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Journal of Human Growth and Development

versão impressa ISSN 0104-1282versão On-line ISSN 2175-3598

J. Hum. Growth Dev. vol.34 no.1 Santo André jan. 2024  Epub 20-Jan-2025

https://doi.org/10.36311/jhgd.v34.15781 

ORIGINAL ARTICLE

Mortality from cerebral stroke in the State of Pernambuco, Brazil: an ecological study

Ana Carolina Netto Djaló, All authors contributed to the manuscripta 
http://orcid.org/0000-0002-3352-9192

Orivaldo Florencio de Souza, All authors contributed to the manuscriptb 
http://orcid.org/0000-0002-3148-6870

Helder Maud, All authors contributed to the manuscriptc 
http://orcid.org/0000-0001-9694-2593

Matheus Paiva Emidio Cavalcanti, All authors contributed to the manuscriptd 
http://orcid.org/0000-0001-5264-8181

Gabrielle do Amaral Virginio Pereira, All authors contributed to the manuscriptd 
http://orcid.org/0000-0002-5069-0762

Marcelo Ferraz Campos, All authors contributed to the manuscripte 
http://orcid.org/0000-0002-6939-8390

José Luiz Figueiredo, All authors contributed to the manuscripta 
http://orcid.org/0000-0003-0915-7947

aPrograma de Pós-Graduação em Cirurgia – Centro de Ciências Médicas da Universidade Federal de Pernambuco- - CCM/UFPE;Brasil

bPrograma de Pós-Graduação em Nutrição e Saúde da Universidade Federal do Espírito Santo, Vitória, Brasil

3e Professor Associado da Universidade Federal do Acre, Rio Branco, Acre, Brasil; Departamento de Ciências Fisiológicas, Universidade Federal do Espírito Santo, Vitória, Brasil;

dPrograma de Pós-graduação em Ciências Médicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil;

ePrograma de Pós-graduação em Políticas Públicas e Desenvolvimento Local. EMESCAM, Vitoria, ES, Brasil.

Authors summary

Why was this study done?

The study aims to provide information on the epidemiology of stroke in the Pernambuco region, identify possible temporal changes in mortality rates and support the development of health policies and programs aimed at preventing and controlling this serious condition.

What did the researchers do and find?

An ecological time series study was conducted using data from DATASUS, covering the period from 2000 to 2021, to analyze mortality from cerebrovascular accident (CVA) in Pernambuco. The mortality rate and proportional mortality due to stroke were calculated, stratifying by sex and age group, and Joinpoint regression models were used to identify temporal trends. A progressive increase in stroke deaths from 2018, disparities between the sexes in proportional mortality, and variations in mortality by age group were discovered, providing crucial information for health policies aimed at preventing and controlling stroke in the region.

What do these findings mean?

The findings indicate a worrying trend of progressive increase in stroke deaths in Pernambuco from 2018 onwards, highlighting the urgent need for public health interventions and policies aimed at preventing and treating this condition. Furthermore, variations in mortality by age group highlight the need for preventive strategies adapted to different age groups to mitigate the impact of stroke on the population of Pernambuco.

Key words: stroke; mortality; epidemiology

Abstract

Introduction

cerebrovascular accident (CVA) is the second leading cause of death globally, characterized by cerebrovascular events due to dysfunctions in the cerebral blood supply. It can be ischemic or hemorrhagic and has high morbidity and mortality rates. In Brazil, it is the main cause of death, disabling many over 50 years of age and leading to around 40% of early retirements. Despite advances in initial treatment, mortality rates remain high, indicating flaws in prevention and treatment strategies. Therefore, the World Health Organization (WHO) emphasizes the need for immediate implementation of preventive and treatment measures for this condition.

Objective

to evaluate the trend in the mortality coefficient and proportional mortality from stroke in the population of Pernambuco, from 2000 to 2021.

Methods

This is an ecological time series study with data from the population of the state of Pernambuco, located in northeast region of Brazil, from 2000 to 2021. The eligibility criteria were deaths with a stroke occurring in the state of Pernambuco. Information on mortality, population estimates and number of deaths by sex and age group were extracted from the database of the Department of Informatics of the Unified Health System (DATASUS). For statistical analysis, it was calculated the mortality coefficient, proportional mortality, mean, standard deviation, skewness and kurtosis. The temporal trend of stroke was assessed by jointpoint regression.

Results

Between 2000 and 2021, there were 39,410 deaths from stroke. Around 49.0% were male and 51.0% female. The female sex had an average of 913.45 in the number of deaths, being quantitatively higher than the average identified for the male sex of 877.04 deaths. The years with the highest number of deaths were 2006, 2007 and 2008, while 2018 had the lowest number. There was a progressive increase in the number of deaths from stroke from 2018 to 2021. There was a decline in the average annual percentage variation in the mortality rate for stroke in all groups studied, in addition to a drop in the average annual percentage of proportional mortality for stroke in the entire population. Throughout the period, there was a decline in the average annual percentage of proportional mortality from stroke in the entire population studied.

Conclusion

In the period from 2000 to 2021 there was a greater number of deaths due to stroke in women in contrast to men in the population of Pernambuco, Brazil. Furthermore, there was a downward trend in stroke rates in both the mortality rate and proportional mortality. In the period from 2018 to 2021 there was a progressive increase in the mortality rate and proportional mortality from stroke.

Key words: stroke; mortality; epidemiology

Highlights

There is a trend of progressive increase in stroke deaths in Pernambuco from 2018 onwards.

Disparities between the sexes were observed, with females showing higher proportional mortality throughout the studied period.

Analysis by age group revealed a significant decline in stroke mortality in age groups over 30 years.

Key words: stroke; mortality; epidemiology

Síntese dos autores

Por que este estudo foi feito?

O estudo visa fornecer informações sobre a epidemiologia do AVC na região de Pernambuco, identificar possíveis mudanças temporais nas taxas de mortalidade e subsidiar o desenvolvimento de políticas e programas de saúde direcionados para a prevenção e controle dessa condição grave..

O que os pesquisadores fizeram e encontraram?

Foi conduzido um estudo ecológico de séries temporais utilizando dados do DATASUS, abrangendo o período de 2000 a 2021, para analisar a mortalidade por acidente vascular cerebral (AVC) em Pernambuco. Foi calculado o coeficiente de mortalidade e a mortalidade proporcional por AVC, estratificando por sexo e faixa etária, e utilizaram modelos de regressão Joinpoint para identificar tendências temporais. Foi descoberto um aumento progressivo nos óbitos por AVC a partir de 2018, disparidades entre os sexos na mortalidade proporcional, e variações na mortalidade por faixa etária, fornecendo informações cruciais para políticas de saúde direcionadas à prevenção e controle do AVC na região.

O que essas descobertas significam?

As descobertas indicam uma preocupante tendência de aumento progressivo nos óbitos por AVC em Pernambuco a partir de 2018, ressaltando a necessidade urgente de intervenções e políticas de saúde pública voltadas para a prevenção e tratamento desta condição. Além disso, as variações na mortalidade por faixa etária destacam a necessidade de estratégias preventivas adaptadas a diferentes faixas etárias para mitigar o impacto do AVC na população de Pernambuco.

