Abstract 13034: Reduction in Cardiovascular Disease Mortality Rates in Brazil is Heterogeneous Across Municipalities: Estimates From the Global Burden of Disease Study, 2000-2018

Introduction: Age-standardized mortality rates (ASMR) for cardiovascular diseases (CVD) decreased in Brazil in the last decades due to better control of risk factors and access to treatment. However, how this reduction distributes across the country’s municipalities is not known, which is important due to the socioeconomic and healthcare disparities in its regions (Northern regions being the most vulnerable) and in municipalities with small vs. large populations. Methods: Ecological study in which the ASMR for CVD were estimated by the Global Burden of Disease (GBD) method for 5,568 Brazilian municipalities from the 5 regions in the triennials: 2000-2002, 2009-2011, and 2016-2018. A visuospatial analysis was applied to create clusters in ASMR with Moran Local analysis. Municipalities were then stratified by population size in <30,000, 30,000-300,000, and >300,000 inhabitants per region, and the % changes in ASMR from 2000-2002 to 2016-2018 were calculated. Results: In 2000-2002, ASMR for CVD were higher in the more developed regions and in the larger municipalities of all regions, except the South. In 2016-2018, CVD ASMR became higher in the least developed Northern regions ( Fig 1 ). Moreover the % reduction in CVD ASMR were lower in small vs. large municipalities within all 5 regions varying from -7% in the small North municipalities to -78% in the large South municipalities. Conclusions: Reduction in CVD mortality in Brazil was lower in the municipalities from the most vulnerable regions and in those with smaller populations. Public policies focusing and tailored to these smaller municipalities, particularly of the least developed regions must be considered a priority.