{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:27:26Z","timestamp":1790267246870,"version":"4.1.0"},"reference-count":62,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T00:00:00Z","timestamp":1759449600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["gh"],"abstract":"<jats:p>Background: Brazil has one of the highest stroke rates in Latin America. It is important to understand the impact of other causes of death and sociodemographic factors, as this may contribute to a better comprehension of the stroke mortality process. Machine learning provides a means to explain this process.\nObjective: To investigate the stroke deaths profile and its subtype in Brazil using machine learning.\nMethods: This is a time series analysis where deaths mentioning stroke and other conditions were identified using individual death records from the country\u2019s mortality information system (SIM) between 2000 and 2019. Strokes were grouped into the following subtypes: ischemic stroke (IS), hemorrhagic stroke (HS), and unspecified stroke (US). A decision tree model was built to identify the strongest factors distinguishing IS from HS.\nResults: There were 2,459,742 deaths mentioning stroke. There was a progressive increase in the number of deaths mentioning stroke over the study period. The most common type of stroke was US, accounting for more than 62% of deaths. Among HS deaths, hypertensive diseases were the most frequent group of associated causes (40.6%), while the most frequent group in subtypes IS and US was diseases of the respiratory system (48.30% and 42.30%, respectively). The decision tree analysis revealed that IS was more likely to occur in patients aged 60 years and over and in cases where respiratory diseases, endocrine diseases, arrhythmias, ischemic heart disease and heart failure were present. However, HS was more frequent in younger patients without these conditions but with nervous system diseases.\nConclusions: The decision tree analysis identified the strongest factors distinguishing IS from HS, highlighting variables involved in each subtype of stroke-related death that can be recognized in clinical practice. These variables may also support the redistribution of deaths initially classified as unspecified stroke.<\/jats:p>","DOI":"10.5334\/gh.1476","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T09:22:08Z","timestamp":1759483328000},"page":"85","source":"Crossref","is-referenced-by-count":2,"title":["Stroke Deaths Profile and Its Subtypes in Brazil: Analysis Using Machine Learning"],"prefix":"10.5334","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0203-6395","authenticated-orcid":false,"given":"Alessandro Rocha Milan","family":"De Souza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0613-5582","authenticated-orcid":false,"given":"Let\u00edcia Martins","family":"Raposo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0776-0769","authenticated-orcid":false,"given":"Glenda Corr\u00eaa Borges","family":"De Lacerda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0057-7363","authenticated-orcid":false,"given":"Paulo Henrique","family":"Godoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"issue":"1","key":"key20251003092201_B1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1747-4949.2010.00538.x","article-title":"Stroke prevalence in a poor neighbourhood of S\u00e3o Paulo, Brazil: applying a stroke symptom questionnaire","volume":"6","year":"2011","journal-title":"Int J Stroke"},{"issue":"9","key":"key20251003092201_B2","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1590\/0004-282X20150115","article-title":"Prevalence of stroke and associated disability in Brazil: National Health Survey \u2013 2013","volume":"73","year":"2015","journal-title":"Arq Neuropsiquiatr"},{"issue":"4","key":"key20251003092201_B3","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1159\/000362210","article-title":"Stroke in the rain forest: prevalence in a Ribeirinha community and an urban population in the Brazilian Amazon","volume":"42","year":"2014","journal-title":"Neuroepidemiology"},{"issue":"1","key":"key20251003092201_B4","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1093\/ije\/dyu027","article-title":"Cohort profile: longitudinal study of adult health (ELSA-Brasil)","volume":"44","year":"2015","journal-title":"Int