Palavras-Chave: acidente vascular cerebral; mortalidade; epidemiologia

Resumo

Introdução

o Acidente Vascular Cerebral a segunda principal causa de morte global, caracterizado por eventos cerebrovasculares devido a disfunções na irrigação sanguínea cerebral. Pode ser isquêmico ou hemorrágico e apresenta altos índices de morbimortalidade. No Brasil, é a principal causa de morte, incapacitando muitos acima dos 50 anos e levando a cerca de 40% das aposentadorias precoces. Apesar dos avanços no tratamento inicial, as taxas de mortalidade permanecem altas, indicando falhas nas estratégias de prevenção e tratamento. Desta forma, a Organização Mundial de Saúde enfatiza a necessidade de implementação imediata de medidas preventivas e de tratamento para essa condição.

Objetivo

avaliar a tendência do coeficiente de mortalidade e da mortalidade proporcional de Acidente Vascular Cerebral na população de Pernambuco, no período de 2000 a 2021.

Método

trata-se de um estudo ecológico de séries temporais com dados da população do estado de Pernambuco, localizado na região nordeste do Brasil, no período de 2000 a 2021. Os critérios de eligibilidade foram os óbitos com causa básica o Acidente Vascular Cerebral ocorridos no estado de Pernambuco. As informações sobre mortalidade, estimativa populacional e número de óbitos por sexo e faixa etária foram extraídos do banco de dados do Departamento de Informática do Sistema Único de Saúde. Para a análise estatística, foi calculado o coeficiente de mortalidade, mortalidade proporcional, média, desvio padrão, assimetria e curtose. A tendência temporal foi avaliada por regressão Jointpoint.

Resultados

entre 2000 a 2021, ocorreram 39.410 óbitos. Cerca de 49,0% eram do sexo masculino e 51,0% do sexo feminino. O sexo feminino apresentou uma média de 913,45 no número de óbitos, sendo quantitativamente maior do que o a média identificada para o sexo masculino de 877,04 óbitos. Os anos com maior quantidade de óbitos foram 2006, 2007 e 2008, enquanto 2018 teve o menor registro. Houve um aumento progressivo do número de óbitos de 2018 a 2021. Foi apresentado um declínio na variação percentual média anual do coeficiente de mortalidade em todos os grupos estudados, além de uma queda na média percentual anual da mortalidade proporcional em toda a população. Em todo o período, houve declínio na média percentual anual da mortalidade proporcional para o Acidente Vascular Cerebral em toda a população estudada.

Conclusão

no período de 2000 até 2021 houve maior número de óbitos em mulheres em contraste aos homens na população do Pernambuco, Brasil. Ademais, houve tendência de declínio no Acidente Vascular Cerebral tanto no coeficiente de mortalidade como na mortalidade proporcional. No período de 2018 até 2021 houve aumento progressivo no coeficiente de mortalidade e mortalidade proporcional do Acidente Vascular Cerebral.

Palavras-Chave: acidente vascular cerebral; mortalidade; epidemiologia

Highlights

Há uma tendência de aumento progressivo nos óbitos por AVC em Pernambuco a partir de 2018.

Disparidades entre os sexos foram observadas, com o sexo feminino mostrando maior mortalidade proporcional ao longo do período estudado.

A análise por faixa etária revelou um declínio significativo na mortalidade por AVC em faixas etárias acima de 30 anos.

Palavras-Chave: acidente vascular cerebral; mortalidade; epidemiologia

INTRODUCTION

Stroke (Cerebral Vascular Accident) is a health concern in Brazil and around the world. Stroke is a serious condition that can result in permanent brain damage or even death if not treated quickly, and it is a disease that causes morbidity and mortality.

Cerebral Vascular Accident (CVA) is characterized by a set of cerebrovascular events, which occur due to a dysfunction present in the cerebral blood supply. It can be classified as ischemic or hemorrhagic, presenting high morbidity and mortality rates1,2.

The first occurs due to permanent or transient blockage of the blood vessels that supply the brain, which can be intracranial or extracranial3, in addition to being significantly more common than hemorrhagic, representing around 87% of all cases4. In contrast, hemorrhagic stroke is defined as the rupture of a cerebral artery, often already affected by aneurysms and arteriovenous malformations5.

Stroke is the second leading cause of death globally6 and ranks third as a disabling condition in the world7. Every year, 17 million cases of stroke occur worldwide. Of these, 6.5 million result in death, while the rest contribute to the increase in the prevalence of the disease8,9.

In Brazil, stroke is the disease with the highest prevalence of deaths10, the biggest cause of disability in the population over the age of 50, and is responsible for around 40% of early retirements11. Furthermore, there is a rapid increase in its incidence7. According to the World Health Organization, this trend will persist until 2060, representing 12.8% of deaths in Brazil12.

Among the various risk factors for the development of stroke, high blood pressure, smoking, diabetes mellitus, hyperlipidemia, consumption of toxic substances, inadequate dietary patterns and lack of physical activity stand out13.

The consequences of stroke vary depending on the arteries affected. Among the most common manifestations are changes in strength and/or sensitivity on one or both sides of the body, speech difficulties, facial paralysis, vision problems, dizziness, memory impairment, sudden and unusual headaches, difficulty with balance, disturbances of consciousness and confusion14, functional limitations15 and decreased cardiorespiratory capacity16.

Despite advances in initial stroke treatment, mortality rates remain high17,18, which suggests that current primary prevention strategies for stroke and cardiovascular diseases are not being implemented comprehensively or are not adequately effective19,20. Given this scenario, the World Health Organization (WHO) emphasizes the need to immediately implement preventive and treatment measures for this condition21.

In this context, the need for a greater understanding of mortality resulting from stroke stands out, in order to significantly contribute to the improvement of prevention, diagnosis, treatment strategies and the development of public health actions. The challenge of detecting an increase or decrease in stroke mortality rates and estimating a value is characteristic of trend analysis in time series. Time series regression models provide estimates of population parameters that can be used to understand the current state of the population and design various population management decisions22.

Joinpoint regression can be used to accurately estimate changes in mortality rates for a given condition, in order to identify and evaluate when changes occur in population parameters22.

It was used to evaluate variations in driver mortality rates after the implementation of traffic laws23, to examine trends in cancer incidence in countries such as Canada, the United Kingdom, Japan and Italy, among others24-27, to investigate changes in the suicide rate in Denmark28, to analyze the incidence of syphilis and gonorrhea29, among others.

In this way, it is noteworthy that the identification of specific epidemiological patterns and regional disparities allows a personalized and effective approach, capable of providing essential information for the development of public policies and targeted health programs, and may contribute to the reduction of mortality rates due to Stroke.

Thus, the objective is to evaluate the trend in the mortality rate and proportional mortality from stroke in the population of Pernambuco, from 2000 to 2021.

METHODS

Type of study

This is an ecological time series study with data from the population of the state of Pernambuco, Brazil and from 2000 to 2021.

Study population and data source

Information on the number of deaths and demographic data of the resident population were obtained for the state of Pernambuco, located in the Brazilian Northeast Region, with a demographic density of 92.37 inhabitants/km2, and a Human Development Index of 0.719. All information on mortality and population estimates for the state of Pernambuco were extracted from the database of the Department of Informatics of the Unified Health System - DATASUS (https://datasus.saude.gov.br/informacoes-de-saude-tabnet/).

The number of deaths by sex and age group in the period from 2000 to 2021 were extracted from the Vital Statistics and Mortality tab since 1996 by ICD-10 on the DATASUS website (https://datasus.saude.gov.br/mortalidade-desde-1996 -pela-cid-10). In Brazil, death certificates are issued by health professionals and registered in the Mortality Information System of the Brazilian Ministry of Health. Subsequently, the information from the death certificates was transferred to DATASUS. DATASUS is the Department of Informatics of the Unified Health System (SUS) of Brazil, responsible for collecting, processing, and disseminating health information.

