title: Regional differences in cardiovascular risk factor profile cannot fully explain differences in cardiovascular morbidity in the Netherlands: a comparison of two urban areas.
abstract: BACKGROUND
  Our objective was to investigate whether a region in the south of the Netherlands (Heerlen/Kerkrade) had a high burden of cardiovascular disease in comparison with a nearby region (Maastricht) and the average Dutch population, respectively. We also wanted to determine if there are interregional differences in cardiovascular risk factor profile.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Data from a nationwide registry (CBS) were used to analyse cardiovascular mortality in the two regions and the average in the Netherlands. Data from a primary care morbidity registration network (RNH) were used to compare cardiovascular morbidity and cardiovascular risk factors in both regions. A standardisation procedure was carried out for age and sex. Data were analysed using logistic regression analyses.
  
  
  RESULTS
  The overall cardiovascular mortality rate was higher in the Heerlen/Kerkrade region (7.8 per thousand) compared with Maastricht (6.1 per thousand, OR=1.3, 95% CI 1.2-1.5) and the average in the Netherlands (5.7 per thousand). Similarly, most cardiovascular morbidity rates for Heerlen/Kerkrade were more elevated compared with the RNH overall and with Maastricht. Prevalence rates of risk factors such as diabetes mellitus (7.2%, OR=1.5, 95% CI 1.3-1.7) and overweight (10.8%, OR= 2.0, 95% CI 1.8-2.2) were significantly higher in the Heerlen/Kerkrade region compared with Maastricht. There were no differences with regard to hypertension (15.2%, OR=1.0, 95% CI 0.9-1.1).
  
  
  CONCLUSIONS
  Heerlen/Kerkrade is indeed a region with a high burden of cardiovascular disease. Differences in morbidity between Heerlen/Kerkrade and Maastricht cannot be fully explained by differences in cardiovascular risk factor profile.
authors.affiliation: Department of General Practice, Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands. Arian.Plat@HAG.unimaas.nl
authors.forename: A W
authors.initials: AW
authors.lastname: Plat
authors.forename: M J M
authors.initials: MJ
authors.lastname: te Wierik
authors.forename: A A
authors.initials: AA
authors.lastname: Kroon
authors.forename: H J A
authors.initials: HJ
authors.lastname: Schouten
authors.forename: M
authors.initials: M
authors.lastname: van den Akker
authors.forename: C P
authors.initials: CP
authors.lastname: van Schayck
authors.forename: P W
authors.initials: PW
authors.lastname: de Leeuw
authors.forename: K-J
authors.initials: KJ
authors.lastname: Hajema
authors.forename: H E J H
authors.initials: HE
authors.lastname: Stoffers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D003430:Cross-Sectional Studies; D003644:Death Certificates; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D014504:Urban Health / Q000706:statistics & numerical data*