ABC | Volume 114, Nº2, February 2020

Original Article Martins et al. Mortality from cardiovascular disease and cancer Arq Bras Cardiol. 2020; 114(2):199-206 Table 3 shows the three main causes of mortality, stratified by early and late, and by gender, in the most populous capital cities of the five regions. There were differences between the cities, the age ranges and the genders. Discussion Mortality from DCS and CA in Brazil compared with the world In Brazil, the discussion about the increase in cancer mortality is more recent than in European countries and USA, where the epidemiological transition occurred earlier than in Brazil. In Brazil in 2005, 32% of deaths were caused by DCS, followed by cancer (15%). At that time, Rosa et al. 19 drew attention to a probable intersection of the curves of mortality from DCS and CA. In the United Kingdom, in 2011, the DCS passed from the first cause of mortality to second position for the first time since the middle of the 20 th century; 20 29% of the deaths were caused by CA, while 28% by DCS. 21 The reduction of mortality from DCS in the United Kingdom was explained by a decrease in the mortality from myocardial infarction, increase of pharmacological and surgical treatments, and decrease of risk factors like smoking. 21-23 Similar situation to Brazil was observed in the USA, where mortality from DCS decreased more than from CA. If this tendency continues, CA will be the leading cause of deaths in 2020. 24 The different stages of growth and development of the Brazilian regions made us make a particularized analysis, since it is difficult to draw a reliable picture of Brazil as a whole. The choice of the most populous capitals came from the assumption of a higher degree of urbanization and its influence on the health of the inhabitants. In general, in the western world, the interception of the mortality curves is caused by a marked decrease of mortality from DCS, especially in more developed countries in terms of socioeconomic development. Table 1 – Trends in estimated annual percentage change of mortality from diseases of the circulatory system and cancer in the most populated capital cities of the five geographic regions of Brazil, 2015 Capitals Early mortality Late mortality Male Female Male Female CA DCS CA DCS CA DCS CA DCS Manaus APC 95%CI -0.8* (-1.5;0) -2.0* (-2.9;-1.1) 0.5 (-0.4;1.3) -2.3* (-2.8;-1.7) 1.1* (0.5;1.7) 1.1* (0.5;1.7) -3.0 (-6.6;0.8) -0.3 (-0.9;0.3) Salvador APC 95%CI -0.9* (-1.4;-0.4) -3.4* (-4.1;-2.7) -1.7 (-4.4;1.1) -4.3* (-4.9;-3.6) 0.9* (0.3;1.5) -1.4* (-2.1;-0.8) 0.5 (0;1) -2.4* (-2.9;-1.9) Goiania APC 95%CI 0.4 (-0.4;1.2) -4.0* (-4.5;-3.4) 0.7* (0.1;1.4) -4.0* (-4.8;-3.2) 1.2* (0.4;2) -2.3* (-3;-1.7) 1.4* (0.7-2.1) -2.5* (-3;-2) São Paulo APC 95%CI -1.9* (-2.1;-1.7) -2.6* (-3.1;-2.2) -0.9* (-1.1;-0.8) -2.9* (-3.5;-2.3) -1.5* (-1.7;-1.3) -3.1* (-3.3;-2.8) -1.0* (-1.3;-0.8) -3.1* (-3.4;-2.8) Curitiba APC 95%CI -3.4* (-4.2;-2.7) 0.3 (-6.8;7.8) -2.2* (-2.8;-1.5) -6.5* (-7.1;-5.9) -1.9* (-2.3;-1.4) -4.1* (-4.5;-3.6) -1.1* (-1.9;-0.3) -4.4* (-4.8;-3.9) Brazil APC 95%CI -0.9* (-1.1;-0.7) -2.7* (-3.5;-1.9) 0.1 (-0.1;0.4) -2.4* (-2.6;-2.2) 0.1 (-0.1;0.3) -2.1* (-2.5;-1.6) 0.2 (-0.1;0.4) -2.1* (-2.6;-1.7) *indicates statistically significant association (p < 0.05); CA: cancer; DCS: diseases of the circulatory system; EAPC: estimated annual percentage change; CI: confidence interval Table 2 – Estimated intersection point (year) of the mortality curves from diseases of the circulatory system and cancer in the most populated capital cities of the five geographic regions of Brazil Locality Age range of early mortality Age range of late mortality Male Female Male Female Year of intersection Manaus 2009 1992 - - Salvador 2023 - 2031 2038 Goiania 2018 2000 2026 2034 São Paulo 2071 2009 2047 2051 Curitiba - 2004 2032 2033 Brazil 2035 2015 2045 2057 Source: DATASUS, according to chapters II and IX from International Classification of Diseases-10; age of early mortality: between 30 and 60 years old; age of late mortality: older than 70 years 202