Both the expansion of life expectancy and the reduction of the disease burden - by postponing the age of onset of chronic infirmity relative to average life duration - are phenomena that are taking place in the populations across the Region of the Americas.
Cerebrovascular diseases (ICD 10: I60-I69) are among those chronic cardiovascular illnesses for which a great number of preventive interventions and disease management are available and, indeed, there has been a sustained reduction in mortality due to stroke in most countries of the Region of the Americas between 1970 and 2000. Despite these health gains, mortality due to cerebrovascular diseases remains four times greater in Latin American and Caribbean than in North American countries. More importantly, a considerable proportion of deaths originated by cerebrovascular diseases (~22%) occurs prematurely: each year, this untimely burden of mortality represents on average, 90,000 deaths among people younger than 65 years of age in the Americas (out of a total burden of more than 400,000 deaths due to this same group of causes). This burden of premature mortality disproportionately affects women.
The reasons for these differences are not well known, although it is suspected that there are significant disparities in the incidence of cerebrovascular events, access to health services, quality of medical care for stroke, and risk-factor control. The map of this brochure depicts the quintile distribution of proportional premature mortality due to cerebrovascular diseases in the countries and territories of the Americas.
Among the many uses of the PAHO Basic Indicators to generate evidence in public health, an exploratory analysis of the relationship between premature mortality due to cerebrovascular diseases (CeVD) and potential socioeconomic inequality determinants, at the ecological level, is presented here.
Figure 1 shows the non-linear inverse relationship between premature mortality due to CeVD, as a proportion of the total number of deaths due to CeVD, and gross national income per capita, adjusted by purchasing power parity; the higher the income, the lower the proportional premature mortality due to CeVD; in other words, the wealthier people are more able to postpone deaths due to CeVD to ages older than 65 years than the poorer.
There is also a non-linear direct relationship (not shown) between the risk of dying prematurely due to CeVD, as measured by the mortality rate, and the magnitude of the average income ratio of the richest quintile to the average income of the poorest quintile. This so-called “20/20 Kuznets ratio” is a summary measure of the depth of income inequality in a society: the deeper the income inequality, the greater the risk of dying prematurely due to CeVD.
Figure 2 tells us how unequally distributed those premature deaths due to CeVD are among the countries of the Americas or, more specifically, along the social gradient of the population defined by income level. The concentration index, a robust summary measure of inequality, is 0.16, indicating that premature mortality due to CeVD is disproportionately concentrated among the poorer in the social gradient. The concentration curve indicates that almost
30% of the premature deaths due to CeVD are in the poorest 20% of the population of the Americas, whereas only 13% of those premature deaths are concentrated in its richest 20%.
Map below depicts the distribution of prematuire mortality due to CeVD by countries of the Region of the Americas.
This exploratory analysis shows the importance of chronic diseases with regard to premature mortality and its unequal distribution in the population.
These untimely deaths are associated with both poverty and income inequality, as well as with difficulties to access health services and benefits of social policies. In fact, poverty-reduction and inequality-reduction strategies could contribute to reduce the burden of premature mortality due to cerebrovascular diseases in the Americas, along with other strategies such as those aimed at strengthening and developing health policies directed at the prevention and control of chronic diseases, health promotion, and access to health care.
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