P2-68 Trends in chronic disease mortality in Brazil, 1996-2007

Background In recognition of the large burden and economic impact of non-communicable chronic diseases (NCDs), especially in low and middle income countries, the WHO has proposed a goal of an additional 2% reduction in mortality rates per year over current trends, and the United Nations is holding a High level Meeting on NCDs in September, 2011. Objective To describe recent NCD mortality trends in Brazil, a middle-income country, taking into account recent improvements in death reporting. Methods We obtained ICD-10 coded mortality data from the Brazilian mortality information system and population denominators from the Brazilian Institute of Geography and Statistics (IBGE). IBGE enumerated the population in 1996 and 2000, and extrapolated estimates for 2007. We redistributed ill-defined causes of death equally across all non-external cause deaths. We corrected for underreporting of deaths based on the ratio of expected to observed deaths. Expected deaths were estimated by IBGE, on the basis of life table analyses. Mortality rates were age-adjusted to the world population standard. Results NCDs now account for 72% of deaths. In unadjusted analyses, corrected NCD mortality rates increased 5% over the 12-year period. Age-adjusted rates declined 1.8%/yr. Declines were greatest for chronic respiratory diseases (2.8%/yr) and cardiovascular diseases (3.5%/yr). Though declines occurred in all regions, 2007 rates are greatest in Brazil9s poorest regions, where diabetes deaths have increased markedly. Conclusion The decline in NCD mortality observed in Brazil demonstrates that a 2% decline/year is feasible, and encourages further public health action.