Premature mortality due to cardiovascular disease and social inequalities in Porto Alegre: from evidence to action

Background: Two perspectives, the economic (disease causing impoverish) and social (poverty causing illness), have internationally disputed the justification for public health policies. Objective: To investigate the relationship between early mortality by cardiovascular disease (CVD) and socioeconomic (SE) conditions in the city of Porto Alegre (RA), and discuss bases and strategies for the prevention of CVD. Methods: An ecological analysis of the association between mortality by CVD at 45-64 years of age and SE conditions of 73 districts/neighborhoods in PA. The relative risk (RR) and the fraction of risk (FRA) attributable to inequality among the districts grouped into 4 SE strata were estimated. Results: Early mortality by CVD was 2.6 times higher in the districts classified in the worst compared to the best of the 4 SE strata. Among the extreme districts, the RR reached 3.3 for CVD and 3.9 for cerebrovascular disease. Compared to the mortality in the best stratum, 62% of the early deaths in the worst stratum and 45% of those in the city as a whole could be attributed to socioeconomic inequality. Conclusion: Almost half of the mortality by CVD before 65 years of age can be attributed to poverty. Disease, on the other hand, contributes towards poverty and reduces competitiveness of the country. It is necessary to reduce illness and recover the health of the poorest inhabitants with investments that result in national economic development and improvement of the social conditions of the population.