Income and heart disease mortality trends in Sao Paulo, Brazil, 1996 to 2010

Background: Reductions in heart disease mortality rates are variable according to socioeconomic status. Methods: We performed a time trend analysis of all heart diseases (all circulatory diseases, except rheumatic, cerebrovascular, and aortic diseases) comparing three different household income levels (high, middle, and low) in the city of Sao Paulo from 1996 to 2010. Results: A total of 197,770 deaths were attributed to heart diseases; 62% of them were due to coronary diseases. The rate of death due to heart diseases declined for the city as a whole. The annual percent change (APC) and 95% confidence intervals for men living in the high, middle and low income areas were -4.1 (-4.5 to -3.8), -3.0 (-3.5 to -2.6), and -2.5 (-2.8 to -2.1), respectively. The decline in death rate was greatest among men in the wealthiest area. The trend rates of women living in the high-income area had one joinpoint; APC was -4.4 (-4.8 to -3.9) from 1996-2005 and -2.6 (-3.8 to -1.4) from 2005-2010. Middle and low income areas had an APC of -3.6 (-4.1 to -3.1) and -3.0 (-3.2 to -2.7) from 1996-2010, respectively. During the last 5 years of observation, there was a gradient of the decline of the risk of death, faster for people living in the wealthiest area and slower for people living in the more deprived neighborhoods. Conclusion: Reduction in deaths due to heart diseases is greatest for men and women living in the wealthiest neighborhoods. (C) 2012 Elsevier Ireland Ltd. All rights reserved.