Excess of cardiovascular deaths during the COVID-19 pandemic in Brazilian capital cities
Excess of cardiovascular deaths during the COVID-19 pandemic in Brazilian capital cities
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DOI：
10.1136/heartjnl-2020-317663
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发表时间：
2020-12-01
期刊：
影响因子：
5.7
通讯作者：
Ribeiro, Antonio Luiz Pinho
中科院分区：
文献类型：
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作者：
Brant, Luisa Campos Caldeira;Nascimento, Bruno Ramos;Ribeiro, Antonio Luiz Pinho
前言在新冠肺炎大流行期间，有报道称死亡率过高，而因急性心血管事件而住院的人数减少。巴西是第二个因新冠肺炎死亡人数较多的国家。我们的目标是评估新冠肺炎大流行期间巴西6个首都城市的心血管超额死亡率。方法使用民事登记处公共数据库，我们评估了总死亡和心血管超额死亡，并对新冠肺炎死亡人数较多的6个巴西城市(圣保罗、里约热内卢、福塔莱萨、累西腓、贝伦、马瑙斯)的特定心血管死亡(急性冠脉综合征和中风)和未指明的心血管死亡进行了分层。我们将观察到的死亡人数与2020年第12-22周的预期死亡人数进行了比较。我们还比较了在此期间住院和居家死亡的人数。结果在研究期间和2020年的城市中，死亡人数分别为65449人和17877人。大多数城市的心血管死亡率都有所上升，北方首府的死亡率更高。然而，尽管大多数城市的特定心血管死亡人数有所减少，但北方首府的这类事件却有所增加。未指明的心血管疾病死亡在所有城市都有明显增加，这与家庭死亡的增加密切相关(r=0.86，p=0.01)。结论欠发达城市的心血管意外死亡较高，可能与医疗服务崩溃有关。在最发达的城市中，特定的心血管死亡人数减少，同时不明原因的心血管和家庭死亡人数增加，这可能是由于误诊造成的。相反，在医疗保健崩溃的城市中，特定的心血管死亡人数增加。
IntroductionDuring the COVID-19 pandemic, excess mortality has been reported, while hospitalisations for acute cardiovascular events reduced. Brazil is the second country with more deaths due to COVID-19. We aimed to evaluate excess cardiovascular mortality during COVID-19 pandemic in 6 Brazilian capital cities.MethodsUsing the Civil Registry public database, we evaluated total and cardiovascular excess deaths, further stratified in specified cardiovascular deaths (acute coronary syndromes and stroke) and unspecified cardiovascular deaths in the 6 Brazilian cities with greater number of COVID-19 deaths (Sao Paulo, Rio de Janeiro, Fortaleza, Recife, Belem, Manaus). We compared observed with expected deaths from epidemiological weeks 12-22 of 2020. We also compared the number of hospital and home deaths during the period.ResultsThere were 65 449 deaths and 17 877 COVID-19 deaths in the studied period and cities for 2020. Cardiovascular mortality increased in most cities, with greater magnitude in the Northern capitals. However, while there was a reduction in specified cardiovascular deaths in the most cities, the Northern capitals showed an increase of these events. For unspecified cardiovascular deaths, there was a marked increase in all cities, which strongly correlated to the rise in home deaths (r=0.86, p=0.01).ConclusionExcess cardiovascular mortality was greater in the less developed cities, possibly associated with healthcare collapse. Specified cardiovascular deaths decreased in the most developed cities, in parallel with an increase in unspecified cardiovascular and home deaths, presumably as a result of misdiagnosis. Conversely, specified cardiovascular deaths increased in cities with a healthcare collapse.