Information on the population estimate was extracted from the DATASUS website (https://datasus.saude.gov.br/populacao-residente) in the tab sequences: Demographic and Socioeconomic, Resident Population and Population Estimate Study by municipality, sex and age - 2000-2021 This information was extracted for the total group and by sex and age group for the period from 2000 to 2021.

The eligibility criteria were deaths with the underlying cause being stroke that occurred in the state of Pernambuco. The exclusions were data cataloged as ignored for sex and age group. Data extractions were carried out by trained researchers. Possible discrepancies in data extraction between researchers were corrected by consensus through repeated extractions.

Study variable

The study variable was death with the underlying cause being stroke (not specified as hemorrhagic or ischemic) occurring in the state of Pernambuco. The stroke variable was extracted for the entire population and stratified by sex (male and female) and age group (0 to 29 years, 30 to 39 years; 40 to 49 years; 50 to 59 years; 60 to 69 years; 70 to 79 years old). years; 80 years or older) for calendar years between 2000 and 2021. In the International Classification of Diseases version 10, stroke is coded as I6430.

In this study, the definition of stroke presented by the American Heart Association /American Stroke Association31 was adopted, as follows: episode of acute neurological dysfunction, presumably caused by ischemia or hemorrhage, persisting for 24 hours or longer or until death, but without sufficient evidence to be classified as ischemia or hemorrhage.

Data analysis

Information on the number of deaths from stroke, deaths from all causes and population, with stratification by sex and age group, was extracted using the file transfer system from the DATASUS database to a file in the format of values separated by comma (CSV).

For each year between 2000 and 2019, the mortality rate per 100,000 inhabitants and the proportional mortality from stroke were calculated using a routine created in the Microsoft Office Excel spreadsheet. Subsequently, in the Stata 17 program, the mean, standard deviation, asymmetry and kurtosis of the total number of deaths were calculated for the total group and by sex.

To calculate the mortality rate, the number of deaths from stroke was divided by the total population or stratified by sex and age group and the product of the division was multiplied by 100 thousand inhabitants. Proportional mortality was calculated by dividing the number of deaths from stroke by the number of deaths from all causes for the total population and stratified by sex and age group and the product of the division was multiplied by 100.

Joinpoint regression model

The temporal trend of stroke was evaluated by Jointpoint regression, with the help of the Joinpoint Regression Program (version 5.0.2, 2023) developed by the National Cancer Institute, Rockville, MD, USA. Joinpoint32 and regression models were applied to identify change points in the time series and the trend of each segment of the mortality rate and proportional mortality from 2000 to 2021.

The models were analyzed for the total group and stratified by sex and age group. In each model, the dependent variables were the mortality rate or proportional mortality indicators, and the independent variable was the year. The options of heteroscedastic errors with constant variation, the maximum number of 3 joinpoints and the log-linear model were chosen for the analysis of the models. The weighted BIC method was applied for model selection.

The annual percentage change (APC) and the average annual percentage change (AAPC) with 95% confidence intervals estimated by the parametric method indicated the direction and magnitude of temporal trends. When there was no segment trend in the period, the APC was similar to the AAPC. Joinpoint regression models with a p value equal to or less than 5% were statistically significant.

Legal and ethical aspects of research

The present study was carried out using secondary data available in a public domain database, without intervention to individuals or groups of people, therefore the opinion of the Research Ethics Committee was waived.

RESULTS

In the period from 2000 to 2021 there were 39,410 deaths with stroke as the underlying cause. Of these, 49.0% (19,295 deaths) were male and 51.0% (20,107 deaths) were female. In the sex variable, there were 8 cases without sex recorded. Females showed an average of 913.45 (standard deviation: 189.51) in the number of deaths, being quantitatively higher than the average identified for males of 877.04 deaths (standard deviation: 181.52).

The years with the highest number of deaths due to stroke were 2006, 2007 and 2008. In 2018 there was the lowest number of deaths recorded (1057 deaths) due to stroke. There was a progressive increase in the number of deaths from stroke from 2018 to 2021. In most years, males had higher mortality rate values.

In 2006 there was the highest mortality rate for both sexes. From 2018 onwards, there was a progressive increase in the mortality rate for men and women. In proportional mortality, females showed higher values throughout the studied period.

In both sexes, in 2006 there were the highest values of proportional mortality and in 2018 the lowest values of proportional mortality. A progressive increase in proportional mortality occurred from 2018 onwards (table 1).

Table 1 : Number of deaths, mortality coefficient and proportional mortality from stroke disease by sex in the population of the state of Pernambuco, Brazil between 2000 and 2021 

Total Masculine Feminine
Deaths CM MP* Deaths CM MP* Deaths CM MP*
2000 1831 22.6 1.8 930 23.7 3.1 901 21.5 4.1
2001 1894 23.0 1.8 957 24.1 3.2 937 22.1 4.4
2002 2016 24.3 2.0 1019 25.4 3.4 997 23.2 4.5
2003 2003 23.8 1.9 982 24.2 3.2 1020 23.5 4.5
2004 2055 24.2 1.8 964 23.5 3.2 1090 24.8 4.7
2005 2171 25.3 2.0 1025 24.8 3.5 1146 25.8 5.1
2006 2384 27.5 2.2 1166 27.9 3.9 1218 27.1 5.5
2007 2255 25.8 2.1 1140 27.0 3.7 1114 24.6 4.9
2008 2265 25.6 2.0 1081 25.4 3.5 1184 25.8 5.1
2009 2036 22.8 1.8 991 23.1 3.2 1044 22.6 4.4
2010 1915 21.3 1.7 914 21.1 3.0 1000 21.4 4.2
2011 1998 22.0 1.8 1005 23.1 3.1 992 21.1 4.0
2012 1818 19.9 1.6 890 20.3 2.8 927 19.6 3.6
2013 1669 18.2 1.4 789 17.9 2.4 879 18.4 3.4
2014 1523 16.5 1.3 743 16.7 2.3 780 16.2 3.1
2015 1567 16.8 1.3 794 17.7 2.3 773 16.0 2.8
2016 1572 16.8 1.1 746 16.6 2.0 826 17.0 2.8
2017 1216 12.9 0.9 572 12.6 1.6 644 13.1 2.3
2018 1057 11.1 0.9 528 11.6 1.5 529 10.7 1.9
2019 1196 12.5 0.9 570 12.4 1.6 626 12.6 2.1
2020 1402 14.6 0.9 706 15.3 1.7 696 13.9 2.0
2021 1567 16.2 1.0 783 16.9 1.8 784 15.6 2.1
Total 39410 19295 20107
Average 1791.36 877.04 913.45
Standard deviation 367.89 181.52 189.51
Kurtosis 2.22 2.25 2.21
Asymmetry -0.36 -0.39 -0.21

CM: Mortality coefficient per 100,000; MP: Proportional mortality.

In figure 1, it is observed that the number of deaths due to stroke stratified by age group in the population of the state of Pernambuco, Brazil, 2000 and 2021. In all the years studied, the age group with the highest number of deaths due to stroke was aged 80 or over with 16,376 deaths (41.5%) and aged 70 to 79 with 11,526 deaths (29.2%). At 80 years of age or older, the years with the highest number of deaths from stroke were 2006 (1004 deaths), 2007 (995 deaths) and 2008 (1047 deaths).

Figure1 : Number of deaths from stroke stratified by age group in the population of the state of Pernambuco, Brazil, 2000 and 2021. 

