comparison of the mortality caused by cerebrovascular...
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Comparison of the mortality caused by Cerebrovascular disease and Ischemic heart disease in Panama from 2001 to 2009, its relationship to
gender and cardiovascular risk factorsJorge Motta1, Carlos Gordón1, Beatriz Gómez1, Eva Castillo1, Víctor Herrera Ballesteros1
INTRODUCTION: Cerebrovascular disease (CVD) and ischemic heart disease (IHD) are among the top 5 leading causes of death in the Republic of Panama. Despite this, little information is available about mortality trends and the relation between mortality by these diseases and their risk factors.
OBJECTIVES:To characterize mortality trends of CVD and IHD in Panama and their relationship to biological and socioeconomic risk factors.
MATERIALS AND METHODS:The methodology involved compilation and analysis of data from the National Quality of Life and Health, and Living Standards Survey obtained in a sample of 25,748 individuals, data from the National Population Census of 2000 and 2010 and the National Registries of mortality from all causes for the years 2001 to 2009. Mortality trends were analyzed monthly, using a first-order autoregressive model generated with the software ECOTRIM 10.1 version.
We generated indicators of crude, adjusted and specific rates of mortality from CVD and IHD. We then compared these rates with the prevalence of biological and socioeconomic risk factors at provincial, district and county levels. We derived regression coefficients from multivariate analysis of biologic and socioeconomic factors known to be related to the risk of dying from CVD and IHD. We summarized in maps, using a composite health index, the principal components of the factorial analyses. In the maps, biological factors are displayed by districts, and socioeconomic factors by counties. The stacked column charts represent the proportional contribution of different risks factors to the crude mortality rate by province.
RESULTS:In the study period CVD was the cause of 9% of all mortality in men and 10% of all mortality in women. For IHD caused 12% of all mortality in men and 10% of all mortality in women.
The crude and age adjusted death rates from CVD for 2001-2009 tended to decrease while the death rates for IHD showed a minimal increase. Males had a higher mortality rate than females in CVD and IHD. But the mortality rate gap was less for CVD than for IHD.
Mortality rates for CVD and IHD were higher in urban areas. Biological risk factors had a greater influence in the mortality rate of both diseases in urban and more developed districts. Socioeconomic risk factors had a greater influence in the mortality rate of these diseases in rural and less developed counties.
CONCLUSIONSIn Panama, during the years 2001 - 2009, crude mortality rates for CVD decreased, while crude mortality rates for IHD remained unchanged. We have no explanation for the secular trends observedgiven the absence of a specific national strategy for control of CVD.diseases.
1Instituto Conmemorativo Gorgas de Estudios de la Salud
ICGES. Panamá, Ave. Justo Arosemena y calle 35. Tel.: (507) 527 - 4811 Fax: (507) 527 - 4889Apartado Postal: Nº 0816 – 02593. email: [email protected] Panamá, República de Panamá
http://www.gorgas.gob.pa/
Estimated proportional mortality by major causes of death in Panamaaccording to gender, 2001-2009.
Men Women
Source: Life Events: Mortality, 2001 - 2009. INEC
gene
Fact Sheet: Republic of Panama
Population: 3,405,813 inhab.
Area: 75,510 km2
PIB:20,862.9 millions US dollars
PIB per capita:5,953 US dollars
%
Age structrure (%)
0- 14 years: 29.215- 64 years: 63.464 years and over: 7.4
Sex sctructure101.1 men/ 100 women
Life expectancy at birth
Both sexs: 75.9 yearsMale: 73.3 yearsWomen: 78.6
Mortality
Crude rate: 4.5/ 1,000 inhabts.Infant mortality rate: 12.2/ 1,000 inhabts
Annual % of growth:7.5%
Poverty population: 32%
Indigeneous population (%):12.3%
Afro population (%)9.2%
Economic, Social and Health Indicators of Republic of Panama. 2010.
Source: INEC/ MINSA
geneEstimated mortality rate for ischemic heart disease (ICD/10: I20- I25) in
Panama and other selected countries, 1996-2008.
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 20080.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
59.1 59.156.3
52.8 53.3 54.3 54.556.4 57.4
53.3 54.757.8
53.5
PanamáChileCosta Rica
Years
Rat
e x
100,
000
inha
b
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 20080
10
20
30
40
50
60
70
55
58.756
58
51.9
58.955.8
57.3 58.2
53.3 52.350.3
48.6
28 27.2 26.1 27.2 26.328.7 28
23.8 25.1 25.1 23.9 23.7 22.5
PanamáChileCosta RicaEstados Unidos
Years
Rat
e x
100,
000
inha
b
Composite index of biological risks factors and mortality forischemic heart disease, coronary disease, acute coronary syndrome and
angina pectoris (ICD/10: I20-I25), by district. Panama. 2001 to 2009.
Composite index of biological risks factors and mortalityfor cerebrovascular disease (ICD/10: I60-I69), by district.
Panama. 2001 to 2009.
Composite index of socioeconomic determinants and mortality for cerebrovascular disease (ICD/10: I60-I69) as counties.
Panama. 2001 to 2009.
