Epidemiology of Environmental, Behavioral, and Metabolic Risk Factors for Stroke: Temporal Analysis in the Brazilian Population
DOI:
https://doi.org/10.54727/cbps.2.2.42Keywords:
Stroke, Epidemiology, Risk factors, Time trendAbstract
Objective: To analyze the temporal trend of mortality and incidence attributed to environmental, behavioral, and metabolic risk factors for stroke in the Brazilian population between 1998 and 2017.
Method: Ecological study using secondary data on the evolution of incidence and mortality related to the risk factors identified in the ICD-10, both available on the GBD (Global Burden Disease) platform.
Results: In the period analyzed, there was a reduction of 1.46% in smoking-related stroke mortality per year (p=0.016), with a decrease of 2.18% in women (p=0.006). The metabolic risk increased by 1.41% (p=0.029), and by 3.33% among men (p=0.001). Pollution decreased by 1.53% for both sexes (p=0.013), with a decrease of 2.06% for women (p=0.017). Stroke mortality also fell by 6.8% for men (p<0.001) and 6.0% for women (p<0.001). Analyzing the Brazilian states, there was a reduction in smoking (5.55%; p=0.022) in the Pará region. Regarding pollution, reductions were noted for the state of Piauí (6.76%; p=0.042), Ceará (6.57%; p= 0.001) and Paraná (4.86%; p=0.027).
Conclusion: Between 1998 and 2017, Brazil showed a significant reduction in stroke incidence and mortality, with more pronounced falls in women. Smoking-associated mortality decreased, especially among women, while metabolic risk increased among men. Mortality from pollution was significantly reduced, especially the falls in Pará, Piauí, Ceará and Paraná.
References
Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet Neurol. 2007;6(2):182-7. PMID: 17239805.
Lotufo PA. Stroke in Brazil: a neglected disease. Sao Paulo Med J. 2005;123(1):3-4. PMID: 15821807; PMCID: PMC11052446.
Botelho TS, Neto CDM, Araújo FLC, Assis SC. Epidemiologia do acidente vascular cerebral no Brasil. Temas em saúde. 2016;16(1):361-377.
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. 2014;45(7):2160-236. PMID: 24788967.
Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MS, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JÁ. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. 2014;45(12):3754-832. PMID: 25355838; PMCID: PMC5020564.
Howard VJ, McClure LA, Meschia JF, Pulley L, Orr SC, Friday GH. High prevalence of stroke symptoms among persons without a diagnosis of stroke or transient ischemic attack in a general population: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Arch Intern Med. 2006;166(18):1952-8. PMID: 17030827.
Guzik A, Bushnell C. Stroke Epidemiology and Risk Factor Management. Continuum (Minneap Minn). 2017;23:15-39. PMID: 28157742.
Graber M, Mohr S, Baptiste L, Duloquin G, Blanc-Labarre C, Mariet AS, Giroud M, Béjot Y. Air pollution and stroke. A new modifiable risk factor is in the air. Rev Neurol. 2019;175(10):619-624. PMID: 31153597.
Paiva LS, Oliveira FR, Sousa LV, Figueiredo FW, Sá TH, Adami F. Decline in Stroke Mortality Between 1997 and 2012 by Sex: Ecological Study in Brazilians Aged 15 to 49 Years. Sci Rep. 2019;9(1):2962. PMID: 30814591; PMCID: PMC6393459.
Kleinbaum DG, Kupper LL, Nizam A, Rosenberg ES. Applied regression analysis and other multivariable methods. 5ª ed. Cengage Learning; 2013.
Fay MP, Tiwari RC, Feuer EJ, Zou Z. Estimating average annual percent change for disease rates without assuming constant change. Biometrics. 2006;62(3):847-54. PMID: 16984328.
Lotufo PA, Goulart AC, Passos VM, Satake FM, Souza MF, França EB, Ribeiro AL, Bensenõr IJM. Cerebrovascular disease in Brazil from 1990 to 2015: Global Burden of Disease 2015. Rev Bras Epidemiol. 2017;20:129-141. PMID: 28658378.
Gottlieb, Valle MG, Morassutti AL, Cruz IB. Transição epidemiológica, estresse oxidativo e doenças crônicas não transmissíveis sob uma perspectiva evolutiva. Scientia Medica. 2011;21(2).
Rodrigues S, Mateus, Fernandes L, Galvão IM. Fatores de risco modificáveis e não modificáveis do AVC isquêmico: uma abordagem descritiva. Revista de Medicina. 2017;96(3).
