RESUMO
BACKGROUND: Deaths from diseases of the circulatory system and ischemic heart diseases are declining, but slowly in developing countries, emphasizing its probable relationship with determinants of social vulnerability. OBJECTIVES: To analyze the temporal progression of mortality rates of diseases of the circulatory system and ischemic heart diseases from 1980 to 2019 and the association of the rates with the Municipal Human Development Index and Social Vulnerability Index in Brazil. METHODS: We estimated the crude and standardized mortality rates of diseases of the circulatory system and ischemic heart diseases and analyzed the relationship between the obtained data and the Municipal Human Development Index and Social Vulnerability Index. Data on deaths and population were obtained from the DATASUS. The Municipal Human Development Index and the Social Vulnerability Index of each federative unit were extracted from the websites Atlas Brazil and Atlas of Social Vulnerability, respectively. RESULTS: The age-standardized mortality rates of diseases of the circulatory system and ischemic heart diseases showed a downward trend nationwide, which was unequal across the federative units. There was an inversely proportional relationship between the standardized mortality rates of diseases of the circulatory system and ischemic heart diseases and the Municipal Human Development Index. The downward mortality trend was observed when the indices were greater than 0.70 and 0.75, respectively. The Social Vulnerability Index was directly proportional to the standardized mortality rates of diseases of the circulatory system and ischemic heart diseases. An upward mortality trend was observed with a Social Vulnerability Index greater than 0.35. CONCLUSIONS: Social determinants represented by the Municipal Human Development Index and the Social Vulnerability Index were related to mortality from diseases of the circulatory system and ischemic heart diseases across the Brazilian federative units. The units with most development and least social inequalities had the lowest mortality from these causes. The most vulnerable die the most.
Assuntos
Sistema Cardiovascular , Isquemia Miocárdica , Humanos , Brasil/epidemiologia , Determinantes Sociais da Saúde , Fatores SocioeconômicosRESUMO
Our hypothesis is that the fortification of flour with folic acid contributes to the reduction of plasma homocysteine (Hcy). We conducted a cross-sectional study covering 2 periods, before and after fortification (2002-2003 and 2008-2009, respectively), to assess the influence of the consumption of corn and wheat flours prefortification and postfortification with folic acid on Hcy levels and other biomarkers. In the total, 93 women (38 prefortification and 55 postfortification) were included. Levels of lipids and glucose, total Hcy and serum folate, and cobalamin were determined using commercial kits by colorimetric method, competitive immunoassay, and chemiluminescence, respectively The participants' average age was 48.1 ± 9.5 years for the prefortification group and 39.1 ± 4.1 years for the postfortification group (P < .001) but adjusted statistical tests by age. Both groups presented obesity class 1. In the prefortification group, 71.1% (n = 27) of women had a dietary intake of folate, which was lower than the current recommended for adults (< 400 µg/d), whereas in the postfortification group, only 16.4% (n = 9) of women had lower intakes than recommended. In the prefortification group, 42.1% (n = 16) of women had hyperhomocysteinemia (> 10 mmol/L) compared with only 9.1% (n = 5) in the postfortification group. Moreover, statistically significant differences were found between the 2 groups in total cholesterol, high-density lipoprotein, triglycerides, and dietary fiber. Our findings corroborate the hypothesis that fortification of wheat and corn flours with folic acid can possibly be associated with lower concentrations of plasma Hcy, providing probable greater cardiovascular protection in this group.