ABSTRACT

OBJECTIVE:

to estimate the burden of cardiovascular diseases in Santa Catarina State, Brazil.

METHODS:

this is an ecological study with the nine health macroregions of the state as units of analysis; the number of years of life lost, the number of years lived with disability and the number disability-adjusted life years (DALYs) for 2009 were estimated.

RESULTS:

a total of 358,777 DALYs were estimated, with a rate of 5,852 DALYs/100,000 inhabitants, 51.1% in males; age groups with the highest rates were 45-59, 60-69, and 70-79 years; diseases that most contributed to the DALYs were ischemic heart diseases and cerebrovascular diseases; health regions with the highest DALYs rates were Planalto Norte, Sul and Serra Catarinense.

CONCLUSION:

the high burden of cardiovascular diseases in Santa Catarina shows the need to intensify actions of health promotion and prevention in all regions of the state.

Keywords:
Cardiovascular Diseases; Disability-Adjusted Life Years; Cost of Illness; Mortality; Ecological Studies.

Introduction

Cardiovascular diseases represent a major issue, being the leading cause of death in Brazil and accounting for one third of the total of deaths in the country.¹1. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Diretrizes para o cuidado das pessoas com doenças crônicas nas redes de atenção à saúde e nas linhas de cuidado prioritárias. Brasília: Ministério da Saúde; 2013. They contribute significantly for the global burden of diseases, with ascending behavior in developing countries and descending behavior in developed countries.²2. Institute of Health Metrics and Evaluation. GBD history [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep 13]. Available from: Available from: http://www.healthdata.org/gbd/about/history
http://www.healthdata.org/gbd/about/hist... Countries such as Ukraine with 33.9% and Russia with 31.2% presented the highest percentages for this diseases, in 2013.²2. Institute of Health Metrics and Evaluation. GBD history [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep 13]. Available from: Available from: http://www.healthdata.org/gbd/about/history
http://www.healthdata.org/gbd/about/hist... In Brazil, the percentage increased from 11.9% in 1990 to 14.5% in 2003.²2. Institute of Health Metrics and Evaluation. GBD history [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep 13]. Available from: Available from: http://www.healthdata.org/gbd/about/history
http://www.healthdata.org/gbd/about/hist...

The mortality burden related to cardiovascular diseases increased around 41% in the period from 1990 to 2013, although it has decreased 39% in specific age groups.³3. Roth GA, Forouzanfar MH, Moran AE, Barber R, Nguyen G, Feigin VL, et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med. 2015 Apr;372:1333-41.

Among cardiovascular diseases, ischemic heart diseases and cerebrovascular diseases constitute the subgroups which contribute the most to the global burden of diseases.²2. Institute of Health Metrics and Evaluation. GBD history [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep 13]. Available from: Available from: http://www.healthdata.org/gbd/about/history
http://www.healthdata.org/gbd/about/hist... In the 2008 Brazilian study on Global Burden of Diseases, cardiovascular diseases accounted for the first (7.2%) and fourth place (4.4%) among males, and second (6.4%) and fourth (4.8%) place among females.⁴4. Leite IC, Valente JG, Schramm JMA, Daumas RP, Rodrigues RN, Santos MF, et al. Carga de doença no Brasil e suas regiões, 2008. Cad Saude Publica. 2015 Jul;31(7): 1551-64.

The estimation of the burden of disease, composed by indicators of early mortality and morbidity, reveals priorities in health prevention and offers subsidies for the conception of public policies. The Disability-Adjusted Life Years (DALYs) indicator, which was idealized by Murray,⁵5. Murray CJ. Quantifying the burden of disease the technical basis for disability-adjusted life years. Bull World Health Organ. 1994;72(3):429-45. has been used worldwide in the studies on Global Burden of Disease in 1990,²2. Institute of Health Metrics and Evaluation. GBD history [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep 13]. Available from: Available from: http://www.healthdata.org/gbd/about/history
http://www.healthdata.org/gbd/about/hist... 2010⁶6. Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012 Dec;380(9859):2197-223 and 2013.⁷7. Institute of Health Metrics and Evaluation. GBD 2013: global burden of diseases, injuries, and risk factors: protocol 2013 [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2013 [cited 2016 Sep 13]. Available from: Available from: http://www.healthdata.org/sites/default/files/files/GBD_2013_Protocol.pdf
http://www.healthdata.org/sites/default/...

