Search

Background Monitoring premature mortality due to noncommunicable diseases (NCDs) is a global priority, as part of the Agenda 2030. Objective The current study aims to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and states, projections for 2030. Methods We analyzed the following NCDs: cardiovascular diseases, chronic respiratory diseases, neoplasms, diabetes mellitus, comparing deaths and mortality rates between 1990 and 2017, for Brazil and states. The study used the concept of premature mortality used by the World Health Organization (30 to 69 years). The absolute number of deaths, mortality rates, DALYs, years of life lost (YLL), were used, comparing 1990 and 2017. We also analyzed the premature death fraction (YLL) for NCDs attributable to risk factors. Results There was a reduction of 35,3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCD in 2017. DALYs rate decreased by 33.6% and the YLL rate by 36.0% in the same period. There was a reduction in the NCD rates in all 27 states. The main risk factors related to premature deaths by NCDs in 2017 among women were - high body mass index, diet risks, high systolic blood pressure, tobacco, and among men, diet risks, high systolic blood pressure, tobacco, high body mass index. Trends in mortality rates due to NCDs were declining in the period, however, after 2015, the curve reversed and fluctuation and tendency to increase rates were observed. Conclusions Trends of mortality rates by NCD were declining in the period, however, after 2015, the curve was inverted and the fluctuation and trend of increasing rates was observed, which can compromise the SDG goals in 2030. Key messages The austerity policies adopted and the economic crisis in Brazil after 2015, resulted in increased poverty and worsening NCD mortality indicators. With the NCD indicators worsening in 2015, SDG targets may not be achieved.

Background Hypertension remains the leading risk factor for cardiovascular disease worldwide. In Brazil, a third of adults have hypertension. The prevalence and impact of this risk factor on disease burden in Brazil and its federal units should be assessed in order to better address the issue. Objective To describe trends in prevalence and burden of diseases attributable to high systolic blood pressure (HSBP) among Brazilians ≥25 years old according to sex and federal units using the Global Burden of Disease (GBD) 2017 estimates. Methods We used the comparative risk assessment developed for the GBD study to estimate trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALY), by sex, and federal units for HSBP from 1990 to 2017. This study included 14 HSBP-outcome pairs that met the GBD study criteria for evidence of causation. HSBP was defined as ≥140mmHg for prevalence estimates and, to evaluate the burden of HSBP, a theoretical minimum risk exposure level (TMREL) of 110–115 mmHg was considered. We estimated the portion of deaths and DALYs that could be attributed to HSBP. We also explored the drivers of trends in attributable burden of HSBP, as well as the relation of HSBP burden and sociodemographic development. Results In Brazil, the prevalence of HSBP is 18.9 (95% uncertainty intervals [UI] 18.5 to 19.3%) and the age-standardized death rate attributable to HSBP decreased from 189.2 (95%UI 168.5 to 209.2) deaths to 104.8 (95%UI 94.9 to 114.4) deaths per 100,000 from 1990 to 2017. In spite of that, the total number of deaths attributable to HSBP increased 53.4% and HSBP raised from 3rd to 1st position, as the leading risk factor for deaths during the period. Regarding total DALYs, HSBP raised from 4th in 1990 to 2nd cause in 2017 - in the last, only behind smoking. The main driver in the change of HSBP burden in Brazil is population aging. Across federal units, the reduction in the age-standardized death rates attributable to HSBP are heterogeneous and the greater reduction correlated to higher sociodemographic development. Conclusions The age-standardized death and DALY rates attributable to HSBP are decreasing in Brazil, probably as results of successful public health policies for primary prevention and control of HSBP. However, the reduction was more significant in federal units with higher sociodemographic development, suggesting that the effect of health policies was heterogeneous. Moreover, HSBP has become the main risk factor for death in the country, mainly due to population aging. As such, the Brazilian health system should increase investments in policies to address the situation and prepare itself to cope with higher burden of HSBP in the near future. Acknowledgement/Funding The GBD 2017 Brazil study is primarily funded by the Bill & Melinda Gates Foundation