ABC | Volume 110, Nº6, June 2018

Original Article Nascimento et al Cardiovascular disease in Portuguese-speaking countries Arq Bras Cardiol. 2018; 110(6):500-511 2016, based on the estimates of the GBD 2016 Study, and to assess the association between those trends and the sociodemographic index (SDI) of those countries. Methods Portuguese-speaking countries The PSC are the official members of the Community of Portuguese-Speaking Countries (CPLP), an international organization created in July 17, 1996, aimed at "deepening the mutual friendship and cooperation between its members". 2 The initial list of countries included Angola, Brazil, Cape Verde, Guinea-Bissau, Mozambique, Portugal and Sao Tome and Principe. In 2002, after its independence, Timor-Leste was accepted as a member. In 2014, Equatorial Guinea was accepted as a member, after Portuguese was adopted as the official language of the country. Table 1 and Figure 1 show the location and the demographic, social and economic characteristics of the PSC. The GBD Study The GBD Study is a multinational collaborative research project with the goal of producing consistent estimates of health loss due to over 333 diseases and injuries. A wide range of data sources (data of national surveillance, verbal autopsy and vital registration, published and unpublished registries of diseases, and published scientific literature) and methods are applyed to produce specific results with uncertainty intervals for age, sex and country for the years 1990-2016, and such results are annually updated for the entire temporal series. The present study is based on data from the GBD 2016 Study and its previously detailed methodology. 4-6 Definitions of CVD The nine most common global causes of death and morbidity related to CVD and an additional category for ‘other CVD’ were considered, in addition to the estimates of global morbidity and mortality grouped by CVD. 7 The underlying cause of death was defined as CVD according to the International Classification of Diseases (ICD) codes, from the death certificate (DC), the basic document that informs the causes of death in countries with systems of vital statistics, such as Brazil. The following causes were analyzed, with their corresponding ICD-10 codes according to the GBD Study’s classification list of causes: 1- rheumatic fever with cardiac involvement (codes I01-I01.9, I02.0, I05-I09.9); 2‑ischemic heart disease (codes I20-I25.9); 3- cerebrovascular disease (CbVD) (G45-G46.8, I60-I69.9); 4- hypertensive heart disease (I11); 5- cardiomyopathy and myocarditis (A39.52, B33.2-B33.24, D86.85, I40-I43.9, I51.4-I51.5); 6- atrial fibrillation and flutter (I48); 7- aortic aneurysm (I71); 8- peripheral artery disease (I70.2-I70.7, I73-I73.9); 9‑endocarditis (A39.51, I33-I33.9, I38-I39.9). Garbage codes, such as heart failure (I50) and pulmonary embolism (I26), which do not define the pathology that caused the death, were redistributed to those specific causes based on the GBD methodology, according to algorithms defined in that study. Regarding mortality, those causes were grouped based on the specific sequelae of disease (for example, ischemic heart disease due to acute coronary syndrome, chronic stable angina, chronic ischemic heart disease and ischemic cardiomyopathy). Adjustments were performed for data that did not comply with the specific definition of case (for example, electronic confirmation for the clinical diagnosis). 4,8,9 Table 1 – Demographic, social and economic characteristics of the Portuguese-speaking countries, 2013 Angola Brazil Cape Verde Equatorial Guinea Guinea- Bissau Mozambique Portugal Sao Tome and Principe Timor-Leste Population (millions) 19 201 1 1 2 24 10 0.2 1 Population density (inhab/km²) 15 24 127 39 44 31 113 190 79 Area (1,000 km²) 1247 8516 4 28 36 786 92 1.0 15 GDP (USD, billions) 125 2473 2 22 1 16 226 0.3 1 GDP per capita (USD) 4805 12217 3589 20247 611 606 21619 1620 1108 Major religion Catholicism Catholicism Catholicism Catholicism Islam Catholicism Catholicism Catholicism Catholicism Public expenditure with health (%GDP) 2.6 4.0 2.5 2.6 1.1 2.1 9.1 2.0 10.4 Public expenditure with education (%GDP) 4.9 6.2 5.5 2.2 2.2 5.7 4.2 5.6 16.2 Illiteracy rate (% population) 28.4 8.5 12.8 6.0 40.1 41.2 5.2 9.6 35.9 Sociodemographic index * 0.42 0.66 0.55 0.61 0.29 0.28 0.75 0.45 0.45 *Data from 2015. GDP: gross domestic product. USD: United States dollars. 501