ArticleCureus2026
Out-of-Hospital Excess Mortality From Cardiovascular Diseases During the COVID-19 Pandemic in Brazil.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe COVID-19 pandemic disrupted health systems worldwide; yet, the magnitude of collateral mortality occurring outside hospitals, particularly from cardiovascular disease (CVD), remains poorly characterized in low- and middle-income countries (LMICs). Brazil, which experienced one of the highest cumulative death tolls globally, offers a critical setting for quantifying this indirect burden.
methodsWe conducted an ecological time-series analysis of all deaths recorded outside health care facilities (domicile or public thoroughfare) in Brazil from 2015 through 2021 using national mortality data from the Mortality Information System (SIM)/Department of Informatics of the Brazilian Unified Health System (DATASUS). Crude mortality rates and age-sex adjusted mortality rates were calculated and standardized to the 2022 Census population structure. Pre-pandemic (2015-2019) and pandemic (2020-2021) periods were compared descriptively.
resultsOut-of-hospital deaths increased from a pre-pandemic mean of 313660 per year (151.6 per 100000 inhabitants) to 381720 per year (180.2 per 100000 inhabitants) during 2020-2021, representing an 18.8% increase. Age-sex adjusted cardiovascular out-of-hospital mortality rates, which had declined steadily from 53.43 per 100000 in 2015 to 47.16 per 100 000 in 2019, rose sharply to 53.48 per 100000 in 2020 and 54.53 per 100000 in 2021. The Southeast exhibited the steepest rate increase (+23%), whereas the Northeast maintained the highest overall proportion of out-of-hospital cardiovascular deaths. CVD remained the leading cause of death (115228; 29.8%), followed by external causes (65009; 16.8%) and ill-defined causes (62433; 16.1%). Ill-defined deaths increased by 44% between 2019 and 2021, suggesting substantial diagnostic gaps.
conclusionsThe pandemic period was associated with a substantial rise in out-of-hospital mortality in Brazil, reversing the prior declining trend in age-sex adjusted cardiovascular mortality. These findings underscore the need for resilient primary care networks and decentralized emergency response systems during public health emergencies.
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