[Mortality from ischemic cardiopathy in Spain: the trends and geographic distribution]

In order to obtain epidemiological information for health planification, age-adjusted time series and provincial distribution of ischaemic heart disease mortality have been constructed.

Analysis of time trends includes data from 1901 to 1989. Trends have been identified by linear regression analysis. For the period 1976-1986 age-adjusted and age and sex specific mortality rates have been calculated for each province. 1984 and 1989 levels have been compared to those of the European Union countries.

After the sharp rise of the curve in the 50-70 decades, since 1976 mortality falls with an statistically significant negative slope. This change in trends cannot be explained by time variations in prevalence of the main risk factors. Although in many European countries mortality began to fall much earlier, Spain still remains between the lowest mortality rates in Europe. Provinces showing the highest rates are the islands, Andalucia, Badajoz, Murcia, Alicante and Asturias. This clear north-south pattern is maintained after stratifying by age and sex, thus indicating that geographical distribution is related more to environmental or socio-economic factors and to accessibility to qualified health care, than to the geographical distribution of age and sex related risk factors.

Additional studies including other variables are needed to explain these time and spatial variations. Allocation of specialized health care resources can be an effective intervention, mostly in the above mentioned provinces.