J Epidemiol"},{"issue":"6","key":"key20251003092201_B5","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1590\/S0066-782X2012005000041","article-title":"An\u00e1lise da tend\u00eancia da mortalidade por acidente vascular cerebral no Brasil no s\u00e9culo XXI","volume":"98","year":"2012","journal-title":"Arq Bras Cardiol"},{"issue":"Supl. 2","key":"key20251003092201_B6","article-title":"Doen\u00e7a cerebrovascular isqu\u00eamica e hemorr\u00e1gica no Brasil: tend\u00eancia de mortalidade e correla\u00e7\u00e3o com indicadores socioecon\u00f4micos em 20 anos","volume":"30","year":"2024","journal-title":"Ciencia e Saude Coletiva Saude Colet"},{"issue":"2","key":"key20251003092201_B7","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1159\/000506396","article-title":"Global, regional and country-specific burden of ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage: a systematic analysis of the global burden of disease study 2017","volume":"54","year":"2020","journal-title":"Neuroepidemiology"},{"issue":"4","key":"key20251003092201_B8","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/S1474-4422(09)70025-0","article-title":"Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review","volume":"8","year":"2009","journal-title":"Lancet Neurol"},{"issue":"10","key":"key20251003092201_B9","first-page":"1","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"20","year":"2021","journal-title":"Lancet Neurol"},{"key":"key20251003092201_B10","article-title":"Causas m\u00faltiplas de morte: formas de apresenta\u00e7\u00e3o e m\u00e9todos de an\u00e1lise","year":"1989"},{"issue":"11","key":"key20251003092201_B11","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.2105\/AJPH.72.11.1265","article-title":"New dimensions in cause of death statistics","volume":"72","year":"1982","journal-title":"Am J Public Health"},{"key":"key20251003092201_B12","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/j.neucom.2017.01.026","article-title":"Machine learning on big data: opportunities and challenges","volume":"237","year":"2017","journal-title":"Neurocomputing"},{"issue":"4","key":"key20251003092201_B13","doi-asserted-by":"crossref","first-page":"769","DOI":"10.4103\/1673-5374.382228","article-title":"Machine learning applications in stroke medicine: advancements, challenges, and future prospective","volume":"19","year":"2024","journal-title":"Neural Regen Res"},{"issue":"9","key":"key20251003092201_B14","first-page":"1","article-title":"Microdatasus: a package for downloading and preprocessing microdata from Brazilian Health Informatics Department (DATASUS)","volume":"35","year":"2019","journal-title":"Cad Saude Publica"},{"key":"key20251003092201_B15","volume-title":"Classification and regression trees","year":"1984"},{"key":"key20251003092201_B16","volume-title":"Multi-state models and competing risks"},{"issue":"5","key":"key20251003092201_B17","first-page":"1","article-title":"Building predictive models in R using the caret package","volume":"28","year":"2008","journal-title":"J Stat Softw"},{"key":"key20251003092201_B18","article-title":"Plot \u201crpart\u201d models: an enhanced version of \u201cplot.rpart.\u201d","year":"2024"},{"key":"key20251003092201_B19","first-page":"1","volume-title":"Applied logistic regression","year":"2013","edition":"Second"},{"issue":"1","key":"key20251003092201_B20","first-page":"89","article-title":"Cerebrovascular disease mortality trend in Brazil (1996 to 2015) and association with human development index and social vulnerability","volume":"116","year":"2021","journal-title":"Arq Bras Cardiol"},{"issue":"8","key":"key20251003092201_B21","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1590\/0102-311X00131113","article-title":"Evolution of the deaths registry system in Brazil: associations with changes in the mortality profile, under-registration of death counts, and ill-defined causes of death","volume":"30","year":"2014","journal-title":"Cad Saude Publica"},{"issue":"6","key":"key20251003092201_B22","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1590\/S0066-782X2012005000041","article-title":"An\u00e1lise da tend\u00eancia da mortalidade por acidente vascular cerebral no Brasil no s\u00e9culo XXI","volume":"98","year":"2012","journal-title":"Arq Bras Cardiol"},{"issue":"4","key":"key20251003092201_B23","first-page":"271","article-title":"A mortalidade de idosos no Brasil: a quest\u00e3o das causas mal defenidas TT \u2013 Brazilian mortality of elderly person: the question about ill-defined underlying causes of death","volume":"17","year":"2008","journal-title":"Epidemiol serv sa\u00fade"},{"issue":"19","key":"key20251003092201_B24","doi-asserted-by":"crossref","first-page":"142","DOI":"10.5712\/rbmfc6(19)390","article-title":"Declara\u00e7\u00e3o de Bras\u00edlia \u2018O Conceito de rural e o cuidado \u00e0 sa\u00fade.