Introduction: Cardiovascular diseases are the leading cause of death in Brazil, accounting for over seven million deaths annually worldwide. These diseases primarily affect elderly individuals, women, and people with lower socioeconomic status. This study aims to determine the prevalence of deaths among hospitalized patients with circulatory system diseases, evaluating their association with age and sex, as well as identifying the most common conditions contributing to hospitalization and mortality.

Methods: A retrospective descriptive study was conducted using data from the DATASUS database, analyzing hospitalizations and mortality records in hospitals in Porto Alegre/RS from 2009 to 2019. Descriptive statistics were applied to assess mortality prevalence, length of hospital stay, and predominant diseases.

Results: The results indicated that 5.1% of all hospitalized patients with circulatory system diseases died, with an average hospital stay of 7.6 days. The most frequent cause of hospitalization was circulatory diseases affecting the lower limbs, with a mortality rate of 13.2% among these patients, predominantly males. The highest hospitalization rates were observed in patients over 60 years of age.

Discussion: Between 2009 and 2019, cardiovascular diseases were responsible for a significant proportion of hospital admissions and deaths, particularly among elderly and male patients.

Conclusion: This study provides insights into hospitalization and mortality trends, contributing to the development of targeted public health policies aimed at improving the prevention and management of circulatory system diseases.

Keywords: Cardiovascular diseases, circulatory system, vascular diseases, peripheral arterial disease, mortality trends

Cardiovascular diseases are responsible for 29.4% of all annual deaths in Brazil, resulting in more than 308,000 fatalities, predominantly due to acute myocardial infarction and stroke. This persistent public health issue places Brazil among the top 10 countries with the highest rates of cardiovascular mortality.^1,2 CVD remains a leading cause of hospital admissions in Brazil, particularly among the elderly. While advances in cardiovascular treatment have improved survival, they have also led to increased clinical complexity due to the emergence of comorbidities such as hypertension, diabetes mellitus, renal dysfunction, and cognitive decline.³

Aging is associated with physiological changes in the cardiovascular system, including rising systolic blood pressure, reduced cardiorespiratory capacity, and attenuated autonomic reflexes. Age alone is a significant risk factor for CVD, as evidenced by established tools such as the Framingham Risk Score, SCORE, and the Diamond-Forrester model for coronary artery disease prediction.³ According to data from 2008 to 2019, the South region recorded the highest hospitalization rates for cardiovascular and respiratory diseases (1,173 per 100,000 inhabitants), followed by the Southeast, Midwest, Northeast, and North regions.⁴ Despite the South having the highest hospitalization rates, mortality was most pronounced in the Southeast region (8.42 per 100 hospitalizations), followed by the Northeast, North, Midwest, and finally the South, which had the lowest mortality rate (6.5 per 100 hospitalizations).⁵

Cardiovascular diseases are responsible for 29.4% of all annual deaths in Brazil, resulting in more than 308,000 fatalities, predominantly due to acute myocardial infarction and stroke. This persistent public health issue places Brazil among the top 10 countries with the highest rates of cardiovascular mortality.² CVD remains a leading cause of hospital admissions in Brazil, particularly among the elderly. While advances in cardiovascular treatment have improved survival, they have also led to increased clinical complexity due to the emergence of comorbidities such as hypertension, diabetes mellitus, renal dysfunction, and cognitive decline.³ Aging is associated with physiological changes in the cardiovascular system, including rising systolic blood pressure, reduced cardiorespiratory capacity, and attenuated autonomic reflexes. Age alone is a significant risk factor for CVD, as evidenced by established tools such as the Framingham Risk Score, SCORE, and the Diamond-Forrester model for coronary artery disease prediction.³

This is a retrospective, descriptive, and observational study that analyzed data from the DATASUS Hospital Information System (SIH), focusing on hospital admissions and deaths due to circulatory system diseases in patients treated in hospitals in Porto Alegre, Brazil, between January 1, 2009, and December 31, 2019. The study included all hospitalizations and deaths related to circulatory diseases classified under International Classification of Diseases (ICD-10: I00-I99), with patients aged ≥20 years, both male and female. The data were retrieved from DATASUS, an official Brazilian public health database that compiles hospital admission records nationwide. Patients were included in the study if they were ≥20 years old, hospitalized for circulatory diseases (ICD-10 codes I00-I99), and registered in hospitals in Porto Alegre between 2009 and 2019. Only complete records containing information on age, sex, length of hospital stay, and clinical outcome (discharge or death) were considered. Records were excluded if they lacked these key variables or if patients were admitted for conditions outside the circulatory disease classification.

