Int J Health Geogr - East-West gradient in cardio-vascular mortality in Austria: how much can we explain by following the pattern of risk factors?

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Resumo

CKGROUND: Various studies show major regional differences in the prevalence of cardio-vascular disease morbidity and mortality, both in Europe and within European countries. In Austria, these differences are documented by an East-West gradient with declining morbidity and mortality rates when moving from the East to the West of the country. It was the aim of this study to analyse if, and to what extent, socio-demographic and socio-economic determinants, social resources and health behaviour can contribute to the clarification of this East-West gradient by conducting secondary analyses of an existing Austrian health dataset.RESULTS: The data were analysed using bivariate analyses, as well as univariate and multivariate logistic regression models. These analyses revealed significant East-West gradients for various risk factors, as well as socio-demographic and socio-economic health determinants. There was a gradual decrease of hypertension, diabetes mellitus, obesity, and psycho-social discomfort in both sexes, with the highest prevalences in those Austrian regions with the highest cardio-vascular mortality and a stepwise decrease to the regions with the lowest cardio-vascular mortality. Controlling for educational level significantly raised the odds for diabetes, hypertension and obesity. In the results of the multivariate analyses, factors that significantly and independently predicted diabetes mellitus were geographic location, psycho-social discomfort, lack of physical exercise, and age in both sexes. For women these factors additionally included a low educational level, lack of social support, and being born abroad.CONCLUSIONS: Our study shows a clear gradual decline of cardio-vascular mortality and some of its risk factors from East to West in Austria. Concerning these risk factors, the geographic region and psycho-social discomfort showed the greatest association with diabetes mellitus, hypertension, and obesity. Hence, they contribute to the explanation of the variance in spatial cardio-vascular disease mortality. Yet, a large proportion of this variance remains unexplained. It would be of great importance to public health and preventive measures to take a closer look at spatial differences in cardio-vascular disease morbidity and mortality to better tailor programmes to the regional environments and settings. Our results also call for a greater importance of preventative measures for psycho-social discomfort and increase of social support.

Resumo Limpo

ckground various studi show major region differ preval cardiovascular diseas morbid mortal europ within european countri austria differ document eastwest gradient declin morbid mortal rate move east west countri aim studi analys extent sociodemograph socioeconom determin social resourc health behaviour can contribut clarif eastwest gradient conduct secondari analys exist austrian health datasetresult data analys use bivari analys well univari multivari logist regress model analys reveal signific eastwest gradient various risk factor well sociodemograph socioeconom health determin gradual decreas hypertens diabet mellitus obes psychosoci discomfort sex highest preval austrian region highest cardiovascular mortal stepwis decreas region lowest cardiovascular mortal control educ level signific rais odd diabet hypertens obes result multivari analys factor signific independ predict diabet mellitus geograph locat psychosoci discomfort lack physic exercis age sex women factor addit includ low educ level lack social support born abroadconclus studi show clear gradual declin cardiovascular mortal risk factor east west austria concern risk factor geograph region psychosoci discomfort show greatest associ diabet mellitus hypertens obes henc contribut explan varianc spatial cardiovascular diseas mortal yet larg proport varianc remain unexplain great import public health prevent measur take closer look spatial differ cardiovascular diseas morbid mortal better tailor programm region environ set result also call greater import prevent measur psychosoci discomfort increas social support

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