\u2019","volume":"6","year":"2011","journal-title":"Revista Brasileira de Medicina de Fam\u00edlia e Comunidade"},{"issue":"6","key":"key20251003092201_B25","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1590\/S0102-311X2010000600015","article-title":"Uso da aut\u00f3psia verbal na investiga\u00e7\u00e3o de \u00f3bitos com causa mal definida em Minas Gerais, Brasil","volume":"26","year":"2010","journal-title":"Cad Saude Publica"},{"issue":"3","key":"key20251003092201_B26","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1590\/S0034-89102007000300016","article-title":"Quality of death statistics by unknown causes in Brazilian states. [Portuguese] Qualidade das estatisticas de obitos por causas desconhecidas dos Estados brasileiros","volume":"41","year":"2007","journal-title":"Rev Saude Publica"},{"issue":"10053","key":"key20251003092201_B27","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1016\/S0140-6736(16)31012-1","article-title":"Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980\u20132015: A systematic analysis for the Global Burden of Disease Study 2015","volume":"388","year":"2016","journal-title":"The Lancet"},{"issue":"2","key":"key20251003092201_B28","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1590\/S1415-790X2002000200008","article-title":"O sistema de informa\u00e7\u00f5es sobre mortalidade: problemas e propostas para o seu enfrentamento II \u2013 Mortes por causas externas TT - The national mortality information system: problems and proposals for solving them II \u2013 deaths due to external causes","volume":"5","year":"2002","journal-title":"Revista Brasileira de Epidemiologia"},{"issue":"11","key":"key20251003092201_B29","article-title":"Incidence of hospitalization and mortality due to stroke in young adults, residents of developed regions in Brazil, 2008\u20132018","volume":"15","year":"2020","journal-title":"PLoS One"},{"key":"key20251003092201_B30","unstructured":"Ag\u00eancia de Not\u00edcias. Censo 2022: Pela primeira vez, desde 1991, a maior parte da popula\u00e7\u00e3o do Brasil se declara parda [Internet]. [cited 2024 Nov 1]. Available from: https:\/\/agenciadenoticias.ibge.gov.br\/agencia-noticias\/2012-agencia-de-noticias\/noticias\/38719-censo-2022-pela-primeira-vez-desde-1991-a-maior-parte-da-populacao-do-brasil-se-declara-parda"},{"issue":"9","key":"key20251003092201_B31","first-page":"e139","article-title":"Heart disease and stroke statistics\u20142020 update: a report from the American Heart Association","volume":"141","year":"2020","journal-title":"Circulation"},{"issue":"4","key":"key20251003092201_B32","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1001\/jama.2009.1063","article-title":"Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality","volume":"302","year":"2009","journal-title":"JAMA"},{"issue":"21","key":"key20251003092201_B33","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1056\/NEJMc1616085","article-title":"Racial disparities in risks of stroke","volume":"376","year":"2017","journal-title":"N Engl J Med"},{"issue":"6","key":"key20251003092201_B34","first-page":"1201","article-title":"Race and stroke mortality in Brazil","volume":"47","year":"2013","journal-title":"Rev Saude Publica"},{"key":"key20251003092201_B35","unstructured":"de Siqueira VR, Fonseca AVSS, N\u00f3brega LVV, de Carvalho AAB. Perfil epidemiol\u00f3gico dos \u00f3bitos por doen\u00e7as cerebrovasculares no estado do Tocantins no per\u00edodo de 2015 a 2019. Rev Cient Tocantins. 