B. del Toro Coclé Colón Chiriquí Darién Herrera Los Santos Panamá Veraguas Guna Yala Emberá Gnabe-6
-4
-2
0
2
4
6
8
Provinces
Com
poun
d In
dex
% 6 years of schoolCrude rate%Men% Women% 65 years and older% Unemployment% Lower than $ 100.00% Afro% Indigenous
Composite index of socioeconomic determinants and mortality for ischemic heart disease, coronary disease, acute coronary syndrome and angina
pectoris (ICD/10: I20- I25) as counties. Panama. 2001 to 2009.
B. del Toro Coclé Colón Chiriquí Darién Herrera Los Santos Panamá Veraguas Guna Yala Emberá Gnabe-6
-4
-2
0
2
4
6
8
% 6 years of schoolCrude rate%Men% Women% 65 years and older% Unemployment% Lower than $ 100.00% Afro% Indigenous
Provincias
Z sc
ores
01/0
1/20
0101
/03/
2001
01/0
5/20
0101
/07/
2001
01/0
9/20
0101
/11/
2001
01/0
1/20
0201
/03/
2002
01/0
5/20
0201
/07/
2002
01/0
9/20
0201
/11/
2002
01/0
1/20
0301
/03/
2003
01/0
5/20
0301
/07/
2003
01/0
9/20
0301
/11/
2003
01/0
1/20
0401
/03/
2004
01/0
5/20
0401
/07/
2004
01/0
9/20
0401
/11/
2004
01/0
1/20
0501
/03/
2005
01/0
5/20
0501
/07/
2005
01/0
9/20
0501
/11/
2005
01/0
1/20
0601
/03/
2006
01/0
5/20
0601
/07/
2006
01/0
9/20
0601
/11/
2006
01/0
1/20
0701
/03/
2007
01/0
5/20
0701
/07/
2007
01/0
9/20
0701
/11/
2007
01/0
1/20
0801
/03/
2008
01/0
5/20
0801
/07/
2008
01/0
9/20
0801
/11/
2008
01/0
1/20
0901
/03/
2009
01/0
5/20
0901
/07/
2009
01/0
9/20
0901
/11/
2009
2.50
2.70
2.90
3.10
3.30
3.50
3.70
3.90
4.10
4.30
f(x) = 0x + 3.57R² = 0.07
f(x) = -0.01x + 4R² = 0.63
Adjuted rate-IschemicRegresión lineal para Adjuted rate-IschemicAdjuted rate- CerebrovascularRegresión lineal para Adjuted rate- Cerebrovascular
Rate
x 1
00,0
00 in
hab.
Estimated mortality rate for cerebrovascular disease (ICD/10: I60- I69)in Panama and other selected countries, 1996-2008.
Source: Organización Panamericana de la Salud. http://www.paho.org/Spanish/SHA/coredata/tabulator/newTabulator.htm
40 - 4445 - 49
50 - 5455 - 59
60 - 6465 - 69
70 - 7475 - 79
80 and more
0
500
1000
1500
2000
MenWomen
Age groups
Rat
e x
100,
000
inha
b
40 - 4445 - 49
50 - 5455 - 59
60 - 6465 - 69
70 - 7475 - 79
80 and more
0
500
1000
1500
2000
MenWomen
Age groups
Rat
e x
100,
000
inha
b
Specific mortality rate for ischemic heart disease (ICD/10: I20- I25) and cerebrovascular disease (ICD 10: I60-I69) by sex and age groups.
Panama. 2001 to 2009.Ischemic (CIE/10: I20- I25) Cerebrovascular (CIE/10: I60- I69)
Adjusted monthly mortality rate for ischemic heart disease (ICD/10: I20-I25) and cerebrovascular disease (ICD 10: I60-I69) by sex and age groups.
Panama. 2001 to 2009.
n = 25,748 n = 25,748
N = 3,405,813 N = 3,405,813
B. del Toro Coclé Colón Chiriquí Darién Herrera Los Santos Panamá Veraguas Guna Yala Emberá Gnabe-12
-10
-8
-6
-4
-2
0
2
4
6
8
Provinces
Com
poun
d In
dex
% Women% Men% 55 year and older% Obesity% Diabetes mellitus% Hipertension% HypercholesterolemiaCrude rate
B. del Toro Coclé Colón Chiriquí Darién Herrera Los Santos Panamá Veraguas Guna Yala Emberá Ngabe-12
-10
-8
-6
-4
-2
0
2
4
6
8
% Women% Men% 55 year and older% Obesity% Diabetes mellitus% Hipertension% HypercholesterolemiaCrude rate
Provinces
Com
poun
d In
dex
Source: Life Events. 2001- 2009. INEC, Panama. Source: Life Events. 2001- 2009. INEC, Panama.
Source: ENSCAVI, 2007. ICGES.Source: ENSCAVI, 2007. ICGES.
Source: Life Events and Census 2010. INEC, Panama Source: Life Events and Census 2010. INEC, Panama
Month
Source: Organización Panamericana de la Salud. http://www.paho.org/Spanish/SHA/coredata/tabulator/newTabulator.htm