# Comparison of Cardiovascular Disease Burden between Brazil and Denmark (1990–2021) Based on Global Burden of Disease: Availability of Universal Health System Is Not Enough

## TL;DR

This study compares how Brazil and Denmark reduced cardiovascular disease over 30 years, finding Denmark had faster and more consistent progress.

## Contribution

The study reveals differing patterns in CVD reduction between a high-income and middle-income country using GBD data and joinpoint regression.

## Key findings

- Denmark showed faster and more consistent CVD mortality and DALY reductions compared to Brazil.
- Brazil experienced sharper mortality declines but persistent disability, indicated by less reduction in DALYs.
- Denmark had one joinpoint in trends, while Brazil had two, suggesting less stable progress.

## Abstract

Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide. High-income countries such as Denmark achieved sustained reductions, whereas middle-income countries such as Brazil continue to face high mortality and disability, reflecting distinct stages of the epidemiological transition.

To describe and compare temporal trends in age-standardized mortality and disability-adjusted life years (DALYs) due to CVD in Brazil and Denmark from 1990 to 2021, focusing on magnitude, stability, and inflection points.

We conducted an ecological time-series study using Global Burden of Disease (GBD) 2021 estimates. Age-standardized mortality and DALY rates per 100,000 inhabitants were analyzed for Brazil and Denmark. Joinpoint regression identified changes in trends, estimating annual percentage change (APC) for each segment and average annual percentage change (AAPC) across the period. Analyses assumed Poisson distribution with robust variance and Monte Carlo permutation tests.

Between 1990 and 2021, CVD mortality declined by 53.9% in Brazil (AAPC: –2.4%; 95% CI: –2.7 to –2.1) and 69.7% in Denmark (AAPC: –3.6%; 95% CI: –3.9 to –3.2). DALY rates fell by 51.0% in Brazil (AAPC: –2.1%; 95% CI: –2.4 to –1.9) and 69.6% in Denmark (AAPC: –3.5%; 95% CI: –3.8 to –3.1). Denmark showed faster and more consistent reductions, with parallel declines in mortality and DALYs. In Brazil, mortality decreased more sharply than DALYs, suggesting persistent disability. Trend stability also differed: Brazil presented two joinpoints for each indicator, while Denmark exhibited only one.

Both countries substantially reduced CVD burden, but disparities widened. Denmark’s experience reflects stable prevention, acute care, and rehabilitation strategies. Brazil’s progress, though significant, was uneven and limited by inequalities and slower declines in disability. Integrated policies are needed to ensure equitable and sustained reductions.