Lee Juyeon, Bahk Jinwook, Kim Ikhan, Kim Yeon-Yong, Yun Sung-Cheol, Kang Hee-Yeon, Lee Jeehye, Park Jong Heon, Shin Soon-Ae, Khang Young-Ho
People's Health Institute, Dongjak-gu, Seoul 07004, Republic of Korea.
Department of Public Health, Keimyung University, Daegu 42601, Republic of Korea; Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul 03080, Republic of Korea.
J Stroke Cerebrovasc Dis. 2018 Mar;27(3):747-757. doi: 10.1016/j.jstrokecerebrovasdis.2017.10.011. Epub 2017 Nov 8.
Little is known about within-country variation in morbidity and mortality of cerebrovascular diseases (CVDs). Geographic differences in CVD morbidity and mortality have yet to be properly examined. This study examined geographic variation in morbidity and mortality of CVD, neighborhood factors for CVD morbidity and mortality, and the association between CVD morbidity and mortality across the 245 local districts in Korea during 2011-2015.
District-level health care utilization and mortality data were obtained to estimate age-standardized CVD morbidity and mortality. The bivariate Pearson correlation was used to examine the linear relationship between district-level CVD morbidity and mortality Z-scores. Simple linear regression and multivariate analyses were conducted to investigate the associations of area characteristics with CVD morbidity, mortality, and discrepancies between morbidity and mortality.
Substantial variation was found in CVD morbidity and mortality across the country, with 1074.9 excess CVD inpatients and 73.8 excess CVD deaths per 100,000 between the districts with the lowest and highest CVD morbidity and mortality, respectively. Higher rates of CVD admissions and deaths were clustered in the noncapital regions. A moderate geographic correlation between CVD morbidity and mortality was found (Pearson correlation coefficient = .62 for both genders). Neighborhood level indicators for socioeconomic disadvantages, undersupply of health care resources, and unhealthy behaviors were positively associated with CVD morbidity and mortality and the relative standing of CVD mortality vis-à-vis morbidity.
Policy actions targeting life-course socioeconomic conditions, equitable distribution of health care resources, and behavioral risk factors may help reduce geographic differences in CVD morbidity and mortality in Korea.
关于一个国家内脑血管疾病（CVDs）发病率和死亡率的地区差异知之甚少。CVD发病率和死亡率的地理差异尚未得到充分研究。本研究调查了2011 - 2015年韩国245个地区CVD发病率和死亡率的地理差异、CVD发病率和死亡率的社区因素，以及CVD发病率和死亡率之间的关联。
获取地区层面的医疗保健利用和死亡率数据，以估计年龄标准化的CVD发病率和死亡率。采用双变量Pearson相关性分析来检验地区层面CVD发病率和死亡率Z分数之间的线性关系。进行简单线性回归和多变量分析，以研究地区特征与CVD发病率、死亡率以及发病率和死亡率差异之间的关联。
全国范围内CVD发病率和死亡率存在显著差异，CVD发病率和死亡率最低与最高的地区之间，每10万人中分别有1074.9例额外的CVD住院患者和73.8例额外的CVD死亡。较高的CVD住院率和死亡率集中在非首都地区。发现CVD发病率和死亡率之间存在中等程度的地理相关性（男女的Pearson相关系数均为0.62）。社会经济劣势、医疗保健资源供应不足和不健康行为的社区层面指标与CVD发病率、死亡率以及CVD死亡率相对于发病率的相对排名呈正相关。
针对生命历程中的社会经济状况、医疗保健资源公平分配和行为风险因素采取政策行动，可能有助于减少韩国CVD发病率和死亡率的地理差异。