In table 2 and figure 2 there is a demonstration of the annual percentage change and the average annual percentage change in the stroke mortality rate by sex and age. In the period from 2000 to 2021 there was a decline in the AAPC of -1.5 in the mortality rate for stroke in the total group and in females (p=0.056).

Table 2 : Annual percentage variation and average annual percentage variation in the mortality rate of stroke disease by sex and age group in the population of the state of Pernambuco, Brazil, between 2000 and 2021 

Segment VPA (IC95%) P VPMA (IC95%) P
All
2000-2021 -1.5 (-3.0; 0.0) 0.056
2000-2006 3.2 (1.5; 5.0) 0.002
2006-2015 -5.0 9-6.0; -3.9) <0.001
2015-2018 -12.5 (-20.8; -3.2) 0.014
2018-2021 12.5 (7.0; 18.3) <0.001
Sex
Masculine
2000-2021 -1.4 (-3.6; 0.8) 0.217
2000-2007 2.2 (-0.8; 5.3) 0.136
2007-2019 -6.4 (-7.8; -5.0) <0.001
2019-2021 18.8 (-4.7; 48.2) 0.116
Feminine
2000-2021 -1.5 (-3.0; 0.0) 0.056
2000-2006 4.0 (2.2; 5.7) <0.001
2006-2015 -5.2 (-6.2; -4.1) <0.001
2015-2018 -12.0 (-20.3; -2.7) 0.017
2018-2021 11.0 (5.6; 16.7) 0.001
Age range
0 to 29 years old
2000-2021 -0.9 (-4.8; 3.2) 0.656 -0.9 (-4.8; 3.2) 0.656
30 to 39 years old
2000-2021 -5.3 (-7.0; -3.5) <0.001 -5.3 (-7.0; -3.5) <0.001
40 to 49 years old
2000-2021 -6.8 (-8.0; -5.6) <0.001 -6.8 (-8.0; -5.6) <0.001
50 to 59 years old
2000-2021 -4.1 (-6.5; -1.6) 0.001
2000-2012 -5.1 (-6.6; -3.5) <0.001
2012-2018 -12.1 (-17.3; -6.6) <0.001
2018-2021 19.2 (4.0; 36.5) 0.015
60 to 69 years old
2000-2021 -4.4 (-6.2; -2.6) <0.001
2000-2007 -2.1 (-4.9; 0.8) 0.148
2007-2018 -9.0 (-10.6; -7.5) <0.001
2018-2021 8.7 (-2.7; 21.3) 0.129
70 to 79 years old
2000-2021 -3.9 (-5.8; -1.9) <0.001
2000-2006 0.5 (-2.7; 3.9) 0.731
2006-2019 -8.2 (-9.3; -7.1) <0.001
2019-2021 13.5 (-6.8; 38.2) 0.189
80 years or more
2000-2021 -2.6 (-4.9; -0.2) 0.031
2000-2006 5.2 (2.5; 8.0) 0.001
2006-2015 -6.0 (-7.6; -4.4) <0.001
2015-2018 -15.7 (-27.8; -1.4) 0.035
2018-2021 7.1 (-1.0; 15.7) 0.080

VPA: Annual percentage variation; VPMA: average annual percentage change. p-value < 0.05*.

Figure 2 : Annual percentage variation in the stroke mortality rate by sex and age group in the population of the state of Pernambuco, Brazil, 2000 and 2021. 

The male sex showed stability in the mortality rate during the period studied, except for those aged zero to 29 years. The total group had four segments of annual percentage change (table 2).

Between 2000 and 2006, an increase in the APC of 3.2 (p=0.002) in the mortality rate was identified. In the segments from 2006 to 2015 and from 2015 to 2018, there were declines in the APC of the mortality rate of -5.0 (p<0.001) and -12.5 (p=0.018), respectively. Subsequently, there was an increase in the mortality rate (APV: 12.5; p<0.001) (table 2).

Females showed segments in similar periods to the total group, with an increase in the mortality rate between 2000 and 2006, declines from 2006 to 2018 and a subsequent increase until 2021. Males had a decline only in the segment between 2007 and 2019 (APC: -6.4; p<0.001) (table 2).

With the exception of the age group between 0 and 29 years, there was a downward trend (p<0.05) in the mortality rate in age groups over 30 years. The age groups from 30 to 39 years and from 40 to 49 years had a segment with a declining trend (p<0.001) in the mortality rate between 2000 and 2021. In the age group from 50 to 59 years, the APC showed a decline (p< 0.001) in the segments from 2000 to 2012 and from 2012 to 2018, with a subsequent increase (p<0.014) from 2018 to 2021 (figure 2).

In the age groups from 60 to 69 years old and from 70 to 79 years old there was a segment with a decline in APC, from 2007 to 2018 with -9.0 (p<0.001) and from 2006 to 2019 with -8.2 (p< 0.001), respectively. In the age group of 80 years or more in APC there was an increase (p<0.001) in the segment from 2000 to 2006, with a subsequent decline (p<0.05) in the segments from 2006 to 2015 and from 2015 to 2018 and followed by a stable segment until 2021 (figure 2).

Table 3 and figure 3 present the annual percentage change and the average annual percentage change in proportional mortality from stroke by sex and age group in the population of the state of Pernambuco, Brazil, between 2000 and 2021. In the period from 2000 to 2021 there was a decline in AAPC of -2.9 (p<0.001) in proportional mortality for stroke in the total group. Likewise, males and females showed a decline in proportional mortality in AAPC of -2.6 (p=0.001) and -3.2 (<0.001), respectively.

Table 3 : Annual percentage variation and average annual percentage variation in proportional mortality from stroke disease by sex and age group in the population of the state of Pernambuco, between 2000 and 2021 

Segment VPA (IC95%) P VPMA (IC95%) P
All
2000-2021 -2.9 (-4.5; -1.4) <0.001
2000-2008 2.1 (0.1; 4.2) 0.043
2008-2018 -8.3 (-9.9; -6.8) <0.001
2018-2021 2.5 (-6.6; 12.4) 0.579
Sex
Masculine
2000-2021 -2.6 (-4.2; -1.1) 0.001
2000-2008 2.5 (0.4; 4.6) 0.022
2008-2018 -8.1 (-9.7; -6.5) <0.001
2018-2021 3.1 (-6.1; 13.2) 0.497
Feminine
2000-2021 -3.2 (-4.1; -2.4) <0.001
2000-2007 3.9 (2.5; 5.4) <0.001
2007-2018 -8.1 (-8.9; -7.4) <0.001
2018-2021 -0.9 (-6.0; 4.4) 0.702
Age range
0 to 29 years old
2000-2021 1.4 (-2.7; 5.7) 0.479 1.4 (-2.7; 5.7) 0.479
30 to 39 years old
2000-2021 -4.0 (-5.9; -2.1) <0.001 -4.0 (-5.9; -2.1) <0.001
40 to 49 years old
2000-2021 -5.8 (-6.9; -4.7) <0.001 -5.8 (-6.9; -4.7) <0.001
50 to 59 years old
2000-2021 -4.1 (-6.3; -1.9) <0.001
2000-2011 -3.2 (-4.8; -1.5) 0.001
2011-2018 -10.5 (-14.2; -6.6) <0.001
2018-2021 8.4 (-4.5; 22.9) 0.194
60 to 69 years old
2000-2021 -4.6 (-6.1; -3.0) <0.001
2000-2007 -0.0 (-2.6; 2.6) 0.971
2007-2018 -8.6 (-10.0; -7.2) <0.001
2018-2021 0.2 (-9.0; 10.4) 0.957
70 to 79 years old
2000-2021 -4.0 (-5.5; -2.6) <0.001
2000-2007 1.1 (-0.8; 3.1) 0.244
2007-2019 -8.2 (-9.1; -7.3) <0.001
2019-2021 4.0 (-10.0; 20.3) 0.569
80 years or more
2000-2021 -3.0 (-4.3; -1.6) <0.001
2000-2007 6.3 (4.0; 8.6) <0.001
2007-2018 -9.1 (-10.3; -8.0) <0.001
2018-2021 -0.0 (-7.8; 8.3) 0.991

VPA: Annual percentage variation; VPMA: average annual percentage change

Figure 3 : Annual percentage variation in the stroke mortality rate by sex and age group in the population of the state of Pernambuco, Brazil, 2000 and 2021. 

