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Time trends, cohort effect and spatial distribution of cerebrovascular disease mortality in Spain
M T Olalla1, M J Medrano, M J Sierra
1Cardiovascular Disease Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.
Study Objective:
This study describes mortality due to cerebrovascular disease (CVD) in Spain, based on time-series analysis in the period 1951-1995 by age, sex, and cohort of birth; spatial distribution observed for the five-year period 1991 1995, and time-spatial analysis in the period 1992-1995 vs. 1988-1991. Special attention is paid to risk of medium aged population.
Design:
Longitudinal and cross-sectional observational study.
Setting And Participants:
Spanish population. All mortality data used were taken from official statistics. Time trends and spatial distribution were analyzed using log-linear Poisson regression models.
Main Results:
CVD mortality declined over the last two decades of the study period (1974-1995) by an annual average of 4.16% (95% CI: 3.95-4.36) and 4.00% (95% CI: 3.77-4.24) in men and women, respectively. The downward trends were accelerated in last decade. An excess of male mortality was in evidence. For all age groups mortality declined with more recent cohorts, but the decline was less marked among ages 35 64. Spatial distribution of CVD mortality revealed a north-south pattern, but this is being difuminated by increasing rates in the lower risk provinces. Internationally, Spain ranks midway to low in terms of its overall CVD mortality.
Conclusions:
Efforts to reduce CVD incidence and case fatality are the essential prerequisite for any long-term improvement in mortality. Accordingly, further research is called for into current disease morbidity and the risk factors to be targeted at a general population level, nationwide.