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Regional differences in mortality, hospital discharges and primary care contacts for cardiovascular disease
Sigridur Haraldsdottir1,2, Sigurdur Gudmundsson1,3, Guđmundur Thorgeirsson3,4
11 Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
Insights
Cardiovascular disease (CVD) mortality and risk factors are higher in rural Iceland, especially for women. Targeted health promotion and treatment are needed in these areas to reduce regional disparities.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Medicine
Background:
- Geographical variations in cardiovascular health (CVD) are critical for addressing regional health disparities.
- Understanding urban-rural differences in CVD outcomes and risk factors is essential for public health strategies.
Purpose of the Study:
- To investigate geographical variations in CVD mortality, diagnosis prevalence, and risk factor distribution in Iceland.
- To compare CVD health indicators between urban and rural regions within Iceland.
Main Methods:
- Utilized nationwide health registers for CVD mortality, primary care contacts, and hospital discharges (N=7113, 58,246, 14,039 respectively).
- Analyzed CVD risk factors from a national health survey (N=5909, 60.3% response rate).
- Calculated age-standardized rates and used logistic regression to assess regional differences.
Main Results:
- Higher total CVD mortality rates were observed in rural areas compared to urban areas, particularly among women.
- Specific conditions like atrial fibrillation, heart failure, and ischemic heart disease showed increased mortality in rural regions.
- Prevalence of modifiable risk factors and healthcare contacts for CVD were generally higher in rural areas, especially for women.
Conclusions:
- Rural areas in Iceland exhibit a higher prevalence of modifiable risk factors and cardiovascular disease, particularly in women.
- These findings highlight the need for tailored treatment and health-promoting initiatives in rural regions.
- Addressing these disparities is crucial for achieving equitable cardiovascular health outcomes across Iceland.
Aims:
Surveillance of geographical variations in cardiovascular health is important in order to achieve the objectives of reducing regional health disparities. We aimed to explore differences in cardiovascular disease (CVD) mortality and prevalence of CVD diagnoses made in primary and in-patient care, as well as risk factor distribution by geographic regions (urban/rural) in Iceland.
Methods:
From nationwide health registers, we obtained data on CVD mortalities ( N = 7113), primary healthcare CVD contacts ( N = 58,246) and hospital CVD discharges ( N = 14,039), as well as data on CVD risk factors from a national health survey ( N = 5909; response rate 60.3%). Age-standardised annual mortality, primary healthcare contact and hospital discharge rates due to CVD were calculated per 100,000 population inside (urban) and outside (rural) the Capital Area (CA). Logistic regression was used to explore regional differences in CVD risk factors.
Results:
We observed slightly higher total CVD mortality rates among women outside compared to inside the CA (Standardised Rate Ratio (SRR) 1.06 (95% confidence interval (CI) 1.05-1.07)), particularly due to atrial fibrillation (SRR 1.47 (95% CI 1.46-1.48)), heart failure (SRR 1.29 (95% CI 1.27-1.31)) and ischemic heart disease (SRR 1.11 (95% CI 1.10-1.12)), while reduced mortality risk for cerebrovascular disease (SRR 0.81 (95% CI 0.80-0.83)). The rates of hospital discharges and primary care contacts for these diseases, as well as prevalence of several modifiable risk factors, were generally higher outside the CA, particularly among women.
Conclusions:
The higher prevalence of modifiable risk factors and CVD in rural areas, especially among women, calls for refined treatment and health-promoting efforts in rural areas.
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