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 – Three main causes of specific deaths (according to the International Classification of Diseases-10) in the most populated capital cities of the five geographic regions of Brazil, 2015 Gender/ Age range Manaus Salvador Goiania São Paulo Curitiba Cancer DCS Cancer DCS Cancer DCS Cancer DCS Cancer DCS Female 30-69 years Cervix CVD Breast CVD Breast IHD Breast IHD Breast IHD Breast IHD Colon IHD Lung CVD Lung CVD Lung CVD Lung MI Lung MI Cervix MI Colon MI Colon MI Female ≥ 70 years Lung CVD Breast CVD Breast CVD Breast IHD Breast CVD Cervix IHD Colon IHD Colon IHD Colon CVD Colon IHD Breast MI Lung MI Lung HD Lung MI Lung MI Male 30-69 years Stomach IHD Lung IHD Lung IHD Lung IHD Lung IHD Lung CVD Prostate CVD Colon MI Colon MI Colon MI Larynx MI Pharynx MI Pharynx CVD Stomach CVD Stomach CVD Male ≥ 70 years Prostate CVD Prostate CVD Prostate CVD Prostate IHD Prostate CVD Lung IHD Lung IHD Lung IHD Lung MI Colon IHD Stomach MI Colon MI Colon MI Colon CVD Lung MI Source: DATASUS. DCS: diseases of the circulatory system; CVD: cerebrovascular disease; IHD: ischemic heart diseases; MI: myocardial infarction; HD: hypertensive diseases; for the analysis, MI was considered a separate cause (from ischemic diseases) of death, and the sections 069 (chapter about DCS) and section 052 (chapter about cancer) of the International Classification of Diseases-10 were not included in the ranking of diseases General trend of the curves of mortality from DCS and CA in Brazil Analysis of the historical trend of the curves of mortality from DCS and CA reveled an important and sustained decrease of deaths from DCS in the most populous capital cities of each of the five Brazilian regions, except for Manaus. In this city, late mortality from DCS increased in men. Data from Brazil showed that DCS continue the main cause of mortality. However, an analysis of the cities revealed that CA already surpassed DCS as the leading cause of deaths in nearly 10% of the Brazilian cities. 25 The results of the present work suggest two patterns of trends that led to the grouping of the five capitals into two subgroups: in the first subgroup, São Paulo and Curitiba, whose pattern is more similar to that of developed countries, i.e., with a significant fall in mortality fromDCS, plus maintenance or slight decrease of mortality from CA. In this pattern, convergence of the curves results from the decrease in deaths fromDCS. In the second pattern, Goiania, Salvador and Manaus, where there was also a decrease in mortality due to DCS, but less significant, in contrast to a modest increase in mortality from CA. In this second group, the convergence of the curves takes longer to occur. Manaus showed a singular behavior, with increase of late mortality from DCS in males. In the Brazilian cities studied, data of 2015 showed that ischemic heart disease and cerebrovascular disease were the main causes of DCS. While individuals in the early age group die more from ischemic heart disease, at late age, mortality from cerebrovascular disease is higher. Between 1996 and 2011, in Brazil, there was a consistent decrease in mortality rate due to cerebrovascular disease in both genders, with differences in the magnitude of decrease between the regions. 26 In addition to socioeconomic development, the control of cardiovascular risk factors and a considerable increase (450%) in the access to primary care services, may have contributed to the decrease. 27 As observed in developed countries, efforts to diagnosis and treatment of risk factors and comorbidities have probably contributed to the decrease of stroke mortality, 28 and hence to the decrease of mortality from DCS. Regional trends in the curves of mortality from DCS and CA São Paulo and Curitiba presented a decrease in early and late mortality in both genders. It could be partly explained by the greater access to the diagnosis and treatment of CA. Chemotherapy and radiotherapy services are more concentrated in the Southern and Southeastern regions of Brazil. 29 In Salvador, it was observed a decrease in early mortality from CA in men. Lung cancer has a high lethality and is the main type of cancer in this population. It is currently the main cause of death among men in North America and Europe and its mortality has significantly increased in Asia, Latin America and Africa. 30 In Brazil, adenocarcinoma is the main cause of early mortality among men and is related to the high prevalence of smoking in male sex. 15,31 The decrease in CA mortality in Salvador can be attributed to the public policies for CA prevention during the last decades, and in 2004, Salvador presented the lowest smoking rate in Brazil. 32 On the other hand, late mortality from CA has increased among men and women. One hypothesis for such increase among women is the high mortality rates from breast cancer, which represents the leading cause of late mortality in women. 15 Mortality rates from breast cancer in the Brazilian population have shown geographic variations, with a trend to stabilization in the southeast, decline in the south and increase in the north, northeast and central-west regions. 203