In Brazil, the global burden was estimated in 1998⁸8. Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Projeto Carga de Doença: relatório final do projeto estimativa da carga de doença do Brasil: 1998. Rio de Janeiro: Fiocruz; 2002. and updated in 2008.⁴4. Leite IC, Valente JG, Schramm JMA, Daumas RP, Rodrigues RN, Santos MF, et al. Carga de doença no Brasil e suas regiões, 2008. Cad Saude Publica. 2015 Jul;31(7): 1551-64. The state of Minas Gerais had its global burden estimated in 2011.⁹9. Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Núcleo de Pesquisa em Métodos Aplicados aos Estudos de Carga Global de Doença. Relatório final do projeto Carga Global de Doença do Estado de Minas Gerais, 2005 [Internet]. Rio de Janeiro: Fundação Oswaldo Cruz; 2011 [citado 2016 set 13]. Disponível em: Disponível em: http://www.saude.mg.gov.br/images/documentos/Estudo%20de%20Carga%20de%20Doencas%20de%20Minas%20Gerais.pdf
http://www.saude.mg.gov.br/images/docume... Studies for some disease groups were conducted in the state of Santa Catarina, at state¹⁰10. Traebert J, Nickel DA, Traebert E, Escalante JJC, Schneider IJC. The burden of infectious diseases in the Brazilian Southern state of Santa Catarina. J Infect Public Health. 2016 Mar-Apr;9(2):181-91.

11. Marcon CE, Schneider IJ, Schuelter-Trevisol F, Traebert J. Trends in the burden of hepatitis B in a southern Brazilian state. Hepat Mon. 2015 Nov;15(11):e31906.

12. Ferrer GCN, Silva RM, Ferrer KT, Traebert J. The burden of disease due to tuberculosis in the state of Santa Catarina, Brazil. J Bras Pneumol. 2014 Jan-Feb;40(1):61-8.

13. Silva HCG, Silva J, Traebert J. Burden of AIDS in a Brazilian state. J Infect Public Health. 2014 Jul-Aug;7(4):308-13.

14. Borba KB, Traebert J. Carga de doença por sífilis congênita em Santa Catarina, 2009. Epidemiol Serv Saude. 2014 out-dez;23(4):761-6.^-1515. Traebert J, Schneider IJ, Colussi CF, Lacerda JT. Burden of disease due to cancer in a Southern Brazilian state. Cancer Epidemiol. 2013 Dec;37(6):788-92. and municipal levels.¹⁶16. Traebert J, Silva MF, Nickel DA, Schneider IJC. Estimativa da carga de doença por AIDS em Florianópolis, Santa Catarina, Brasil, 2009. Epidemiol Serv Saude. 2015 jul-set;24(3):517-22.

17. Da Silva J, Ramos V, Da Silva HC, Traebert J. Morbidity and mortality due to AIDS: a study of burden of disease at a municipal level. Rev Inst Med Trop S Paulo. 2015 Sep-Oct;57(5):407-11.^-1818. Borba KB, Schneider IJC, Lacerda JT, Traebert J. Burden of disease attributable to cancer: a study at a municipal level. Int J Cancer Res. 2013;47(2):1169-75. It is important to highlight the importance of monitoring burden indicators, not only to guide new actions but also to ratify the ones already under way. Up to the conclusion of this article, there was no knowledge of Brazilian studies that have assessed the burden of cardiovascular diseases at a local level. The objective of this study was to estimate the burden of cardiovascular diseases in Santa Catarina State, Brazil.

