Correlates between cardiovascular mortality and social determinants in Colombia, 2008 to 2017
Authors: Rebellon-Sanchez D E , Robledo-Colonia A , Lopez-Erazo L , Cuenca-Velez S , Recio-Gomez M A , Barrera L ,   Prevention and control of chronic diseases (PRECEC)
Published: October 2021

Abstract

Introduction
Cardiovascular disease is the leading cause of morbidity and mortality worldwide. In Colombia, a Latin-American country, cardiovascular disease accounts for nearly 30% of total deaths. The country has a high heterogeneity in social conditions, health services and ethnicity across the regions. Health is coverage by two main insurances as subsidized for the poor and contributive for formal workers.

Purpose
The aim of this study was to identify factors related with cardiovascular mortality

Methodology
A cross-sectional study using data from the official mortality registries of the National Administrative Department of Statistics of Colombia (DANE). Cardiovascular mortality was defined using the International Classification of Diseases 10 (ICD-10) I00–I09, I10–I15, I20–I25, I26–I45, I47–I49, I51, I46, I50, I60–I69, I70, I71–I99 and the corresponding ICD-9. Measures of frequency by region was estimated. Factors related to cardiovascular death were explored using a multilevel mixed-effects logistic regression.

Results
There were 2,073,275 deaths in Colombia between 2008 and 2017. 74.0% of them was due to noncommunicable diseases, 14.7% to injuries, and 11.2% to communicable, maternal, neonatal, and nutritional diseases. Of total 30.7% (636,987 deaths) were due to cardiovascular causes and 43.3% (897,502 deaths) to other non-communicable diseases. 29.6% of cardiovascular deaths were in people under 70 years of age. The highest proportion of premature deaths was in the San Andrés Island with 36.5%, following by the Orinoquía (34.8%), the Amazonía (34.1%) and the Caribe region (31.3%).
Male had higher cardiovascular mortality (OR=1.11, 95% CI: 1.10–1:12) related to women. Compared with people between 15 and 44 years of age, the chance of cardiovascular death increased in the categories of 45–70 years (OR=1.91, 95% CI: 1.87–1.95) and 70 years or older (OR=2.98, 95% CI: 2.92–3.04).
Those with African-Colombian ethnicity were more likely to die from cardiovascular disease (OR=1.13, 95% CI: 1.11–1.15) related to those without ethnic recognition and similarly the raizal ethnic group from San Andrés island, OR=1.35 (95% CI: 1.19–1.52). Illiteracy was related with a 32% (95% CI: 1.29–1.36) higher chance of cardiovascular death compared to having a professional degree. Those affiliated to subsidized were more likely to die from cardiovascular disease than those to the contributive insurance OR 1.26 (95% CI: 1.25–1.27)

Conclusion
Cardiovascular disease is the leading cause of death in Colombia with little reduction in the proportion of premature deaths over the period. Moreover, in the least wealthy regions the proportion was higher than the national average. Health inequalities was identified related to education, ethnic origin, and type of insurance. A region approach is needed to tackle the determinants of cardiovascular mortality.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The researcher David Rebellόn was supported by the Fogarty International Center of the National Institutes of Health under Award Number D43TW006589. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.