Regional variation in coronary heart disease mortality trends in Portugal, 1981-2012.
BACKGROUND
Information is scarce about the geographic variation in time trends of mortality from coronary heart disease (CHD). We aimed to describe trends in death rates, absolute number of deaths and years of life lost (YLL) due to CHD among men and women in Portugal, by region, from 1981 to 2012.


METHODS
The age-standardized mortality rates from CHD were estimated by sex and region. We used joinpoint regression analysis to calculate the annual percent change (APC) in mortality and to identify points of significant change in the trend. The YLL due to premature mortality for CHD were computed using the Global Burden of Disease method.


RESULTS
The age-adjusted mortality from CHD decreased between 1981 and 2012, both in men and women, but with significantly different APC by region. Smaller declines in rates were observed in Alentejo (men: APC 1993-2012: -2.4%; women: APC 1991-2012: -2.4%). The greatest decline was observed in Madeira between 2003 and 2012, in men (APC: -7.6%) and women (APC: -9.7%). The decline in rates in Algarve started only after 2003, whereas it was consistent from 1981 in the North and started in the 1990s in most other regions. A decrease in the number of deaths was only observed after 2000. The YLL from CHD decreased from 1981 to 2012, mainly after 2000.


CONCLUSIONS
In Portugal, between 1981 and 2012, relative declines of CHD mortality indicators were different by geographic region. Consistent decreases in mortality rates were only observed in the Centre, Lisbon and North, the most populated and urbanized regions.
Epidemiology Research Unit (EPIUnit), Institute of Public Health - University of Porto (ISPUP), Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal; Department of Cardiology, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Hospital de São Pedro, Vila Real, Portugal. Electronic address: carla-r-araujo@hotmail.com.
Carla
C
Araújo
Epidemiology Research Unit (EPIUnit), Institute of Public Health - University of Porto (ISPUP), Porto, Portugal.
Marta
M
Pereira
Epidemiology Research Unit (EPIUnit), Institute of Public Health - University of Porto (ISPUP), Porto, Portugal.
Marta
M
Viana
Epidemiology Research Unit (EPIUnit), Institute of Public Health - University of Porto (ISPUP), Porto, Portugal.
Olga Laszczyńska
OL
Rocha
Population Health Sciences Division, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland.
Kathleen
K
Bennett
Epidemiology Research Unit (EPIUnit), Institute of Public Health - University of Porto (ISPUP), Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
Nuno
N
Lunet
Epidemiology Research Unit (EPIUnit), Institute of Public Health - University of Porto (ISPUP), Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
Ana
A
Azevedo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality*; D003710:Demography / Q000639:trends*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011174:Portugal / Q000453:epidemiology; D055815:Young Adult
Coronary disease; Mortality; Portugal; Trends