Aluísio JD, Cascaes AM, Wehrmeister FC, Martínez-Mesa J, Menezes AM. Tabagismo no Brasil: desigualdades regionais e prevalência segundo características ocupacionais. Ciência & Saúde Coletiva. 2011;16:3707-3716.
Araújo JP, Darcis JVV, Tomas ACV, Mello WA. Tendência da mortalidade por acidente vascular cerebral no Município de Maringá, Paraná entre os anos de 2005 a 2015. InternationalJournalof Cardiovascular Sciences. 2018;31: 56-62.
Malta DC, Iser BPM, Sá NNB, Yokota RTC, Moura L, Claro RM, Luz MGC, Bernal RIT. Tendências temporais no consumo de tabaco nas capitais brasileiras, segundo dados do VIGITEL, 2006 a 2011. Cadernos de Saúde Pública. 2013;29(4):812-822.
Ministério da Saúde. Saúde Brasil 2004: uma análise da situação de saúde. Secretaria de Vigilância em Saúde, Departamento de Análise de Situação de Saúde. Brasília: Ministério da saúde. 2004;(1):350.
Instituto Brasileiro de Geografia e Estatística (IBGE). Pesquisa de orçamentos familiares 2002-2003: análise da disponibilidade domiciliar de alimentos e do estado nutricional no Brasil. 2004;76.
Pandya R, Solomon G, Kinner A, Balmes J. Diesel Exhaust and Asthma: Hypotheses and Molecular Mechanisms of Action. 2002;103(1100):12.
Pereira, Regina G, Sant’Anna FSP. Uma análise da produção mais limpa no Brasil. BrazilianJournalof Environmental Sciences (Online) 2012;24:17-26.
Abramovay R. Desenvolvimento sustentável: qual a estratégia para o Brasil?. Novos estud. – CEBRAP. 2010;87:97-113.
Garritano CR, Luz PM, Pires MCE, Barbosa MTS, Batista KM. Análise da tendência da mortalidade por acidente vascular cerebral no Brasil no século XXI. Arquivos Brasileiros de Cardiologia. 2012;98(6):519-527.
Merz AA, Cheng S. Sex differences in cardiovascular ageing. Heart. 2016;102(11):825-31. PMID: 26917537; PMCID: PMC5993677.
McEwen B. Estrogen actions throughout the brain. Recent Prog Horm Res. 2002;57:357-84. PMID: 12017552.
Koszegi Z, Cheong RY. Targeting the non-classical estrogen pathway in neurodegenerative diseases and brain injury disorders. Front Endocrinol (Lausanne). 2022;13:999236. PMID: 36187099; PMCID: PMC9521328.
Niță AR, Knock GA, Heads RJ. Signalling mechanisms in the cardiovascular protective effects of estrogen: With a focus on rapid/membrane signalling. Curr Res Physiol. 2021;4:103-118. PMID: 34746830; PMCID: PMC8562205.
Austin CE. Chronic and acute effects of oestrogens on vascular contractility. J Hypertens. 2000;18(10):1365-78. PMID: 11057423.
Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a “set up” for vascular disease. Circulation. 2003;107:139–46.
Barnett SR, Morin RJ, Kiely DK, Gagnon M, Azhar G, Knight EL, Nelson JC, Lipsitz LA. Effects of age and gender on autonomic control of blood pressure dynamics. Hypertension. 1999;33(5):1195-200. PMID: 10334811.
National Center for Health Statistics (US). Health, United States, 2014: With Special Feature on Adults Aged 55–64. Hyattsville (MD): National Center for Health Statistics (US). 2015. PMID: 26086064.
Ministério da Saúde [Internet]. Instituto Nacional do Câncer - INCA. Prevalência do tabagismo; 2022 [citado em 16 de outubro de 2024]. Disponível em: https://www.gov.br/inca/pt-br/assuntos/gestor-e-profissional-de-saude/observatorio-da-politica-nacional-de-controle-do-tabaco/dados-e-numeros-do-tabagismo/prevalencia-do-tabagismo.
Arora M, ElSayed A, Beger B, Naidoo P, Shilton T, Jain N, Armstrong-Walenczak K, Mwangi J, Wang Y, Eiselé JL, Pinto FJ, Champagne BM. The Impact of Alcohol Consumption on Cardiovascular Health: Myths and Measures. Glob Heart. 2022;17(1):45. PMID: 36051324; PMCID: PMC9306675.
Ardissino M, Slob EAW, Carter P, Rogne T, Girling J, Burgess S, Ng FS. Sex-Specific Reproductive Factors Augment Cardiovascular Disease Risk in Women: A Mendelian Randomization Study. J Am Heart Assoc. 2023;12(5). PMID: 36846989; PMCID: PMC10111460.
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