The total group and the male and female sexes had 3 segments in the annual percentage change in proportional mortality. Similarly, the total group and males and females showed an increase (p<0.05) in the first segment, a decline (p<0.001) in the segment and stability in the third segment (figure 3).

With the exception of the range between 0 and 29 years old, there was a downward trend (p<0.001) in the AAPC of proportional mortality in the age groups over 30 years old. The age groups of 30 to 39 years and 40 to 49 years had a segment with a declining trend (p<0.001) in the APC of proportional mortality between 2000 and 2021. In the age group of 50 to 59 years the APC had a decline (p <0.001) in the segments from 2000 to 2011 and from 2011 to 2018, with a subsequent segment revealing stability until 2021 (p>0.05) (table 3).

In the age groups of 60 to 69 years and 70 to 79 years there was a segment with a decline, from 2007 to 2018 (APC: -8.6; p<0.001) and from 2007 to 2019 (APC: -8.2; p<0.001). In the age group of 80 years or more in APC there was an increase (p<0.001) in the segment from 2000 to 2007, with a subsequent decline (p<0.001) in the segment from 2007 to 2018 and a stable segment between 2018 and 2021 (p>0. 05) (table 3).

DISCUSSION

In the period from 2000 to 2021, there was a greater number of deaths from stroke in women compared to men in the population of Pernambuco, Brazil. There was a tendency for stroke to decline in both the mortality rate and proportional mortality. In most years analyzed, men had a higher mortality rate. However, women showed higher proportional mortality throughout the studied period. In the period from 2018 to 2021 there was a progressive increase in the mortality rate and proportional mortality from stroke.

Between the years 2000 and 2021, there were fluctuations in the absolute number of stroke fatalities in the state of Pernambuco. A total of 39,410 deaths were recorded, with 20,107 occurring among females and 19,295 among males, as indicated in table 1. Furthermore, the average number of deaths among females was higher than the average among males.

Still in table 1, we observe that the years 2006, 2007 and 2008 recorded the highest numbers of deaths from stroke, while in 2018 there was the lowest number. There was a continuous increase in the number of deaths from stroke from 2018 to 2021. In general, males had higher mortality rates, except in the years 2004, 2005, 2008, 2010, 2013, 2016, 2017 and 2019.

Since 2018, there has been a progressive increase in mortality rates for both sexes. Proportional mortality was consistently higher in females throughout the period studied, with 2006 presenting the highest values for both sexes and 2018 the lowest. The progressive increase in proportional mortality began in 2020 for the total and female population, and in 2018 for males.

In all the years analyzed, the age group with the highest number of deaths from stroke was 80 years or more. The years 2006, 2007 and 2008 recorded the highest numbers of deaths in this age group. In 2018, the lowest number of deaths from stroke occurred in individuals between 0 and 29 years old, as shown in figure 1.

In the figure and table 2, a decline in the AAPC of the mortality rate for stroke was identified in the total population and in females. When segmented by periods, from 2000 to 2006, there was an increase in the mortality rate, in the periods from 2006 to 2015 and from 2015 to 2018, there were declines. Subsequently, an increase in the mortality rate was observed.

Females showed similar patterns to the total group, with an increase in the mortality rate between 2000 and 2006, followed by declines between 2006 to 2015 and 2015 to 2018, and an increase until 2021. In contrast, males registered a decline only in the period between 2007 and 2019.

Still in table 2, there was a downward trend in the average annual mortality rate in all age groups over 30 years old. The 30-39 and 40-49 age groups registered a declining trend throughout the period. In individuals between 50 and 59 years old, there was a decline from 2000 to 2018, followed by an increase until 2021. In the age groups from 60 to 69 years old and from 70 to 79 years old, there was a decline from 2007 to 2018 and from 2006 to 2019, respectively . In the group aged 80 and over, there was an increase from 2000 to 2006, followed by a decline from 2006 to 2018 and stability until 2021.

In table 3 and figure 3, a decline in the AAPC of proportional mortality due to stroke was found throughout the entire period. This decline was also observed in males and females. Both the total group and the male and female sexes presented three segments in the annual percentage change in proportional mortality. They exhibited similar patterns, with an increase in the first segment, a decline in the second, and stability in the third segment.

Except for the age group 0 to 29 years, there was a downward trend in VMPA in proportional mortality in all age groups. The age groups of 30 to 39 years and 40 to 49 years of age showed a decline in proportional mortality from 2000 to 2021. In individuals between 50 and 59 years of age, there was a decline from 2000 to 2018, followed by stability until 2021. In the age groups of 60 to 69 years old and from 70 to 79 years old, there was a decline from 2007 to 2018. Finally, in the age group of 80 years old and over, there was an increase from 2000 to 2007, followed by a decline between 2007 and 2018 and a stable period in 2018 to 2021.

The number of deaths from stroke varied throughout the studied period, which indicates a complex dynamic, suggesting that different factors can influence the incidence of deaths from stroke , such as obesity, arterial hypertension, genetic predisposition, atheromatous disease, atrial fibrillation , use of oral contraceptives and auricular myxoma33.

In agreement with the findings of this research, a study that analyzed the trend in stroke mortality rates throughout Brazil between 2000 and 2009 identified a greater increase in the number of mortality rates in female individuals34. Furthermore, in Rondônia, a state in the north of Brazil, 52.1% of hospitalizations for stroke were caused by female patients35.

The study by De Carvalho et al. (2011)36included an epidemiological analysis of stroke in Brazil, demonstrating a higher incidence in females (51.8%) in a group of 2,407 patients. Similar to what was found by Pinheiro and Gomes (2012)37, who observed a higher death rate among females.

Therefore, it is possible that the disparity in the number of deaths resulting from stroke between the sexes may vary according to the different research locations. This geographic variation can be influenced by a series of factors, such as access to health services, specific demographic characteristics of each region, prevalent lifestyle habits and the quality of medical care systems. Therefore, it is essential to explore and understand regional differences to develop effective and personalized approaches to stroke prevention and management34.

In 2019, a study showed that Brazil recorded a total of 73,920 deaths resulting from ischemic stroke. An increase in the prevalence of this type of stroke was observed in accordance with advancing age38. The number of deaths related to cerebrovascular diseases is higher in the elderly age group, especially after 65 years of age39, corroborating the findings of this study.

In general terms, cerebrovascular diseases can manifest themselves in any age group; however, the risk increases after age 60, doubling with each subsequent decade40. Furthermore, the occurrence of stroke increases significantly with advancing age. After reaching the age of 55, the risk of suffering a stroke doubles with each subsequent decade41.

Older individuals have higher incidences and significant adverse outcomes, showing a higher mortality rate in both the acute and long-term phases, influenced by the degree of severity of the disease, cardiovascular profile, sociodemographic aspects and previous functional disability42. In this way, age emerges as one of the main non-modifiable risk factors43.

