Spatial analysis of cerebrovascular mortality in Rio de Janeiro municipality from 2002 to 2007, demographic and socioeconomic correlations

Abstract

Purpose: Despite moderate decline of Cerebrovascular Disease (CBVD) in the last several decades, it is still the leading cause of death in the municipality of Rio de Janeiro (RJ). The spatial distribution of mortality across regions is unknown. The aim of this study was to understand the geographical distribution of deaths from CBVD in Rio de Janeiro and the correlations with socioeconomic and demographic data methods. Methods: This ecological study examined all death certificates from 2002 to 2007 of RJ residents 20 years or older, with CBVD as the underlying cause of death. The geographical distribution of CBVD deaths were observed by geocoding addresses. The proportions of death from each Administrative Region (AR) were analyzed by gender, age, education and marital status and standardized by 2000-2010 population averages. The socioeconomic indicator used in this study was the Human Development Index (HDI) of each AR for the year of 2000. The magnitude of effect of individual variables and HDI were obtained by modeling hierarchical pattern of dots through log-Gaussian Cox model with Bayesian inference credibility intervals (CI) of 95% for each variable (Markov Chain Monte Carlo simulations method -MCMC). The Relative Risk (RR) for death for each AR was calculated and compared with AR 6 (highest HDI-RJ) for variable settings. Results were presented as maps. Results: The spatial distribution of deaths from CBVD in Rio de Janeiro was heterogeneous and showed a strong inverse linear correlation with HDI of the AR (CI: -10,2; -9,7). For each reduction of 0.05 HDI there was a 65% increase in the number of deaths (CI: 1,64; 1,66). Male gender, older age and poor education were risk factors for death from CBVD in almost every AR. For poorly educated people, living together represented a protective factor for death by CBVD in the majority of Administrative Regions (AR's). In all AR's the RR of death was high and occurred earlier compared with AR's of higher socioeconomic status, with regional difference correlating with the HDI of each region. No significant effect was observed for some of the study variables in some slums and Guaratiba AR. Conclusion: Increased risk of death from CBVD in the municipality of Rio de Janeiro was found in areas of lower socioeconomic development where death usually occurs earlier. It is recommended that the government address health issues in a more active manner not only to control individual risk factors, but, most of all, to use multidisciplinary interventions according to the geographical distribution of mortality.