Methods

An ecological study was carried out based on the records of individuals resident in Santa Catarina that were hospitalized or received treatment in hospitals from the Brazilian National Health System (SUS) for cardiovascular diseases or who died for that same reason in 2009.

We used information on the resident population estimated for that year, by sex and age group, in the state as a whole and in its nine health macroregions: Sul, Grande Florianópolis, Nordeste, Planalto Norte, Serra Catarinense, Foz do Rio Itajaí, Vale do Itajaí, Meio Oeste and Grande Oeste. The variable "age" was divided into nine age groups, in years: under 1, 1-4, 5-14, 15-29, 30-44, 45-59, 6-69, 70-79 and 80 or over.

The data on mortality due to cardiovascular diseases were obtained from the Mortality Information System (SIM) database, available at the website of SUS IT Department (Datasus): www.datasus.gov.br (access on March 10^th, 2011). The deaths with unknown age or sex were redistributed proportionally.

The data used were from patients who received treatment or were hospitalized because of cardiovascular diseases and were obtained from the Hospital Admission Authorization (AIH-SUS) of SUS Hospital Information System (SIH/SUS), provided by Datasus. The records of hospitalizations and/or treatments of the same patient, in case there was more than one hospitalization, were excluded from the database, keeping only the first.

All the cases whose codes of the 10^th Revision of the International Classification of Diseases and Related Health Problems (ICD-10) did not correspond to rheumatic heart diseases (I01-I09), ischemic heart diseases (I20-I25), cerebrovascular diseases (I60-I69), inflammatory heart diseases (I30-I33, I38, I40, I42), hypertensive heart diseases (I10-I13 ), pulmonary embolism (I26) and aortic aneurysm and dissection (I71) were included into a category named "residual". However, the codes relating to unspecified diseases/symptoms (I47-I51 and I70), named "garbage-codes", were redistributed proportionally among the other types of cardiovascular diseases, according to the correction proposal used in the Study on Global Burden of Diseases in Brazil,⁸8. Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Projeto Carga de Doença: relatório final do projeto estimativa da carga de doença do Brasil: 1998. Rio de Janeiro: Fiocruz; 2002. which, in turn, was based on the Study on Burden of Disease in Australia.¹⁹19. Mathers C, Vos T, Stevenson C. The burden of disease and injury in Australia. Camberra: Australian Institute of Helth and Welfare; 1999. (AIHW cat. Nº PHE 17). In short, the code I50 (heart failure) was redistributed in different proportions, according to age groups, among ischemic heart diseases, inflammatory heart diseases and hypertensive heart disease. The same was done with the other codes relating to unspecified diseases/symptoms, however, they were placed into the group of ischemic heart diseases and into the group of other heart diseases.

The number of Years of Life Lost (YLLs) due to premature death was estimated by subtracting the age at death from the standardized life expectancy. In this study, we used the same parameters for the studies on global burden of diseases²2. Institute of Health Metrics and Evaluation. GBD history [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep 13]. Available from: Available from: http://www.healthdata.org/gbd/about/history
http://www.healthdata.org/gbd/about/hist... and the estimate of the burden of disease in Brasil⁸8. Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Projeto Carga de Doença: relatório final do projeto estimativa da carga de doença do Brasil: 1998. Rio de Janeiro: Fiocruz; 2002. in its 2008 revision,⁴4. Leite IC, Valente JG, Schramm JMA, Daumas RP, Rodrigues RN, Santos MF, et al. Carga de doença no Brasil e suas regiões, 2008. Cad Saude Publica. 2015 Jul;31(7): 1551-64. i.e., life expectancy at birth of 80 years for males and 82.5 years for females. These values are standardized to allow international comparability between the results of studies which used the same parameters (the study on global burden of diseases carried out in 2015 uses different parameters). To calculate the YLLs, the data from SIM was classified by type of cardiovascular disease according to ICD-10 (Table 1).