Therefore, it is important to highlight that stroke risk factors increase around the age of 60 and from this point onwards, they double every ten years40.

The decline in the stroke mortality rate was also identified by Garritano et al. (2012)34, who reported a downward trend in the mortality rate from this condition between 2000 and 2009 throughout Brazil. Furthermore, in 2000 and 2005, an ecological study carried out with data from the population of the Federal District showed a tendency towards a decrease in mortality rates37.

The reasons that may justify the reduction in the mortality rate due to stroke are related to the incidence and lethality of the disease, with risk factors such as hypertension, diabetes and obesity determining the incidence, in addition to the effectiveness of the treatment. The control of risk factors, the prevention of circulatory diseases and socioeconomic improvements contribute to the reduction in mortality. High-tech procedures, greater availability of diagnostic equipment and quick care also help. However, in Brazil, regional inequality and scarcity of health resources limit access to these procedures in some locations34.

In the findings of Lutufo (2019)44, a reduction in the mortality rate from stroke was observed, according to the Joinpoint regression method. In both sexes, mortality rates showed significant declines between 1990 and 2017. These findings are in agreement with the results described in table 2, however for men and in the period from 2000 to 2007 and 2019 to 2021 this outcome was not maintained. epidemiological.

In scientific literature, many studies oppose the finding that the female population has more deaths from stroke. The results of an epidemiological study of stroke in Brazil showed that the absolute number of fatalities among males was higher34.

The findings found by Santos, Luquini and Fagundes (2020)45, which detailed the epidemiological parameters of deaths resulting from cerebrovascular diseases in the state of Paraná, in the southern region of Brazil, during the period from 2008 to 2018, revealed a greater number of deaths in male individuals. Furthermore, similar results were found by the Brazilian Society of Cerebrovascular Diseases46, by De Almeida and Vianna (2018)47 and Carvalho et al. (2019)48.

Recent research indicates that stroke is no longer considered a disease of elderly people, since young adults are more vulnerable to chronic diseases according to the standard of living adopted49-51. In recent decades, there has been an increase in the incidence of stroke in adults under 45 years of age52, however, this age group has better prognoses53.

Among the risk factors that are highly relevant in the younger population are smoking, immunological diseases, use of oral contraceptives, migraines, hypertension, diabetes, atherosclerosis, consumption of illicit drugs, pregnancy and the postpartum period54.

Thus, statistical analyzes indicate a significant increase in stroke cases in young adults over the last few decades. This scenario places this condition as the main one among the diseases that result most in deaths and disabilities in individuals of working age, thus becoming a pressing public health issue49.

In relation to the mortality rate, between 2018 and 2021, an average annual increase was identified. A study carried out in the municipalities of Paraná and Maringá analyzed the trend of deaths due to stroke in the municipalities between 2005 and 2015. The results showed that the trend in general mortality was constant, however, the increasing trend was found only in males54.

Despite presenting an unequal distribution, current mortality rates in Brazil are still high. The burden of stroke mortality in the main Brazilian cities is significantly higher than that observed in the United States, Canada and Western European countries, and is at levels similar to those in Eastern Europe and Japan. In relation to other Latin American countries, Brazil it also records the highest rates for both men and women. Even after a drop in all age groups, mortality rates among adults and middle-aged people in Brazil still exceed those observed among elderly people in developed countries55-57.

The study findings reveal significant variations throughout the analyzed period, showing temporal changes in the proportions of deaths attributed to stroke in the state of Pernambuco. These variations highlight a general trend of decreasing disease-related mortality rates over time. This finding suggests that preventive measures and public health interventions implemented over the years may be contributing to the improvement of health outcomes related to stroke in the region.

As it is a secondary database study, the results should be used to form hypotheses for new research. However, the study has several strengths and demonstrates its significant importance. The use of a time series analysis method provides a robust approach to examining the temporal variations of health indicators over the period, which allows identifying possible changes in trends over time, providing important information to understand the evolution of stroke mortality in the population of the state of Pernambuco, Brazil.

Furthermore, the use of data from DATASUS allows a broad and representative analysis of the epidemiological situation in the state of Pernambuco, northeastern Brazil. By focusing specifically on Pernambuco, the study offers relevant data for the planning and implementation of targeted health policies aimed at preventing and controlling stroke in that Brazilian state.

Understanding the trend and factors associated with stroke is essential to guide effective public health interventions. Therefore, this study not only contributes to scientific knowledge about the epidemiology of stroke in Pernambuco, but also offers fundamental support for the formulation of health policies and programs aimed at preventing and managing this serious health condition in the population.

Furthermore, it is noteworthy that DATASUS provides information that can serve to support objective analyzes of the health situation, evidence-based decision making and the development of health action programs, just as the research on stroke was carried out.

Measuring the population’s health status is a tradition in public health, allowing a better understanding of the concept of health and its population determinants and the analysis of the Brazilian health situation.

CONCLUSION

In the period from 2000 to 2021, there was a greater number of deaths from stroke in women in contrast to men in the population of Pernambuco, Brazil. There was a tendency for stroke to decline in both the mortality rate and proportional mortality. In most years analyzed, men had a higher mortality rate. However, women showed higher proportional mortality. In the period from 2018 to 2021 there was a progressive increase in the mortality rate and proportional mortality from stroke. At ages zero to 29 years there was no decline in the mortality rate and proportional mortality due to stroke.

Acknowledgments

The authors thanks Professor Luiz Carlos de Abreu.

REFERENCES

1. Machado VS, Hahn L de M, Martins MIM, Marrone LCP. Conhecimento da população sobre acidente vascular cerebral em Torres RS. Rev. bras. neurol. 2020; 11-14. https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1120376 [ Links ]

2. Campbell BCV, Khatri P. Stroke. The Lancet. 2020; 396(10244): 129-142. https://doi.org/10.1016/S0140-6736 (20)31179-X. [ Links ]

3. Singh B, Huang D. The Role of Circadian Rhythms in Stroke: A Narrative Review. Neurochemical research. 2024; 49(2): 290-305. https://doi.org/10.1007/s11064-023-04040-5. [ Links ]

4. Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, et al. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation. 2022; 145(8): e153-e639. https://doi.org/10.1161/CIR.0000000000001052. [ Links ]

5. Lima MJMR, Moreira TMM, Florêncio RS, Braga Neto P. Fatores associados ao conhecimento dos adultos jovens sobre histórico familiar de Acidente Vascular Cerebral. Revista Latino-Americana de Enfermagem. 2016; 24: e2814. https://www.scielo.br/j/rlae/a/t94fPfPvCQc8GJk8TnK9XdL/?lang=pt [ Links ]

6. Paley L, Williamson E, Bray BD, Hoffman A, James MA, Rudd AG, et al. Associations Between 30-Day Mortality, Specialist Nursing, and Daily Physician Ward Rounds in a National Stroke Registry. Stroke; a journal of cerebral circulation. 2018; 49(9): 2155-2162. https://doi.org/10.1161/STROKEAHA.118.021518. [ Links ]

7. Owolabi MO, Thrift AG, Mahal A, Ishida M, Martins S, Johnson WD, et al. Primary stroke prevention worldwide: translating evidence into action. The Lancet. Public health. 2022; 7(1): e74-e85. https://doi.org/10.1016/S2468-2667 (21)00230-9. [ Links ]

8. Chen R, Ovbiagele B, Feng W. Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes. The American journal of the medical sciences. 2016; 351(4): 380-386. https://doi.org/10.1016/j.amjms.2016.01.011. [ Links ]

