Trends in Regional Disparity in Cardiovascular Mortality in Korea, 1983-2019

Abstract

Background and objectives: Despite remarkable reduction in cardiovascular disease (CVD) mortality, the burden has remained the leading cause of death. Since little research has focused on regional disparity in CVD mortality, this study aims to investigate its spatiotemporal trends in Korea from 1983 to 2019.

Methods: Using the causes of death statistics in Korea, we analyzed the geographic variation in deaths from CVDs from 1983 to 2019. The sex and age-standardized mortality rate was calculated according to the 17 administrative regions. The analyses include all diseases of the circulatory system (International Classification of Diseases-10 codes, I00-I99), along with the following 6 subcategories which were not mutually exclusive: total heart disease (I00-I13 and I20-I51), hypertensive heart disease (I10-I13), ischemic heart disease (I20-I25), myocardial infarction (I21-I23), heart failure (I50), and cerebrovascular disease (I60-I69).

Results: Overall, heart failure death rate increased across all regions, and other CVD death rates showed a decreasing trend. Regional disparity in mortality was substantial in the early 1980s but converged over time. In all types of cardiovascular mortality, Busan, Ulsan and Gyeongnam remained the highest, although they showed a downward trend like other regions. Jeju continued to have a relatively low CVD mortality rate.

Conclusions: The regional disparity substantially decreased compared to the 1980s. However, the relatively high burden of CVD mortality in the southeastern region has not been fully resolved.

Keywords: Cardiovascular diseases; Cause of death; Mortality; Spatio-temporal analysis.

Figure 1. Regional trends in sex- and age-standardized mortality for all diseases of circulatory system, 1983–2019. (A) Mortality trends in 6 metropolitan cities and 9 provinces from 1983 to 2019: mortality rates are directly sex- and age-standardized to the 2019 population (deaths per 100,000). (B) The ratio of mortality rates in other regions to Seoul (reference, light grey): blue indicates a lower rate than Seoul and red indicates a higher rate.

Figure 2. Regional trends in sex- and age-standardized mortality for total heart diseases, 1983–2019. (A) Mortality trends in 6 metropolitan cities and 9 provinces from 1983 to 2019: mortality rates are directly sex- and age-standardized to the 2019 population (deaths per 100,000). (B) The ratio of mortality rates in other regions to Seoul (reference, light grey): blue indicates a lower rate than Seoul and red indicates a higher rate.

Figure 3. Regional trends in sex- and age-standardized mortality for hypertensive heart diseases, 1983–2019. (A) Mortality trends in 6 metropolitan cities and 9 provinces from 1983 to 2019: mortality rates are directly sex- and age-standardized to the 2019 population (deaths per 100,000). (B) The ratio of mortality rates in other regions to Seoul (reference, light grey): blue indicates a lower rate than Seoul and red indicates a higher rate.

Figure 4. Regional trends in sex- and age-standardized mortality for myocardial infarction, 1983–2019. (A) Mortality trends in 6 metropolitan cities and 9 provinces from 1983 to 2019: mortality rates are directly sex- and age-standardized to the 2019 population (deaths per 100,000). (B) The ratio of mortality rates in other regions to Seoul (reference, light grey): blue indicates a lower rate than Seoul and red indicates a higher rate.

Figure 5. Regional trends in sex- and age-standardized mortality for heart failure, 1983–2019. (A) Mortality trends in 6 metropolitan cities and 9 provinces from 1983 to 2019: mortality rates are directly sex- and age-standardized to the 2019 population (deaths per 100,000). (B) The ratio of mortality rates in other regions to Seoul (reference, light grey): blue indicates a lower rate than Seoul and red indicates a higher rate.

Figure 6. Regional trends in sex- and age-standardized mortality for cerebrovascular diseases, 1983–2019. (A) Mortality trends in 6 metropolitan cities and 9 provinces from 1983 to 2019: mortality rates are directly sex- and age-standardized to the 2019 population (deaths per 100,000). (B) The ratio of mortality rates in other regions to Seoul (reference, light grey): blue indicates a lower rate than Seoul and red indicates a higher rate.