A discount rate of 3% was applied for each year of life lost in the future to calculate the YLLs.⁴4. Leite IC, Valente JG, Schramm JMA, Daumas RP, Rodrigues RN, Santos MF, et al. Carga de doença no Brasil e suas regiões, 2008. Cad Saude Publica. 2015 Jul;31(7): 1551-64.^,88. Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Projeto Carga de Doença: relatório final do projeto estimativa da carga de doença do Brasil: 1998. Rio de Janeiro: Fiocruz; 2002. Therefore, the future years suffer the effect of the discount rate, so that each year of healthy life lost was counted as 97% of the previous one and so on.

The number of Years Lived with Disability (YLDs) was estimated by multiplying the weight of the disease/sequelae by its length of time. For the cases of pulmonary embolism and diseases classified as of rheumatic, bacterial or viral acute behavior, the length of time considered was the hospitalization period. For the remaining cases, the length of time was considered permanent, calculated by subtracting the individual's age when hospitalized from the standardized life expectancy.⁴4. Leite IC, Valente JG, Schramm JMA, Daumas RP, Rodrigues RN, Santos MF, et al. Carga de doença no Brasil e suas regiões, 2008. Cad Saude Publica. 2015 Jul;31(7): 1551-64.^,88. Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Projeto Carga de Doença: relatório final do projeto estimativa da carga de doença do Brasil: 1998. Rio de Janeiro: Fiocruz; 2002.

The disability weights recommended by the World Health Organization (WHO)²⁰20. World Health Organization. Global burden of disease 2004 update: disability weights for diseases and conditions. Geneva: World Health Organization; 2004. for the several cardiovascular diseases were used (Table 1).

The Disability-Adjusted Life Years - DALYs - were calculated by adding the YLLs to the YLDs.

All the data were inserted in Excel worksheets and then were exported to the Statistical Package for the software Social Sciences (SPSS) version 18.0, through which it was analyzed. The YLLs, YLDs and DALYs rates were calculated per 100,000 inhabitants, taking into account the resident population of the state and its health macroregions in the year studied, and later standardized through the direct method, with the population of Santa Catarina State in 2010 as the standard population.

The study respected the guidelines established by the Resolution of the National Health Council (CNS) No. 466, dated December 12^th 2012, and used data from official health information systems, of public domain, so the project was exempted from appreciation by an Ethics Research Committee.

Results

A total of 9,597 deaths (SIM) and 45,320 cases of hospitalization (SIH/SUS) due to cardiovascular diseases were registered in Santa Catarina, in 2009. Out of this total, 13,763 cases (30.3%) were redistributed for being cases with unspecified codes.

We estimated 358,777.5 DALYs, which generated a rate of 5,852.5 DALYs/100,000 inhabitants, among which 51.1% were males and 48.9% females (Table 2).

The age groups that presented the highest rates were 60-69 (22,083.5 DALYs/100,000 inhabitants), 70-79 (19,861.2 DALYs/100,000 inhabitants) and 45-59 years (13,391.8 DALYs/100,000 inhabitants) (Figure 1). The diseases that contributed the most to DALYs were ischemic heart diseases (36.5%), cerebrovascular diseases (32.7%) and hypertensive heart disease (7.8%) (Figure 2).

Santa Catarina health macroregions with the highest global rates of DALYs were Planalto Norte (9,238.8 DALYs/100,000 inhabitants), Sul (7,563.7 DALYs/100,000 inhabitants) and Serra Catarinense (6,437.7 DALYs/100,000 inhabitants). It should be highlighted that Planalto Norte presented the highest rates in six out of the seven diseases studied; the exception was the hypertensive heart disease, for which the highest rate was observed in the health macroregion Sul (Figure 3).

