Geographic Variation in Morbidity and Mortality of Cerebrovascular Diseases in Korea during 2011-2015

• Published in: Journal of stroke and cerebrovascular diseases 2018-03, Vol.27 (3), p.747-757
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Age Distribution; Aged; Aged, 80 and over; behavioral risk factors; Cause of Death; Cerebrovascular Disorders - diagnosis; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - mortality; Cerebrovascular Disorders - therapy; Cross-Sectional Studies; CVD morbidity; CVD mortality; Female; geographic variation; health care resource; Health Resources - statistics & numerical data; Health Status Disparities; Health Surveys; Humans; Linear Models; Male; Middle Aged; Multivariate Analysis; neighborhood socioeconomic status; Republic of Korea - epidemiology; Risk Factors; Sex Distribution; South Korea; Time Factors
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.011

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.