9. Guzik A, Bushnell C. Stroke Epidemiology and Risk Factor Management. Continuum. 2017; 23(1, Cerebrovascular Disease): 15-39. https://doi.org/10.1212/CON.0000000000000416. [ Links ]

10. Strong K, Mathers C, Bonita R. Preventing stroke: saving lives around the world. Lancet neurology. 2007; 6(2): 182-187. https://doi.org/10.1016/S1474-4422 (07)70031-5. [ Links ]

11. Abramczuk B, Villela E. A luta contra o AVC no Brasil. ComCiência. 2009; (109): 0-0. http://comciencia.scielo.br/scielo.php?script=sci_arttext&pid=S1519-76542009000500002&lng=pt&nrm=iso [ Links ]

12. World Health Organization. Projection of deaths by cause, age and sex, by world bank income group [Internet]. 2018 [cited 2022 Aug 28]. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death [ Links ]

13. Hathidara MY, Saini V, Malik AM. Stroke in the Young: a Global Update. Current neurology and neuroscience reports. 2019; 19(11): 91. https://doi.org/10.1007/s11910-019-1004-1. [ Links ]

14. Faiz KW, Sundseth A, Thommessen B, Rønning OM. Patient knowledge on stroke risk factors, symptoms and treatment options. Vascular health and risk management. 2018; 14: 37-40. https://doi.org/10.2147/VHRM.S152173. [ Links ]

15. Carmo JF do, Morelato RL, Pinto HP, Oliveira ERA de. Disability after stroke: a systematic review. Fisioterapia em Movimento. 2015; 28(2): 407-418. https://doi.org/10.1590/0103-5150.028.002.AR02. [ Links ]

16. van Mierlo ML, van Heugten CM, Post MWM, Hajós TRS, Kappelle LJ, Visser-Meily JMA. Quality of Life during the First Two Years Post Stroke: The Restore4Stroke Cohort Study. Cerebrovascular diseases. 2016; 41(1-2): 19-26. https://doi.org/10.1159/000441197. [ Links ]

17. Purroy F, Vena A, Forné C, de Arce AM, Dávalos A, Fuentes B, et al. Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients. Cerebrovascular diseases. 2019; 47(3-4): 151-164. https://doi.org/10.1159/000500205. [ Links ]

18. Ouriques Martins SC, Sacks C, Hacke W, Brainin M, de Assis Figueiredo F, Marques Pontes-Neto O, et al. Priorities to reduce the burden of stroke in Latin American countries. Lancet neurology. 2019; 18(7): 674-683. https://doi.org/10.1016/S1474-4422 (19)30068-7. [ Links ]

19. Feigin VL, Vos T, Nichols E, Owolabi MO, Carroll WM, Dichgans M, et al. The global burden of neurological disorders: translating evidence into policy. Lancet neurology. 2020; 19(3): 255-265. https://doi.org/10.1016/S1474-4422 (19)30411-9. [ Links ]

20. Pandian JD, Gall SL, Kate MP, Silva GS, Akinyemi RO, Ovbiagele BI, et al. Prevention of stroke: a global perspective. The Lancet. 2018; 392(10154): 1269-1278. https://doi.org/10.1016/S0140-6736 (18)31269-8. [ Links ]

21. Alves B/. O/. Acidente vascular cerebral (AVC). https://bvsms.saude.gov.br/avc-acidente-vascular-cerebral/ [Accessed 15th March 2024]. [ Links ]

22. Gillis D, Edwards BPM. The utility of joinpoint regression for estimating population parameters given changes in population structure. Heliyon. 2019; 5(11): e02515. https://doi.org/10.1016/j.heliyon.2019.e02515. [ Links ]

23. Barrio G, Pulido J, Bravo MJ, Lardelli-Claret P, Jiménez-Mejías E, de la Fuente L. An example of the usefulness of joinpoint trend analysis for assessing changes in traffic safety policies. Accident; analysis and prevention. 2015; 75: 292-297. https://doi.org/10.1016/j.aap.2014.12.010. [ Links ]

24. Jiang Z, Hatcher J. Joinpoint Trend Analysis of Cancer Incidence and Mortality using Alberta Data. 2010; https://www.semanticscholar.org/paper/9a4274679799ea3f712867e5e1aa3a6c4a227459 [ Links ]

25. Qiu D, Katanoda K, Marugame T, Sobue T. A Joinpoint regression analysis of long-term trends in cancer mortality in Japan (1958-2004). International journal of cancer. Journal international du cancer. 2009; 124(2): 443-448. https://doi.org/10.1002/ijc.23911. [ Links ]

26 . Crispo A, Barba M, Malvezzi M, Arpino G, Grimaldi M, Rosso T, et al. Cancer mortality trends between 1988 and 2009 in the metropolitan area of Naples and Caserta, Southern Italy: Results from a joinpoint regression analysis. Cancer biology & therapy. 2013; 14(12): 1113-1122. https://doi.org/10.4161/cbt.26425. [ Links ]

27. Wilson L, Bhatnagar P, Townsend N. Comparing trends in mortality from cardiovascular disease and cancer in the United Kingdom, 1983-2013: joinpoint regression analysis. Population health metrics. 2017; 15(1): 23. https://doi.org/10.1186/s12963-017-0141-5. [ Links ]

28. Dyvesether SM, Nordentoft M, Forman JL, Erlangsen A. Joinpoint regression analysis of suicides in Denmark during 1980-2015. Danish medical journal. 2018; 65(4). https://www.ncbi.nlm.nih.gov/pubmed/29619927 [ Links ]

29. Molnar A, Iancu M, Radu R, Borzan CM. A Joinpoint Regression Analysis of Syphilis and Gonorrhea Incidence in 15-19-Year Old Adolescents between 2005 and 2017: A Regional Study. International journal of environmental research and public health. 2020; 17(15). https://doi.org/10.3390/ijerph17155385. [ Links ]

30. World Health Organization. International Statistical Classification of Diseases and Related Health Problems: Alphabetical index. World Health Organization; 2004. https://play.google.com/store/books/details?id=Tw5eAtsatiUC [ Links ]

31. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJB, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke; a journal of cerebral circulation. 2013; 44(7): 2064-2089. https://doi.org/10.1161/STR.0b013e318296aeca. [ Links ]

32. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Statistics in medicine. 2000; 19(3): 335–351. https://doi.org/10.1002/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z. [ Links ]

33. Pompermaier C, Ferreira AP, Boiani LE, Pereira YCLV. Fatores de risco para o acidente vascular cerebral (AVC). Anuário Pesquisa e Extensão Unoesc Xanxerê. 2020; 5: e24365-e24365. [ Links ]

34. Garritano CR, Luz PM, Pires MLE, Barbosa MTS, Batista KM. Analysis of the mortality trend due to cerebrovascular accident in Brazil in the XXI century. Arquivos brasileiros de cardiologia. 2012; 98(6): 519-527. https://doi.org/10.1590/s0066-782x2012005000041. [ Links ]

35. de Oliveira JG, Damasceno KG, de Souza LP, de Lima MG. Perfil clínico epidemiológico dos pacientes internados com acidente vascular encefálico em um hospital de grande porte na região sul da Amazônia legal. AMAZÔNIA: SCIENCE & HEALTH. 2016; 4(3): 03-11. http://ojs.unirg.edu.br/index.php/2/article/view/1106 [ Links ]

36. de Carvalho JJF, Alves MB, Viana GÁA, Machado CB, dos Santos BFC, Kanamura AH, et al. Stroke epidemiology, patterns of management, and outcomes in Fortaleza, Brazil: a hospital-based multicenter prospective study. Stroke; a journal of cerebral circulation. 2011; 42(12): 3341-3346. https://doi.org/10.1161/STROKEAHA.111.626523. [ Links ]

