RESUMO
BACKGROUND: Cerebrovascular disease (stroke) is the second most common cause of death and among the top five causes of morbidity in many developed and developing countries. The aim of this study was to investigate patterns of increase and decrease in stroke mortality in 48 different countries. METHODS: The mortality curves of stroke for 48 countries that had reliable data and met other selection criteria were examined using age standardised death rates for 35-74 years from the WHO. Annual mortality rates for individual countries from 1950 to 2005 were plotted and a table and graph were used to classify countries by magnitude, pattern and timing of stroke mortality. Male and female trends were plotted separately. RESULTS: The secular trend of stroke mortality varied markedly among countries. Different stroke patterns were distinguishable, including 'declining', 'rise and fall', 'rising' and 'flat'. Furthermore, epidemic peaks per 10(5) (M/F) were higher in Asia, in particular in Japan (433/304), Russian Federation (388/221) and Bulgaria (301/214), and were lowest in Canada and Australia (29/18). There were considerable differences among some continental and regional geographic areas. For example, Japan, Belgium, Portugal and Eastern Europe exhibited a rise and fall pattern while other countries fell into the other three categories. CONCLUSIONS: In many countries, stroke mortality has decreased, between 1950 and 2005, often very considerably. The different dates of mortality downturn likely are consistent with the implementation of various prevention strategies. This could be translated to policy interventions for stroke control in countries with a rising trend of the disease.
Assuntos
Transtornos Cerebrovasculares/mortalidade , Adulto , Idoso , América Central/epidemiologia , Atestado de Óbito , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Análise de Regressão , Fatores de Risco , Fatores Sexuais , América do Sul/epidemiologia , Acidente Vascular Cerebral/mortalidade , População Branca , Organização Mundial da SaúdeRESUMO
OBJECTIVE: To estimate individual and household economic impact of cardiovascular disease (CVD) in selected low- and middle-income countries (LMIC). BACKGROUND: Empirical evidence on the microeconomic consequences of CVD in LMIC is scarce. METHODS AND FINDINGS: We surveyed 1,657 recently hospitalized CVD patients (66% male; mean age 55.8 years) from Argentina, China, India, and Tanzania to evaluate the microeconomic and functional/productivity impact of CVD hospitalization. Respondents were stratified into three income groups. Median out-of-pocket expenditures for CVD treatment over 15 month follow-up ranged from 354 international dollars (2007 INT$, Tanzania, low-income) to INT$2,917 (India, high-income). Catastrophic health spending (CHS) was present in >50% of respondents in China, India, and Tanzania. Distress financing (DF) and lost income were more common in low-income respondents. After adjustment, lack of health insurance was associated with CHS in Argentina (OR 4.73 [2.56, 8.76], India (OR 3.93 [2.23, 6.90], and Tanzania (OR 3.68 [1.86, 7.26] with a marginal association in China (OR 2.05 [0.82, 5.11]). These economic effects were accompanied by substantial decreases in individual functional health and productivity. CONCLUSIONS: Individuals in selected LMIC bear significant financial burdens following CVD hospitalization, yet with substantial variation across and within countries. Lack of insurance may drive much of the financial stress of CVD in LMIC patients and their families.