Ethical considerations

This study exclusively used publicly available, anonymized secondary data from the DATASUS database, ensuring compliance with Resolution No. 466/2012 of the Brazilian National Health Council. Since no identifiable human subjects were involved, Ethics Committee approval was not required, in accordance with the regulations of the National Research Ethics Commission (CONEP/Brazil).

Statistical analysis

Data were compiled and structured using Microsoft Excel 365 (2024), while data visualization and statistical graphics were generated using the R Program, a free software environment for statistical computing and graphics. A descriptive analysis was performed to calculate crude and adjusted mortality rates, stratified by age, sex, and type of circulatory disease. Hospitalization rates per 100,000 inhabitants were estimated, and the mean hospital stay (in days) was calculated for each patient subgroup. To assess trends over time, annual percentage variation (APV) in mortality rates was estimated for the period between 2009 and 2019.

During the study period, hospitalizations due to circulatory system diseases in Porto Alegre showed a significant prevalence among patients over 60 years of age, with a notable predominance of male patients across different subgroups. The overall mortality rate among hospitalized patients was 5.1%, with an average length of hospital stay of 7.6 days. The leading causes of hospitalization were circulatory system diseases related to the lower limbs, and among these patients, 13.2% progressed to death, with a higher prevalence among males.

Hospitalization rates were significantly higher in the older age group (≥60 years). Male patients had higher hospitalization and mortality rates than females across all age groups. Figure 1 illustrates the distribution of male and female hospitalizations due to circulatory system diseases in Porto Alegre from 2009 to 2019.

Figure 1 Data of male and female hospitalizations due to circulatory system problems in Porto Alegre (2009 to 2019). Font: DATASUS, 2022.

Age and gender disparities in hospitalizations

Figure 2 shows a higher number of hospitalizations due to circulatory system diseases among males over 60 years of age in Porto Alegre between 2009 and 2019, especially concentrated in the first year of the analyzed period, with a gradual decline in subsequent years.

Figure 2 Date of hospitalizations due to circulatory system problems in the age group over 60 years of age for males and females in Porto Alegre (2009 to 2019). Font: DATASUS data collection, 2022.

Figure 3 presents a comparison of hospitalizations by age group and gender. The data indicate that in the 20 to 59-year-old group, the difference in hospitalization rates between males and females follows a similar pattern to that observed in the over 60-year-old group. In both age groups, male patients had a higher prevalence of hospitalizations, reinforcing the greater burden of circulatory system diseases among men. Additionally, hospitalizations due to lower limb circulatory diseases were more frequent in older adults, suggesting an age-related increase in the severity of vascular conditions.

Figure 3 Comparison of hospitalizations by age group and male and female gender. Font: DATASUS, 2022.

Mortality trends

Death records for hospitalized patients demonstrated a predominance of male and female patients over 60 years of age, reinforcing the greater burden of circulatory diseases in older populations (Figure 4). In younger age groups, females exhibited a higher prevalence of hospitalizations due to lower limb diseases but a lower death rate, whereas male patients had a lower hospitalization rate but a higher mortality rate. This trend was consistent across both age groups, as shown in Figure 5.

Figure 4 Comparison of deaths by age group and male and female gender. Font: DATASUS, 2022.

Figure 5 Comparison of hospitalization and deaths by age group, by male and female gender, and lower limbs (LL). Source: DATASUS, 2022.

Figure 4 illustrates the distribution of deaths among hospitalized patients due to circulatory system diseases, highlighting a higher prevalence of fatalities in individuals over 60 years of age, regardless of gender. Although mortality rates were significant in both age groups, male patients exhibited a higher number of deaths overall, reinforcing the greater vulnerability of men to fatal outcomes related to circulatory diseases. Additionally, deaths associated with lower limb circulatory diseases were more frequent among older adults, emphasizing the severity of vascular complications in this population.

General data on hospitalizations, deaths, and cases related to lower limb diseases among patients over 20 years of age are summarized below. The overall mortality rate was 5.1%, with lower limb conditions representing 23.5% of hospitalizations and 28.7% of deaths. The average length of hospital stay was 7.6 days, slightly higher for male patients (8.2 days) compared to females (7.0 days), indicating a gender disparity in hospitalization duration and outcomes (Table 1).