Discussion

This study showed high burden of cardiovascular diseases in the entire state of Santa Catarina, in 2009. This corroborates to the behavior of these diseases, identified at national and global levels, as demonstrated in the studies on Global Burden of Disease in 1990, 2010, 2013,²2. Institute of Health Metrics and Evaluation. GBD history [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep 13]. Available from: Available from: http://www.healthdata.org/gbd/about/history
http://www.healthdata.org/gbd/about/hist... in which ischemic heart diseases and cerebrovascular diseases corresponded to the fourth and sixth global causes for DALYs in Brazil, representing 5.7% and 4.1% of the total of DALYs, respectively, in 1990. In 2010, these diseases had already risen up the ranking to the first and fourth positions, with 6.5% and 4.7% of the total of DALYs, respectively.²¹21. Institute of Health Metrics and Evaluation. GBD Profile: Brazil [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2010 [cited 2016 Sep 13]. Available from: Available from: https://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_brazil.pdf
https://www.healthdata.org/sites/default... Data from 2013 confirmed the position of both diseases in the ranking, whilst the contribution of ischemic heart diseases rose to 6.8%.²²22. Institute of Health Metrics and Evaluation. Brazil [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep13]. Available from: Available from: http://www.healthdata.org/brazil
http://www.healthdata.org/brazil... The reduction of 14% in ischemic heart diseases and 8% in cerebrovascular accidents, from 1990 to 2013, is noteworthy.²²22. Institute of Health Metrics and Evaluation. Brazil [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep13]. Available from: Available from: http://www.healthdata.org/brazil
http://www.healthdata.org/brazil...

The estimation of the burden of cardiovascular diseases at a local level is not common in Brazil. Thus, their behavior is unknown, both among the 27 federative units and within each one of them. Thus, the calculation of DALYs in Santa Catarina's health macroregions provides to health services, managers and technicians, a set of information on early deaths and disabilities caused by cardiovascular diseases. The present study demonstrates regional differences in the behavior of the indicator, showing that although the burden is high in the state as a whole, there are regions that show higher burden, such as Planalto Norte, where six of the seven diseases studied had the highest rates in the state. In turn, the Sul region of Santa Catarina showed the highest burden attributed to hypertensive heart disease, revealing differences in health conditions among the state's macroregions; possibly, such differences are not sufficiently sensitive to being detected by other indicators used in epidemiological studies on cardiovascular diseases. The results presented here reflect the need to develop researches with adequate research designs to point out the reasons for higher burden of cardiovascular diseases in certain regions of Santa Catarina state.

Non-communicable chronic diseases, especially cardiovascular diseases, are the highest priority in Brazil's Public Health system. The prevalence of diabetes and systemic arterial hypertension arise alongside overweight, and are associated with sedentary lifestyle. Data on the global burden of disease in 2013 pointed that the biggest risk factors for the increase of DALYs were dietary aspects, systemic arterial hypertension and high body mass index (BMI).²¹21. Institute of Health Metrics and Evaluation. GBD Profile: Brazil [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2010 [cited 2016 Sep 13]. Available from: Available from: https://www.healthdata.org/sites/default/files/files/country_profiles/GBD/ihme_gbd_country_report_brazil.pdf
https://www.healthdata.org/sites/default... ^-2222. Institute of Health Metrics and Evaluation. Brazil [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep13]. Available from: Available from: http://www.healthdata.org/brazil
http://www.healthdata.org/brazil... Adequate treatment for systemic arterial hypertension is well established as a factor for the reduction of cardiovascular diseases.²³23. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb;311(5):507-20.

Despite the efforts in the implementation of public health policies for the prevention and treatment of non-communicable chronic diseases, the reduction of mortality attributed to them has only varied from 1 to 8% a year.²⁴24. Schmidt MI, Duncan BB, Azevedo e Silva G, Menezes AM, Monteiro CA, Barreto SM, et al. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 2011 Jun;377(9781):1949-61.

