ABC | Volume 115, Nº2, August 2020

Original Article Cardiovascular Disease Mortality According to the Brazilian Information System on Mortality and the Global Burden of Disease Study Estimates in Brazil, 2000-2017 Deborah Carvalho Malta, 1 Renato Teixeira, 2 Gláucia Maria Moraes de Oliveira, 3 Antonio L. Ribeiro 4 Universidade Federal de Minas Gerais - Escola de Enfermagem, Programa de Pós-Graduação em Saúde Pública., 1 Belo Horizonte, MG - Brazil Universidade Federal de Minas Gerais Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, 2 Belo Horizonte, MG - Brazil Universidade Federal do Rio de Janeiro, 3 Rio de Janeiro, RJ - Brazil Universidade Federal de Minas Gerais - Centro de Telessaúde - Hospital das Clínicas/Departamento de Clínica Médica - Faculdade de Medicina, UFMG, 4 Belo Horizonte, MG – Brazil Correspondência: Deborah Carvalho Carvalho Malta • Universidade Federal de Minas Gerais - Escola de Enfermagem - Professor Alfredo Balena, 190. CEP 30130-100, Belo Horizonte, MG – Brasil E-mail: dcmalta@uol.com.br Artigo recebido em 04/12/2019, revisado em 21/02/2020, aceito em 16/03/2020 DOI: https://doi.org/10.36660/abc.20190867 Abstract Background: The Brazilian Information System on Mortality (SIM) is of vital importance in monitoring the trends of cardiovascular diseases (CVDs) and is aimed at supporting public policies. Objective: To compare historical series of CVD mortality based on data from the SIM, with and without correction, and from the Brazil Global Burden of Disease (GBD) Study 2017, in the 2000-2017 period. Methods: Analysis of CVD mortality in Brazil between 2000 and 2017. Three CVD mortality estimates were compared: Crude SIM, Corrected SIM, and GBD 2017. Absolute numbers and age-standardized rates were used to compare the estimates for Brazil, its states and the Federal District. Results: In the SIM, the total of deaths ranged from 261,000, in 2000, to 359,000, in 2017. In the GBD 2017, the total of deaths ranged from 292,000 to 388,000, for the same years, respectively. A high proportion of the causes of death from CVD corresponded to garbage codes, classified according to the GBD 2017, reaching 42% in 2017. The rates estimated by GBD ranged from 248.8 (1990) to 178.0 (2017) deaths per 100,000 inhabitants. The rates of the Crude SIM and Corrected SIM also showed a reduction for the whole series analyzed, the Crude SIM showing lower rates: 204.9 (1990) and 155.1 (2017) deaths per 100 thousand inhabitants. When analyzing by the states and Federal District, the Crude SIM trends reversed, with an increase in mortality rates in the Northern and Northeastern states. Conclusion: This study shows the decrease in CVD mortality rates in Brazil in the period analyzed. Conversely, when analyzing by the states and Federal District, the Crude SIM showed an increase in those rates for the Northern and Northeastern states. The use of crude data from the SIM can result in interpretation errors, indicating an increase in rates, due to the increase in death data capture and the improvement in the definition of the underlying causes of death in the past decade, especially in the Northern and Northeastern regions, justifying the use of corrected data in mortality analyses. (Arq Bras Cardiol. 2020; 115(2):152-160) Keywords: Cardiovascular Diseases/mortality; Data Accuracy/trends; Health Information System/trends; Epidemiology The Brazilian Information System on Mortality (SIM), which provides data to identify and address death record information, was implanted in 1975, being the first nationwide epidemiological database of the Brazilian Health Ministry. 3 The cornerstone of SIM is the death certificate, which should be completed by the physician caring for the deceased patient. In the absence of that professional, however, the death certificate can be completed by: the substitute physician; the physician from the Death Verification Service – for natural causes of death; or the coroner – for deaths by external causes. 2,3 All Brazilian municipalities must register their deaths, which results in around 1.3 million deaths reported per year, making SIM one of the major tools to monitor the mortality statistics in Brazil. The SIM coverage has increased in all Brazilian states and Federal District, passing from 86% in 2000 to 98% in 2017; however, some Northern and Introduction In past years, Brazil has compiled different data sources that constitute the information system on morbidity and mortality and periodic health inquiries, which enable the continuous monitoring of data on mortality, morbidity, and risk factors for cardiovascular diseases (CVDs), and support decision-making processes in health policies. 1,2 152