Mortality from Ischemic Heart Disease: Analysis of Multiple Causes of Death

Abstract Context: Both the aging of the population and the increase in noncommunicable diseases may influence the progression and outcomes culminating in death, changing the evolution of ischemic heart diseases (IHDs) and their associated causes. Thus, it is essential to understand the process of death from IHD, the diseases associated with IHD, and the diseases to which IHD is related. Objectives To evaluate the mortality from IHD in Brazil between 2006 and 2020 using the method of multiple causes and identify differences in the distribution pattern of IHD mortality by sex and geographic region. Methods Based on information extracted from death certificates (DCs) obtained from the database of the Department of Informatics of the Unified Health System (DATASUS), we used the multiple causes method to analyze the diseases associated with IHD when IHD was defined as the underlying cause (UC) of death and the diseases listed as the UC when IHD was recorded in any line of the DC, from 2006 to 2020, in Brazil. Subsequently, the proportion of these diseases and differences between sexes and geographic regions were evaluated, with statistical relevance analyzed using the chi-square test, and the dependence between factors illustrated using stacked bar charts and small-world network graphs. Results When IHD was listed as the UC of death, the most frequent associated diseases were, in descending order of frequency, acute myocardial infarction (AMI), arterial hypertension (AH), chronic ischemic heart disease (CHID), heart failure (HF), and diabetes mellitus (DM). When IHD was mentioned in any line of the DC, the most frequent UCs of death were AMI followed by DM, CIHD, chronic obstructive pulmonary disease (COPD), stroke, dyslipidemia, and, in the year 2020, COVID-19. The most frequent diseases in women were DM as the UC and associated disease, AH as the UC, and CIHD and Alzheimer's disease as associated diseases, while the most frequent diseases in men were substance dependence as the UC and associated disease, and cancer as an associated disease. The most frequent diseases were DM and stroke in the North and Northeast, dyslipidemia and obesity in the Midwest, Alzheimer's disease in the South and Southeast, and atherosclerotic heart disease (AHD) and COPD in the South. Conclusions Several diseases – including AMI, AH, CIHD, HF, and DM – were the most frequent associated diseases when IHD was recorded as the UC. In contrast, AMI, DM, CIHD, COPD, and stroke were the most frequent UCs when IHD was listed as an associated disease. The degree of these associations varied between sexes and geographic regions. The use of the multiple causes of death method allows for a better understanding of the magnitude of these relationships and could enable better targeting of investments in health.