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Editorial

Cardiovascular Diseases in Indigenous Populations: An Indicator Of Inequality

The number of articles on cardiovascular diseases in indigenous populations is not sufficient as a basis for the development of health policies. Although the most common conditions reported among indigenous people have been infectious and contagious diseases such as malaria, tuberculosis, respiratory infections, hepatitis, sexually transmitted diseases, among others, the prevalence of noncommunicable diseases (NCDs) have increased in this population as a result of urbanization process and their lifestyle. In addition, approaches of these conditions in indigenous people face logistic issues, as they require continuous medical care and development of health promotion programs in difficult areas.

The original, well-conducted study by Armstrong and colleagues contributes to fill this knowledge gap, as it highlights the impact of public investments that not only promote the development of the country, but also reveals the vulnerability and adverse effects of the changes in the lifestyle of indigenous people. Despite its methodological limitations, the study shows an association between mortality for cardiovascular diseases and rapid urbanization in this population.

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Original Article

Urbanization is Associated with Increased Trends in Cardiovascular Mortality Among Indigenous Populations: the PAI Study

Anderson da Costa Armstrong et al. Ana Marice Teixeira Ladeia Juracy Marques Dinani Matoso Fialho de Oliveira Armstrong … Antonio Marconi Leandro da Silva Jeová Cordeiro de Morais Junior Aldina Barral Luis Claudio Lemos Correia Manoel Barral-Netto João A. C. Lima

Abstract

Background:

The cardiovascular risk burden among diverse indigenous populations is not totally known and may be influenced by lifestyle changes related to the urbanization process.

Objectives:

To investigate the cardiovascular (CV) mortality profile of indigenous populations during a rapid urbanization process largely influenced by governmental infrastructure interventions in Northeast Brazil.

Methods:

We assessed the mortality of indigenous populations (≥ 30 y/o) from 2007 to 2011 in Northeast Brazil (Bahia and Pernambuco states). Cardiovascular mortality was considered if the cause of death was in the ICD-10 CV disease group or if registered as sudden death. The indigenous populations were then divided into two groups according to the degree of urbanization based on anthropological criteria:^, Group 1 – less urbanized tribes (Funi-ô, Pankararu, Kiriri, and Pankararé); and Group 2 – more urbanized tribes (Tuxá, Truká, and Tumbalalá). Mortality rates of highly urbanized cities (Petrolina and Juazeiro) in the proximity of indigenous areas were also evaluated. The analysis explored trends in the percentage of CV mortality for each studied population. Statistical significance was established for p value < 0.05.

Results:

There were 1,333 indigenous deaths in tribes of Bahia and Pernambuco (2007-2011): 281 in Group 1 (1.8% of the 2012 group population) and 73 in Group 2 (3.7% of the 2012 group population), CV mortality of 24% and 37%, respectively (p = 0.02). In 2007-2009, there were 133 deaths in Group 1 and 44 in Group 2, CV mortality of 23% and 34%, respectively. In 2009-2010, there were 148 deaths in Group 1 and 29 in Group 2, CV mortality of 25% and 41%, respectively.

Conclusions:

Urbanization appears to influence increases in CV mortality of indigenous peoples living in traditional tribes. Lifestyle and environmental changes due to urbanization added to suboptimal health care may increase CV risk in this population.