2022;2(2):1\u201311. https:\/\/itpacporto.emnuvens.com.br\/revista\/article\/view\/74"},{"issue":"4","key":"key20251003092201_B36","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1590\/S0034-89102006000500019","article-title":"Desigualdade social e mortalidade precoce por doen\u00e7as cardiovasculares no Brasil","volume":"40","year":"2006","journal-title":"Rev Sa\u00fade P\u00fablica"},{"key":"key20251003092201_B37","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1590\/1980-5497201700050004","article-title":"Qualidade da informa\u00e7\u00e3o das estat\u00edsticas de mortalidade: C\u00f3digos garbage declarados como causas de morte em Belo Horizonte, 2011\u20132013","volume":"20","year":"2017","journal-title":"Revista Brasileira de Epidemiologia"},{"issue":"1","key":"key20251003092201_B38","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1590\/S0104-42302008000100016","article-title":"Causas mal definidas de morte e \u00f3bitos sem assist\u00eancia","volume":"54","year":"2008","journal-title":"Rev Assoc Med Bras"},{"issue":"1","key":"key20251003092201_B39","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1590\/S1415-790X2012000100016","article-title":"O uso de tomografia computadorizada nas interna\u00e7\u00f5es por acidente vascular cerebral no Sistema \u00danico de Sa\u00fade no Brasil","volume":"15","year":"2012","journal-title":"Revista Brasileira de Epidemiologia"},{"issue":"2","key":"key20251003092201_B40","first-page":"1","article-title":"Assessment of incompleteness of mortality information system records on deaths from external causes in the state of Rio Grande do Sul, Brazil, 2000\u20132019","volume":"32","year":"2023","journal-title":"Epidemiologia e Servicos de Saude"},{"issue":"4","key":"key20251003092201_B41","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1590\/1413-81232015214.07922015","article-title":"Qualidade da informa\u00e7\u00e3o dos \u00f3bitos por causas externas em Fortaleza, Cear\u00e1, Brasil","volume":"21","year":"2016","journal-title":"Ciencia e Saude Coletiva"},{"issue":"2","key":"key20251003092201_B42","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1590\/S0047-20852013000200006","article-title":"Completude do sistema de informa\u00e7\u00e3o sobre mortalidade por suic\u00eddio em idosos no estado da Bahia","volume":"62","year":"2013","journal-title":"J Bras Psiquiatr"},{"issue":"4","key":"key20251003092201_B43","doi-asserted-by":"crossref","first-page":"651","DOI":"10.5123\/S1679-49742015000400007","article-title":"Incompletude dos registros de \u00f3bitos por causas externas no Sistema de Informa\u00e7\u00f5es sobre Mortalidade em Pernambuco, Brasil, 2000\u20132002 e 2008\u20132010","volume":"24","year":"2015","journal-title":"Epidemiologia e Servi\u00e7os de Sa\u00fade"},{"issue":"4","key":"key20251003092201_B44","first-page":"1","article-title":"Mortality differentials according to schooling in Brazilian adults in 2010","volume":"32","year":"2016","journal-title":"Cad Saude Publica"},{"issue":"5","key":"key20251003092201_B45","doi-asserted-by":"crossref","first-page":"379","DOI":"10.53660\/398.prw1004","article-title":"Atestado de \u00f3bito: instrumento de educa\u00e7\u00e3o permanente em mortalidade perinatal","volume":"5","year":"2023","journal-title":"Peer Review"},{"issue":"2","key":"key20251003092201_B46","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1590\/S0102-30982010000200004","article-title":"Problemas no preenchimento da Declara\u00e7\u00e3o de \u00d3bito: Estudo explorat\u00f3rio","volume":"27","year":"2010","journal-title":"Rev Bras Estud Popul"},{"issue":"1\u20132","key":"key20251003092201_B47","first-page":"90","article-title":"Tabulador de causas m\u00faltiplas de morte","volume":"2","year":"1999","journal-title":"Revista Brasileira de Epidemiologia"},{"issue":"2","key":"key20251003092201_B48","first-page":"231","article-title":"Multiple causes of death related to cerebrovascular diseases in the state of Parana, Brazil","volume":"14","year":"2011","journal-title":"Revista Brasileira de Epidemiologia"},{"issue":"4","key":"key20251003092201_B49","first-page":"177","article-title":"Doen\u00e7as cr\u00f4nico-degenerativas em adultos da regi\u00e3o centro-sul de Belo Horizonte: An\u00e1lise sob a perspectiva de causas m\u00faltiplas de morte","volume":"10","year":"2001","journal-title":"Informe Epidemiol\u00f3gico do Sus"},{"issue":"1","key":"key20251003092201_B50","first-page":"1","article-title":"Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: A