Muszyńska Magdalena M, Sulkowska Urszula, Zatoński Witold A
Insitute of Statistics and Demography, Warsaw School of Economics, Warsaw, Poland.
Kardiol Pol. 2015;73(3):207-15. doi: 10.5603/KP.2015.0040.
Spatial differences in mortality in Poland are large and remain unexplained to a large extent. Ischaemic heart disease (IHD) is a good candidate for explaining regional inequalities in mortality in Poland due to the high level of mortality from this cause and the large spatial differences.
We describe the contribution of IHD to all-cause mortality in Poland in 2006-2010 on a powiat (Polish district) level and explain the differences in mortality by selected socio-economic factors.
We use mortality data from the population registry at the NUTS-4 level for 2006-2010. We map age-standardised all-cause and IHD mortality rates. The contribution of IHD mortality to all-cause mortality was also assessed through variance decomposition. Correlation coefficients between age-standardised mortality rates and selected socio-economic variables were estimated for all powiats and for a group excluding large cities.
We demonstrated that regional differences between powiats in IHD mortality do not constitute a major factor behind regional mortality disparities in Poland. However, the spatial patterns for all-cause and IHD mortality in Polish powiats were both related to the level of urbanisation, with group of powiats characterised by the lowest IHD mortality comprising only large cities. The negative effect of large cities on the level of all-cause and IHD mortality was confirmed by the significant correlation between the socio-economic contextual variables, standing for the level of urbanisation, and IHD mortality.
Ease of access to medical care in large cities and in particular to cardiology units is an important factor behind the levels of all-cause and IHD mortality in Poland.
波兰死亡率的空间差异很大，且在很大程度上仍无法解释。由于缺血性心脏病（IHD）导致的死亡率较高且存在较大的空间差异，它是解释波兰地区死亡率不平等的一个很好的研究对象。
我们描述了2006 - 2010年波兰县级行政区缺血性心脏病对全因死亡率的贡献，并通过选定的社会经济因素解释死亡率差异。
我们使用了2006 - 2010年NUTS - 4级人口登记处的死亡率数据。我们绘制了年龄标准化的全因死亡率和缺血性心脏病死亡率地图。还通过方差分解评估了缺血性心脏病死亡率对全因死亡率的贡献。估计了所有县级行政区以及排除大城市后的一组地区年龄标准化死亡率与选定社会经济变量之间的相关系数。
我们证明，波兰县级行政区缺血性心脏病死亡率的区域差异并非波兰地区死亡率差异背后的主要因素。然而，波兰县级行政区全因死亡率和缺血性心脏病死亡率的空间模式均与城市化水平相关，缺血性心脏病死亡率最低的县级行政区组仅包括大城市。代表城市化水平的社会经济背景变量与缺血性心脏病死亡率之间的显著相关性证实了大城市对全因死亡率和缺血性心脏病死亡率水平的负面影响。
大城市尤其是心脏病科的医疗服务可及性是波兰全因死亡率和缺血性心脏病死亡率水平背后的一个重要因素。
