title: Regional differences in mortality, hospital discharges and primary care contacts for cardiovascular disease.
abstract: OBJECTIVE
  Surveillance of geographical variations in cardiovascular health is important in order to achieve the objectives of reducing regional health disparities. We aimed to explore differences in cardiovascular disease (CVD) mortality and prevalence of CVD diagnoses made in primary and in-patient care, as well as risk factor distribution by geographic regions (urban/rural) in Iceland.
  
  
  METHODS
  From nationwide health registers, we obtained data on CVD mortalities ( N = 7113), primary healthcare CVD contacts ( N = 58,246) and hospital CVD discharges ( N = 14,039), as well as data on CVD risk factors from a national health survey ( N = 5909; response rate 60.3%). Age-standardised annual mortality, primary healthcare contact and hospital discharge rates due to CVD were calculated per 100,000 population inside (urban) and outside (rural) the Capital Area (CA). Logistic regression was used to explore regional differences in CVD risk factors.
  
  
  RESULTS
  We observed slightly higher total CVD mortality rates among women outside compared to inside the CA (Standardised Rate Ratio (SRR) 1.06 (95% confidence interval (CI) 1.05-1.07)), particularly due to atrial fibrillation (SRR 1.47 (95% CI 1.46-1.48)), heart failure (SRR 1.29 (95% CI 1.27-1.31)) and ischemic heart disease (SRR 1.11 (95% CI 1.10-1.12)), while reduced mortality risk for cerebrovascular disease (SRR 0.81 (95% CI 0.80-0.83)). The rates of hospital discharges and primary care contacts for these diseases, as well as prevalence of several modifiable risk factors, were generally higher outside the CA, particularly among women.
  
  
  CONCLUSIONS
  The higher prevalence of modifiable risk factors and CVD in rural areas, especially among women, calls for refined treatment and health-promoting efforts in rural areas.
authors.affiliation: 1 Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.|2 Division of Health Information and Research, Directorate of Health, Reykjavik, Iceland.
authors.forename: Sigridur
authors.initials: S
authors.lastname: Haraldsdottir
authors.affiliation: 1 Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.|3 Department of Medicine, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Gudmundsson
authors.affiliation: 3 Department of Medicine, Landspitali University Hospital, Reykjavik, Iceland.|4 Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Guđmundur
authors.initials: G
authors.lastname: Thorgeirsson
authors.affiliation: 1 Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Sigrun H
authors.initials: SH
authors.lastname: Lund
authors.affiliation: 1 Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.|5 Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Unnur A
authors.initials: UA
authors.lastname: Valdimarsdottir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000628:therapy; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012042:Registries; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D017678:Sex Distribution; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cardiovascular disease; health service utilisation; mortality rate; residence; risk factors; urban/rural; women