ABC | Volume 115, Nº2, August 2020

Original Article Malta et al. Cardiovascular Disease Mortality in SIM and GBD Arq Bras Cardiol. 2020; 115(2):152-160 rates provided by the Corrected SIM were not corrected by the redistribution of GC, all GBD Study estimates were corrected for death underreporting and redistribution of ill-defined causes and of GC. Thus, the GBD estimated rates differ from those of the other methods that do not use GC redistribution. Some examples of GC causes are as follows: septicemia; cardiac arrest; dehydration; congestive heart failure. They are part of the train of events leading to death, but are not the underlying cause of death. 8 For the GC redistribution, the GBD Study uses algorithms based on medical literature evidence, multiple sources, expert opinions, analysis of multiple causes, and mainly on statistical modelling techniques to define the weight of assigning each GC to the most probable underlying cause of death, called target . 6,8 The SIM is a consolidated system, which the Brazilian Ministry of Health has been perfecting via processes of validation of internal inconsistencies and improvement in death reporting. However, the classification requires refinement, especially regarding the reduction in GC. When comparing the mortality estimates of the GBD Study with the Crude SIM data, the differences observed are due to age and sex inconsistencies related to causes of death, underreporting, and GC redistribution . The GC redistribution has the greatest influence on the difference Table 2 – Standardized cardiovascular disease mortality rates for Brazil, its states and Federal District, in the years 2000 and 2017, as well as their percentage variations in the period Location Crude SIM Corrected SIM GBD 2017 2000 2017 Variation (%) 2000 2017 Variation (%) 2000 2017 Variation (%) Acre 122.4 155.4 26.9 199.1 167.6 -15.8 203.9 158.5 -22.3 Alagoas 159.5 210.7 32.1 261.7 225.7 -13.8 253.6 211.9 -16.4 Amapá 149.7 136.1 -9.0 200.9 160.8 -20.0 242.7 157.2 -35.2 Amazonas 124.2 128.6 3.5 188.4 156.0 -17.2 177.5 147.0 -17.1 Bahia 134.8 137.6 2.1 235.6 173.8 -26.2 210.0 162.9 -22.4 Ceará 139.6 158.5 13.6 219.7 165.6 -24.6 194.1 152.4 -21.5 Federal District 233.1 135.6 -41.8 251.2 142.1 -43.4 301.5 175.4 -41.8 Espírito Santo 220.4 156.0 -29.2 278.6 158.6 -43.1 275.8 165.8 -39.9 Goiás 215.5 161.4 -25.1 247.3 166.6 -32.6 252.3 163.9 -35.1 Maranhão 83.5 179.3 114.8 225.5 211.1 -6.4 190.3 184.6 -3.0 Mato Grosso 228.4 152.1 -33.4 258.1 163.7 -36.6 240.2 162.8 -32.2 Mato Grosso do Sul 240.1 165.1 -31.2 270.5 177.0 -34.6 274.6 198.6 -27.7 Minas Gerais 204.6 132.9 -35.1 242.6 146.3 -39.7 228.4 154.5 -32.4 Pará 132.1 156.0 18.1 223.9 182.4 -18.5 200.9 168.6 -16.1 Paraíba 98.2 168.7 71.7 233.3 188.3 -19.3 213.0 190.9 -10.4 Paraná 287.4 152.8 -46.8 306.6 167.8 -45.3 297.0 188.3 -36.6 Pernambuco 206.0 183.2 -11.1 282.0 205.6 -27.1 263.2 214.6 -18.5 Piauí 136.5 190.6 39.6 269.0 201.9 -24.9 227.8 175.1 -23.1 Rio de Janeiro 252.1 168.1 -33.3 292.7 194.9 -33.4 296.0 207.7 -29.8 Rio Grande do Norte 121.9 145.7 19.6 196.6 156.0 -20.7 185.9 159.2 -14.3 Rio Grande do Sul 263.4 138.6 -47.4 277.1 154.6 -44.2 266.2 177.2 -33.4 Rondônia 191.7 157.3 -17.9 251.2 180.3 -28.2 253.0 184.8 -26.9 Roraima 190.5 177.5 -6.8 221.3 187.6 -15.2 305.9 196.3 -35.8 Santa Catarina 237.3 138.6 -41.6 279.9 150.0 -46.4 277.6 170.2 -38.7 São Paulo 264.3 160.3 -39.3 285.6 172.7 -39.5 283.3 185.6 -34.5 Sergipe 141.7 154.0 8.7 234.8 170.2 -27.5 218.6 171.6 -21.5 Tocantins 155.5 186.2 19.8 259.4 193.2 -25.5 294.6 173.9 -41.0 Brazil 211.7 155.1 -26.7 263.9 172.0 -34.8 248.8 178.0 -28.5 158