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HDI, Technological and Human Resources for the Diagnosis and Treatment of Circulatory System Malformations in Brazil – Analysis of the Reality in Brazil

In Brazil in 2019, circulatory system diseases (CSD) were the leading cause of death. In children under one year of age, CSD is the ninth leading cause of death and, in the age group from 1 to 9 years old, the eighth. In recent decades, there has been a reduction in the infant mortality rate to 11.9/1,000 live births (LB) in 2019. Despite the progressive reduction observed in recent years, this rate remains high when compared to that in developed countries. In Sweden, the infant mortality rate in the period of 2015/2020 was 2.0/1,000 LB. In Brazil, in children under five years of age, mortality was 14.0/1,000 LB, which occurred mainly in the first year of life. The main causes of neonatal mortality are perinatal asphyxia, extreme prematurity, and congenital malformations. Among the congenital malformations (CM), CSD have the greatest impact on mortality, as they are classified as preventable causes of death, which could be reduced through early interventions. High mortality rates due to malformations of the circulatory system (MCS) result from the lack of pre and postnatal diagnosis, resulting in inadequate treatment and a higher number of deaths.^–

The study by Salim et al. aimed to verify the association of MCS diagnosis at birth and death from MCS in the first year of life with the human development index (HDI) and technological and human resources for the diagnosis and treatment of MCS by the macroregions of Brazil, using data obtained from DATASUS, in the period of 2000/2015.

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Original Article

Inequalities in Mortality Rates from Malformations of Circulatory System Between Brazilian Macroregions in Individuals Younger Than 20 Years

Thais Rocha Salim et al. Thayanne Mendes Andrade Carlos Henrique Klein Gláucia Maria Moraes de Oliveira

Abstract

Background

Deaths from malformations of the circulatory system (MCS) have a major impact on mortality reduction. given that most cases are avoidable with correct diagnosis and treatment.

Objectives

To describe the distribution of mortality from MCS by sex. age. and macroregion in Brazil. in individuals under the age of 20. between 2000 and 2015.

Methods

A descriptive study of mortality rates and proportional mortality (PM) from MCS. other congenital malformations (OCM). circulatory system disease (CSD). ill-defined causes (IDC). and external causes (EC) in Brazil.

Results

There were 1.367.355 deaths from all causes in individuals younger than 20. 55.0% under 1 year of age. A total of 144.057 deaths were caused by congenital malformations. 39% of them by MCS. In both sexes. the annual mortality from MCS was 5.3/100.000. PM from MCS was 4.2%. CSD 2.2%. IDC 6.2% and EC 24.9%. Unspecified MCS showed the highest PM rates in both sexes and age groups. especially in the north and northeast regions (60%). Deaths from malformations occurred 5.7 times more frequently during the first year of life than in other ages (MCS: 5.0; OCM: 6.4).

Conclusions

MCS was the leading cause of death among all malformations. being twice as important as CSD. mainly under 1 year of age. The frequency of misdiagnosis of MCS as cause of death was high in all ages and both sexes. especially in the north and northeast regions. These findings highlight the need for the development of public health strategies focused on correct diagnosis and early treatment of congenital cardiopathies. leading to a reduction in mortality. (Arq Bras Cardiol. 2020; 115(6):1164-1173)