In-Hospital Mortality from Cardiovascular Diseases in Brazil During the First Year of The COVID-19 Pandemic

Background: The COVID-19 pandemic has had an impact on mortality from several diseases worldwide, especially cardiovascular diseases (CVD). Brazil is a continent-sized country with significant differences in the health care structure between its federative units.

Objective: Analyze in-hospital mortality from CVDs in the Brazilian public health system during the first year of the COVID-19 pandemic (2020).

Methods: This is an ecological study analyzing the absolute number of in-hospital deaths and the rate of in-hospital mortality in Brazil, its macro-regions, and federative units. Data were obtained from the Hospital Information System of the Brazilian Ministry of Health. To analyze excess mortality, the P-score was used. It compares the events observed with those expected for a given place and period. The P-score was corrected by the joinpoint regression model, with a 95% confidence interval and 5% significance level.

Results: There were 93,104 in-hospital deaths due to CVD in Brazil in 2020, representing 1,495 fewer deaths (P score: -1.58) than expected. The central-west region had a positive P-score, with a 15.1% increase in the number of deaths. Ten federative units showed a greater number of deaths in 2020. There was also a 13.3% excess in-hospital mortality at the country level, and an excess in-hospital mortality in all macro-regions.

Conclusions: There was a decrease in the absolute number of in-hospital deaths, as well as an increase in in-hospital mortality from CVD in Brazil, in 2020, after the COVID-19 pandemic onset.

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References

Bhatt A, Moscone A, McElrath E, Varshney A, Claggett B, Bhatt D . Fewer Hospitalizations for Acute Cardiovascular Conditions During the COVID-19 Pandemic. J Am Coll Cardiol. 2020; 76(3):280-288. PMC: 7250561. DOI: 10.1016/j.jacc.2020.05.038. View

Brant L, Nascimento B, Teixeira R, Lopes M, Malta D, Oliveira G . Excess of cardiovascular deaths during the COVID-19 pandemic in Brazilian capital cities. Heart. 2020; 106(24):1898-1905. DOI: 10.1136/heartjnl-2020-317663. View

M L Aquino E, Silveira I, Pescarini J, Aquino R, Souza-Filho J, Rocha A . Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil. Cien Saude Colet. 2020; 25(suppl 1):2423-2446. DOI: 10.1590/1413-81232020256.1.10502020. View

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J . A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020; 382(8):727-733. PMC: 7092803. DOI: 10.1056/NEJMoa2001017. View

Nascimento J, Costa R, Simvoulidis L, Pinho J, Pereira R, Porto A . COVID-19 and Myocardial Injury in a Brazilian ICU: High Incidence and Higher Risk of In-Hospital Mortality. Arq Bras Cardiol. 2021; 116(2):275-282. PMC: 7909969. DOI: 10.36660/abc.20200671. View

de Souza C . War economy and the COVID-19 pandemic: Inequalities in stimulus packages as an additional challenge for health systems. Rev Soc Bras Med Trop. 2020; 53:e20200245. PMC: 7269523. DOI: 10.1590/0037-8682-0245-2020. View

Mesquita R, Silva Junior L, Santana F, Oliveira T, Alcantara R, Arnozo G . Clinical manifestations of COVID-19 in the general population: systematic review. Wien Klin Wochenschr. 2020; 133(7-8):377-382. PMC: 7689634. DOI: 10.1007/s00508-020-01760-4. View

Normando P, Araujo-Filho J, Fonseca G, Rodrigues R, Oliveira V, Hajjar L . Reduction in Hospitalization and Increase in Mortality Due to Cardiovascular Diseases during the COVID-19 Pandemic in Brazil. Arq Bras Cardiol. 2021; 116(3):371-380. PMC: 8159562. DOI: 10.36660/abc.20200821. View

Baggio J, Machado M, do Carmo R, Armstrong A, Santos A, de Souza C . COVID-19 in Brazil: spatial risk, social vulnerability, human development, clinical manifestations and predictors of mortality - a retrospective study with data from 59 695 individuals. Epidemiol Infect. 2021; 149:e100. PMC: 8111197. DOI: 10.1017/S0950268821000935. View

10.

Kraemer M, Yang C, Gutierrez B, Wu C, Klein B, Pigott D . The effect of human mobility and control measures on the COVID-19 epidemic in China. Science. 2020; 368(6490):493-497. PMC: 7146642. DOI: 10.1126/science.abb4218. View

11.

Eubank S, Eckstrand I, Lewis B, Venkatramanan S, Marathe M, Barrett C . Commentary on Ferguson, et al., "Impact of Non-pharmaceutical Interventions (NPIs) to Reduce COVID-19 Mortality and Healthcare Demand". Bull Math Biol. 2020; 82(4):52. PMC: 7140590. DOI: 10.1007/s11538-020-00726-x. View

12.

Prince M, Wu F, Guo Y, Gutierrez Robledo L, ODonnell M, Sullivan R . The burden of disease in older people and implications for health policy and practice. Lancet. 2014; 385(9967):549-62. DOI: 10.1016/S0140-6736(14)61347-7. View

13.

Mesquita C . Out-Of-Hospital Cardiac Arrest during the Coronavirus Disease 2019 (COVID-19) Pandemic in Brazil: The Hidden Mortality. Arq Bras Cardiol. 2021; 116(2):272-274. PMC: 7909974. DOI: 10.36660/abc.20210041. View

14.

. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015; 386(9995):743-800. PMC: 4561509. DOI: 10.1016/S0140-6736(15)60692-4. View

15.

Malta D, Szwarcwald C, Barros M, Gomes C, Machado I, Souza Junior P . The COVID-19 Pandemic and changes in adult Brazilian lifestyles: a cross-sectional study, 2020. Epidemiol Serv Saude. 2020; 29(4):e2020407. DOI: 10.1590/S1679-49742020000400026. View

16.

Bezerra A, Silva C, Soares F, Silva J . Factors associated with people's behavior in social isolation during the COVID-19 pandemic. Cien Saude Colet. 2020; 25(suppl 1):2411-2421. DOI: 10.1590/1413-81232020256.1.10792020. View

17.

Baldi E, Sechi G, Mare C, Canevari F, Brancaglione A, Primi R . Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med. 2020; 383(5):496-498. PMC: 7204428. DOI: 10.1056/NEJMc2010418. View

18.

Bugger H, Gollmer J, Pregartner G, Wunsch G, Berghold A, Zirlik A . Complications and mortality of cardiovascular emergency admissions during COVID-19 associated restrictive measures. PLoS One. 2020; 15(9):e0239801. PMC: 7514100. DOI: 10.1371/journal.pone.0239801. View

19.

Garcia L, Duarte E . Nonpharmaceutical interventions for tackling the COVID-19 epidemic in Brazil. Epidemiol Serv Saude. 2020; 29(2):e2020222. DOI: 10.5123/S1679-49742020000200009. View

20.

Guimaraes N, Carvalho T, Machado-Pinto J, Lage R, Bernardes R, Peres A . Increased Home Death Due to Cardiopulmonary Arrest in Times of COVID-19 Pandemic. Arq Bras Cardiol. 2021; 116(2):266-271. PMC: 7909962. DOI: 10.36660/abc.20200547. View