calculated. Results: Age-standardized CVD mortality rate as UC of death in the pandemic was 165.9 (95% CI 165.5 - 166.3)/100,000 inhabitants, similar to the expected: (165.6; 95%CI 165.2 - 166.2)/100,000, with a RiR=1.00; 95% CI 1.00 - 0.93). There was an increase in out-of-hospital mortality (18%) (RiR=1.18; 95% CI 1.17 - 1.19) and in deaths with ill-defined CVD causes (43%) (RiR=1.43; 95%CI 1.42 - 1.44), particularly in the out-of-hospital setting (51%). The increase in out-of-hospital deaths was more pronounced in the North (RiR=1.33; 95% CI 1.30 - 1.36) and Center West (RiR=1.26; 95% CI 1.23 - 1.30), regions with less prepared health systems. Conversely, in MC of death analysis, 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)/100,000, RiR=1.10 (95% CI 1.09 - 1.10), noticeably in the out-of-hospital setting (19%). Steeper increasing trends also occurred in the North region (RiR=1.16; 95% CI 1.15 - 1.17), and in individuals ≥60 years (RiR=1.11; 95% CI 1.10 - 1.11), and among men (RiR=1.11; 95% CI 1.11 - 1.12) vs. women (RiR=1.08; 95% CI 1.08 - 1.09). Conclusions: During the pandemic, CVD mortality as UC of death remained stable in Brazil, contrasting with an increase when MC were considered. Higher out-of-hospital mortality, exacerbation of existing CVD by COVID-19, and competing causes of death may have contributed.