meta-analysis","volume":"22","year":"2022","journal-title":"BMC Geriatr"},{"issue":"2","key":"key20251003092201_B51","first-page":"1","article-title":"Dysphagia in acute stroke: incidence, burden and impact on clinical outcome","volume":"11","year":"2016","journal-title":"PLoS One"},{"issue":"1","key":"key20251003092201_B52","article-title":"Causas m\u00faltiplas de morte","volume":"6","year":"1972","journal-title":"Rev Sa\u00fade P\u00fablica"},{"issue":"9735","key":"key20251003092201_B53","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/S0140-6736(10)60834-3","article-title":"Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study","volume":"376","year":"2010","journal-title":"The Lancet"},{"issue":"2","key":"key20251003092201_B54","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/oxfordjournals.aje.a114375","article-title":"Analytical potential for multiple cause-of-death data","volume":"124","year":"1986","journal-title":"Am J Epidemiol"},{"issue":"10","key":"key20251003092201_B55","doi-asserted-by":"crossref","first-page":"2069","DOI":"10.1016\/j.clineuro.2013.07.015","article-title":"Which risk factors are more associated with ischemic rather than hemorrhagic stroke in black Africans?","volume":"115","year":"2013","journal-title":"Clin Neurol Neurosurg"},{"key":"key20251003092201_B56","volume-title":"Pesquisa nacional de sa\u00fade: Percep\u00e7\u00e3o do estado de sa\u00fade, estilos de vida, doen\u00e7as cr\u00f4nicas e sa\u00fade bucal","year":"2020"},{"key":"key20251003092201_B57","volume-title":"Pesquisa nacional de sa\u00fade: 2019: informa\u00e7\u00f5es sobre domic\u00edlios, acesso e utiliza\u00e7\u00e3o dos servi\u00e7os de sa\u00fade","year":"2020"},{"issue":"9","key":"key20251003092201_B58","doi-asserted-by":"crossref","first-page":"3755","DOI":"10.1590\/S1413-81232011001000012","article-title":"Tend\u00eancias das desigualdades sociais e demogr\u00e1ficas na preval\u00eancia de doen\u00e7as cr\u00f4nicas no Brasil, PNAD: 2003\u20132008","volume":"16","year":"2011","journal-title":"Ciencia e Saude Coletiva"},{"issue":"9733","key":"key20251003092201_B59","doi-asserted-by":"crossref","first-page":"2215","DOI":"10.1016\/S0140-6736(10)60484-9","article-title":"Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies","volume":"375","year":"2010","journal-title":"The Lancet"},{"issue":"8","key":"key20251003092201_B60","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1161\/01.STR.22.8.983","article-title":"Atrial fibrillation as an independent risk factor for stroke: the Framingham Study","volume":"22","year":"1991","journal-title":"Stroke"},{"issue":"5","key":"key20251003092201_B61","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1161\/STROKEAHA.116.016022","article-title":"Risk of stroke in patients with heart failure: a population-based 30-year cohort study","volume":"48","year":"2017","journal-title":"Stroke"},{"issue":"4","key":"key20251003092201_B62","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1161\/01.STR.0000260091.13729.96","article-title":"Autopsy prevalence of coronary atherosclerosis in patients with fatal stroke","volume":"38","year":"2007","journal-title":"Stroke"}],"container-title":["Global Heart"],"original-title":[],"link":[{"URL":"https:\/\/account.globalheartjournal.com\/index.php\/up-j-gh\/article\/download\/1476\/2105","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/account.globalheartjournal.com\/index.php\/up-j-gh\/article\/download\/1476\/2106","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/account.globalheartjournal.com\/index.php\/up-j-gh\/article\/download\/1476\/2107","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/account.globalheartjournal.com\/index.php\/up-j-gh\/article\/download\/1476\/2105","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T09:25:16Z","timestamp":1759483516000},"score":1,"resource":{"primary":{"URL":"https:\/\/account.globalheartjournal.com\/index.php\/up-j-gh\/article\/view\/1476"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":62,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,9]]}},"URL":"https:\/\/doi.org\/10.5334\/gh.1476","relation":{},"ISSN":["2211-8179","2211-8160"],"issn-type":[{"value":"2211-8179","type":"electronic"},{"value":"2211-8160","type":"print"}],"subject":[],"published":{"date-parts":[[2025,10,3]]}}}