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Are geographical differences in cardiovascular mortality due to morbidity differences or to methodological
C Nerbrand1, K Svärdsudd, L G Hörte
1Uppsala University, Department of Family Medicine, Sweden.
Insights
Geographical variations in cardiovascular disease mortality exist in Sweden. Differences in survival rates and cause-of-death certification do not fully explain the observed disparities in ischemic heart disease and stroke mortality between western and eastern regions.
Area of Science:
- Cardiovascular epidemiology
- Public health research
- Geographical health disparities
Background:
- Significant geographical variations in cardiovascular mortality, specifically ischemic heart disease (IHD) and stroke, have been observed in Mid-Sweden.
- Western regions exhibit markedly higher mortality rates for IHD and stroke compared to eastern regions, affecting both men and women.
Purpose of the Study:
- To investigate potential explanations for geographical variations in cardiovascular mortality.
- To determine if differences in survival rates or cause-of-death certification account for higher mortality in western Sweden.
Main Methods:
- Retrospective analysis of patient data hospitalized for myocardial infarction or stroke between 1972-1981 in Värmland (west) and Uppsala (east) counties.
- Substudy examining the basis of death certificate diagnoses and autopsy rates in both regions.
Main Results:
- The western area generally showed a higher case fatality rate for myocardial infarction and stroke.
- A greater proportion of deaths occurred outside hospitals in the eastern area.
- Despite higher case fatality in the west, differences in survival and certification did not fully explain the observed mortality disparities.
Conclusions:
- Observed geographical variations in cardiovascular mortality between western and eastern Sweden are not solely explained by differences in survival rates or cause-of-death certification.
- Further research is needed to identify the underlying factors contributing to these regional health disparities.
Abstract:
Geographical variations in cardiovascular mortality have been reported from Mid-Sweden. IHD mortality for men aged 45-64 was 60% higher in the western part than in the east. Mortality from stroke for men aged 45-74 was 73% higher on the west. Similar differences were found for women. One possible explanation could be that there are no incidence differences but that the mortality differences are due to different survival rates or to differences certifying the cause of death. These two possible explanations were tested in this study. Data for all patients hospitalised during the 10-year period 1972-1981 for myocardial infarction or stroke in a high mortality area, the County of Värmland in the west, and a low mortality area, the County of Uppsala in the east, were collected. In addition, a substudy was performed where the basis for the death certificate diagnosis was studied. The western area generally had a higher case fatality rate than the eastern. However, a larger proportion of the deaths the eastern area, occurred outside hospital, so that the net effect would be that the differences found were not large enough to explain the mortality differences. The autopsy rate in the western part was lower than in the east but since a larger proportion of the deaths occurred in hospital the rank order for IHD and stroke mortality between east and west was the same whether all IHD or stroke deaths were counted or only those considered the most well documented.