Figure 5 demonstrates a distinct gender disparity in hospitalizations and mortality due to lower limb circulatory diseases. Females aged 20 to 59 years had the highest hospitalization rates, yet exhibited the lowest mortality rates, suggesting better clinical outcomes despite a higher disease burden. Conversely, male patients in the same age group had fewer hospitalizations but a greater number of deaths, indicating a more severe disease progression or delays in seeking medical care. A similar trend was observed in the over 60-year-old group, where males had slightly lower hospitalization rates but experienced higher mortality compared to females. These findings highlight the need for targeted preventive strategies, particularly for male patients, to reduce the risk of severe complications and fatal outcomes associated with circulatory diseases affecting the lower limbs.

Table 2 focuses on patients over 60 years of age, where hospitalizations accounted for 58.4% of all admissions. The mortality rate in this age group was 6.9%, while lower limb diseases were responsible for 18.1% of hospitalizations and 5.0% of deaths. The average hospital stay increased to 8.6 days in this group.

When comparing age groups, hospitalizations among elderly patients (≥60 years) were 1.4 times higher than those observed in adults aged 20 to 59 years (Table 3). Moreover, the mortality rate in the elderly was markedly elevated, reaching 3.99% compared to 1.1% in younger adults. These results underscore the substantial burden of circulatory system diseases in older populations, especially among males, reinforcing the need for targeted public health strategies to reduce hospitalizations and mortality in this vulnerable group.

The distribution of hospital admissions and deaths in the population of Porto Alegre due to cardiovascular diseases between 2008 and 2019 has a higher incidence in the elderly population and male patients, with a predominance of hospitalizations and deaths due to cardiovascular diseases in the lower limbs. The purpose of this study was to compare data on hospitalizations and deaths resulting from these hospitalized patients, and also to stratify information about these patients, thus bringing a more singular look to the treatment and prevention of these diseases. Even if some data are not surprising, such as: higher prevalence of hospitalizations and deaths in male patients, and in elderly patients. Imitating the national and world average. New and relevant information is presented in this study.

According to the World Health Organization (WHO)⁹ diseases of the circulatory system account for about 17.9 million deaths worldwide, with ischemic heart disease and stroke as the most common causes. In Brazil, cardiovascular diseases cause 29,4% of deaths per year, mainly from heart attacks and strokes.⁹ However, with this study directed to one of the reference capitals in cardiovascular treatment, it was shown that, although the causes of hospitalizations and deaths presented a certain homogeneity, diseases of the circulatory system in the lower limbs stood out. Among the 20 circulatory system diseases classified under Chapter IX of the ICD-10 in the Tabnet system, those specifically related to the lower limbs included: peripheral vascular diseases, arterial embolism and thrombosis, arterial and capillary disorders, phlebitis, thrombophlebitis, venous embolism and thrombosis, and varicose veins of the lower extremities.

In view of the impacts of the strategic actions applied to cope with and control these diseases in the population with greater specificity and clarity, the hospitals in Porto Alegre/RS were selected to quantify the real impact on morbidity and mortality in this population, in addition to stimulating new control strategies and health actions, including cardiovascular rehabilitation programs. Also for this reason, the period analyzed in this study was prior to the pandemic caused by COVID-19, thus providing more reliable data on circulatory problems for these patients. Considering that males had a predominance in both hospitalizations and deaths, a health perspective on this population in the context of prevention is encouraged. Health policies, when potentially well employed, have a beneficial effect on reducing hospitalizations and reducing the length of unavoidable hospitalizations, making these patients less costly for the health system. This study, more specifically addressing lower limb problems as the main cause of these hospitalizations, can direct cardiovascular rehabilitation programs in a more assertive way.^6–8

The findings of this study reinforce the importance of developing regionally adapted public health policies that consider the specific demographic and epidemiological characteristics of the population affected by circulatory system diseases. In the case of Porto Alegre, the high burden of hospitalizations and deaths—especially related to lower limb conditions and among elderly male patients—highlights the need for tailored strategies in prevention, early detection, and care. By strengthening access to primary, secondary, and tertiary healthcare services, as well as enhancing cardiovascular rehabilitation programs, it is possible to reduce hospitalization rates, shorten hospital stays, and ultimately decrease morbidity and mortality. Health services must go beyond monitoring mortality patterns and proactively implement educational and preventive actions to promote healthier lifestyles. This is especially urgent in developing countries like Brazil, where resources are limited and the efficient allocation of investments in health can significantly impact the well-being of the population.

None.

The authors declare that there are no conflicts of interest.

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