To reduce the burden of non-communicable chronic diseases in Brazil, an intervention with six high priority points was settled: (i) systemic arterial hypertension control, (ii) screening of patients for systemic arterial hypertension, (iii) tackling sedentary lifestyles, (iv) controlling hypercholesterolemia, (v) cessation of smoking and (vi) alcoholism. Tackling obesity and overweight was also pointed out as an intermediate priority.²⁵25. Simões EJ, Bouras A, Cortez-Escalante JJ, Malta DC, Porto DL, Mokdad AH, et al. A priority health index identifies the top six priority risk and related factors for non-communicable diseases in Brazilian cities. BMC Public Health. 2015;15:443.

A very common disease, for which an approach in primary health care is equally necessary, is the systemic arterial hypertension,²³23. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb;311(5):507-20. which can be early detected and treated adequately to avoid the development of acute myocardial infarction, cerebrovascular accident, heart failure, renal insufficiency and death.²³23. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb;311(5):507-20. The guideline adopted by the United States of America in the treatment of systemic arterial hypertension presents the following recommendations for its management in adults: for the low-risk population under 60 years old, keeping arterial pressure below 150/90mmHg; and for the high-risk population, keeping arterial pressure below 140/90mmHg. The authors reinforce the need to correlate the guideline with cardiovascular risk recommendations, for the achievement of a general and uniform prevention strategy.²³23. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb;311(5):507-20.

The European Society of Hypertension, in its guideline updated in 2013, presents more simplified recommendations, according to which every individual should keep their arterial pressure below 140/90mmHg; however, it presents specific objectives and targets for lifestyle changes, such as limiting salt intake from 5 to 6 g a day and keeping BMI below 25kg/m²2. Institute of Health Metrics and Evaluation. GBD history [Internet]. Seattle: Institute of Health Metrics and Evaluation; 2016 [cited 2016 Sep 13]. Available from: Available from: http://www.healthdata.org/gbd/about/history
http://www.healthdata.org/gbd/about/hist... .²⁶26. Kjeldsen SE, Aksnes TA, Ruilope LM. Clinical implications of the 2013 ESH/ESC hypertension guidelines: targets, choice of therapy, and blood pressure monitoring. Drugs R D. 2014 Jun;14(2):31-43.

Physiopathology's knowledge on cardiovascular disease makes it clear that the benefits of cardiovascular prevention are accessible in a long-term; as for the obstacles to lifestyle changes, those are current challenges to be overcome. Education and information in health are a priority, since patients with knowledge on their disease and precise information on its management tend to have better adherence to treatment.²⁷27. Katz M, Waingarten M. Cardiologia comportamental: uma nova fronteira de atuação da cardiologia. Arq Bras Cardiol. 2015 jan;104(1):3-4.

Although the present study has detected high burden of cardiovascular diseases in Santa Catarina, it is important to point out that it used relatively old (2009) secondary data, which are susceptible to problems such as the possible under-registration of cases. That is a restriction of unknown effects, so the interpretation of the results presented in this study should be done with caution. Other limitations of this study that may interfere in the results and conclusions of the research should be considered as well. For instance, the non-inclusion of data from hospitals not funded by SUS may have underestimated the burden of disability found. In turn, the incapacity to distinguish individuals who left the hospital without sequelae may have overestimated the burden. Finally, the different proportions of the population that uses SUS, reported by the several health macroregions, may - eventually - change its position in the ranking of the state's burden of disease.

Although the recommended methodological procedure for studies on burden of disease was used, the significant percentage of cases with unspecified codes and with unknown age and sex is worrisome. This finding calls for a reflection on the need for more attention when filling out documents and monitoring records, so that more accurate and reliable information sources may be found. The percentage of cases with unspecified codes also implies caution when reading the results by disease.

We can conclude that the burden of cardiovascular diseases in Santa Catarina is high, and health managers should intensify actions of health promotion and prevention for these diseases in all regions of the state.

References

Publication Dates

History