37. Pinheiro HA, Gomes LG. Taxa de Mortalidade Específica por Doenças Cerebrovasculares no Distrito Federal entre 1995 e 2005. Revista Neurociências. 2012; 20(4): 488-493. https://doi.org/10.4181/RNC.2012.20.483.6p. [ Links ]

38. Lobo PGG, de Barcellos Zanon V, De Lara D, Freire VB, Nozawa CA, de Andrade JVB, et al. Epidemiologia do acidente vascular cerebral isquêmico no Brasil no ano de 2019, uma análise sob a perspectiva da faixa etária / Epidemiology of the ischemic cerebrovascular accident in Brazil in the year of 2019, an analysis from an age group perspective. Brazilian Journal of Health Review. 2021; 4(1): 3498-3505. https://doi.org/10.34119/bjhrv4n1-272. [ Links ]

39. Bierhals CCBK, Day CB, Mocellin D, Santos NO dos, Predebon ML, Pizzol FLFD, et al. Utilização dos serviços de saúde por idosos após acidente vascular cerebral: ensaio clínico randomizado. Revista Gaúcha de Enfermagem. 2019; 41(spe): e20190138. https://www.scielo.br/j/rgenf/a/Vh6d9gpK37LxCLPwZbqKWZL/?lang=pt [ Links ]

40. Castro JAB de, Epstein MG, Sabino GB, Nogueira GLO, Blankenburg C, Staszko KF, et al. Estudo dos principais fatores de risco para acidente vascular encefálico. Rev. Soc. Bras. Clín. Méd. 2009; 171-173. https://pesquisa.bvsalud.org/portal/resource/pt/lil-518174 [ Links ]

41. Neves MMF, de Castro Toledo Guimarães LH. Qualidade de Vida e Grau de Independência Funcional em Pacientes com Acidente Vascular Cerebral. Revista Neurociências. 2016; 24: 1-17. https://doi.org/10.34024/rnc.2016.v24.9940. [ Links ]

42. Eira C Mota, Silvério R, Miranda M, Ribeiro P, Gomes A, et al. Trombólise Intravenosa no Acidente Vascular Cerebral Isquémico Agudo Depois dos 80 Anos. Medicina Interna. 2018; 25(3): 169-178. https://doi.org/10.24950/rspmi/original/189/3/2018. [ Links ]

43. Roxa GN, Amorim ARV, Caldas GRF, dos Santos Holanda Ferreira A, de Alencar Rodrigues FE, Gonçalves MOS, et al. Perfil epidemiológico dos pacientes acometidos com AVC isquêmico submetidos a terapia trombolítica: uma revisão integrativa / Epidemiological profile of patients affected with ischemic stroke subject to thrombolytic therapy: an integrative review. Brazilian Journal of Development. 2021; 7(1): 7341-7351. https://doi.org/10.34117/bjdv7n1-496. [ Links ]

44. Lotufo PA. A queda das taxas de mortalidade cardiovascular no Brasil (1990 a 2017) está diminuindo. Diagnóstico e Tratamento. 2019; 24(1): 1-3. https://periodicosapm.emnuvens.com.br/rdt/article/view/196 [ Links ]

45. Santos KR, Luquini VC, Fagundes TR. Epidemiology of deaths related to stroke in the State of Paraná: a comparison between the years 2008 and 2018. Research, Society and Development. 2020; 9(11): e389119527-e389119527. https://doi.org/10.33448/rsd-v9i11.9527. [ Links ]

46. Sociedade Brasileira de Doenças Cerebrovasculares. (2016). Sociedade Brasileira de Doenças Cerebrovasculares -SBDCV. Acidente Vascular Cerebral. [Online]. Disponível em: http://www.sbdcv.org.br/publica_avc.asp. [ Links ]

47. de Almeida LG, Vianna JBM. Perfil epidemiológico dos pacientes internados por acidente vascular cerebral em um hospital de ensino / Epidemiology of patients hospitalized for stroke in a teaching hospital. Health Sciences Journal. 2018; 8(1): 12-17. https://doi.org/10.21876/rcsfmit.v8i1.741. [ Links ]

48. Carvalho VP, Ribeiro HLS, da Rocha BVE, Barcelos KA, de Andrade FV, Vasconcelos GR, et al. Perfil clínico-epidemiológico de pacientes com acidente vascular cerebral. Revista Saúde e Desenvolvimento. 2019; 13(15). https://www.revistasuninter.com/revistasaude/index.php/saudeDesenvolvimento/article/view/1059 [ Links ]

49. Alves C, de Santana DS, Aoyama E. ACIDENTE VASCULAR ENCEFÁLICO EM ADULTOS JOVENS COM ÊNFASE NOS FATORES DE RISCO. 2020;2. https://www.academia.edu/90949310/Acidente_Vascular_Encef%C3%A1lico_Em_Adultos_Jovens_Com_%C3%8Anfase_Nos_Fatores_De_Risco [ Links ]

50. Henriques M, Henriques J, Jacinto J. Acidente Vascular Cerebral no Adulto Jovem: A Realidade num Centro de Reabilitação. Revista da Sociedade Portuguesa de Medicina Física e de Reabilitação. 2015; 27(1): 9-13. https://doi.org/10.25759/spmfr.180. [ Links ]

51. Benetti LM, Bueno ALM. Acidente vascular cerebral em adulto jovem: análise dos registros do sistema de informação hospitalar. Revista Recien - Revista Científica de Enfermagem. 2019; 9(27): 54-61. https://doi.org/10.24276/revrecien2358-3088.2019.9.27.54-61. [ Links ]

52 . Onaolapo AY , Onaolapo OJ , Nathaniel TI . Cerebrovascular Disease in the Young Adult: Examining Melatonin's Possible Multiple Roles. Journal of experimental neuroscience. 2019; 13: 1179069519827300. https://doi.org/10.1177/1179069519827300. [ Links ]

53. Smajlovic D. Strokes in young adults: epidemiology and prevention. Vascular health and risk management. 2015; 11: 157-164. https://doi.org/10.2147/VHRM.S53203. [ Links ]

54. Araújo JP de, Darcis JVV, Tomas ACV, Mello WA de. Tendência da Mortalidade por Acidente Vascular Cerebral no Município de Maringá, Paraná entre os Anos de 2005 a 2015. International Journal of Cardiovascular Sciences. 2018; 31(1): 56-62. https://doi.org/10.5935/2359-4802.20170097. [ Links ]

55. Feigin VL, Lawes CMM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet neurology. 2009; 8(4): 355-369. https://doi.org/10.1016/S1474-4422 (09)70025-0. [ Links ]

56. Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet neurology. 2009; 8(4): 345-354. https://doi.org/10.1016/S1474-4422 (09)70023-7. [ Links ]

57. Passos VMA, Ishitani LH, Franco GC, Lana GC, Abreu DMX, Marinho M de F, et al. Consistent declining trends in stroke mortality in Brazil: mission accomplished? Arquivos de neuro-psiquiatria. 2016; 74(5): 376-381. https://doi.org/10.1590/0004-282X20160055. [ Links ]

Funding: the authors, and the coauthors did not receive any funding to declare.

Received: May 2023; Accepted: December 2023; Published: April 2024

Corresponding author: joseluiz.figueiredo@gmail.com

Conflicts of Interest:

The authors report on conflict of interest.

© The authors (2024).

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