Cardiovascular mortality and risk behaviours by degree of urbanization before, during and after the economic crisis in Spain

Almudena Moreno-Lostao,Fernando Rodríguez-Artalejo,David Martínez,Juan M Guerras,Luis De La Fuente,Lourdes Lostao,Enrique Regidor

doi:10.1186/s12889-019-7427-4

Abstract

BackgroundTo estimate the relationship of the degree of urbanization to cardiovascular mortality and to risk behaviours before, during and after the 2008 economic crisis in Spain.MethodsIn three areas of residence – large urban areas, small urban areas and rural areas – we calculated the rate of premature mortality (0–74 years) from cardiovascular diseases before the crisis (2005–2007), during the crisis (2008–2010 and 2011–2013) and after the crisis (2014–2016), and the prevalence of risk behaviours in 2006, 2011 and 2016. In each period we estimated the mortality rate ratio (MRR) and the prevalence ratio, taking large urban areas as the reference.ResultsIn men, no significant differences were observed in mortality between the two urban areas, while the MRR in rural areas went from 0.92 [95% confidence interval, 0.90–0.94) in 2005–2007 to 0.94 (0.92–0.96) in 2014–2016. In women, no significant differences were observed in mortality between the rural and large urban areas, whereas the MRR in small urban areas decreased from 1.11 (1.08–1.14) in 2005–2007 to 1.06 (1.02–1.09) in 2014–2016. The rural areas had the lowest prevalence of smoking, obesity and physical inactivity in men, and of obesity in women. No significant differences were observed in smoking or physical inactivity by area of residence in women.ConclusionThe pattern of cardiovascular mortality by degree of urbanization was similar before and after the crisis, although in women the excess mortality in small urban areas with respect to large urban areas was smaller after the crisis. The different pattern of risk behaviours in men and women, according to area of residence, could explain these findings.

Highlights

To estimate the relationship of the degree of urbanization to cardiovascular mortality and to risk behaviours before, during and after the 2008 economic crisis in Spain
Beginning in 2012, the mortality rate in residents of large urban areas was similar to that observed for residents in rural areas (Fig. 1)
Before and during the economic crisis, mortality was slightly higher in rural than in large urban areas, the lowest mortality was observed in small urban areas

Summary

Introduction

To estimate the relationship of the degree of urbanization to cardiovascular mortality and to risk behaviours before, during and after the 2008 economic crisis in Spain. The difference in patterns of health and disease between rural and urban areas has not been widely studied. It is usually believed that urban residents have worse health than those in rural areas due to greater exposure to stress, air pollution and higher drug and alcohol consumption [1]. In some wealthy countries, the mortality rate is higher in rural than in urban areas [2, 3]. The pattern of cardiovascular mortality in Spain has lagged behind that of other countries, both with respect to the decline of this mortality in the last decades of the twentieth century, and to the behavioural factors affecting cardiovascular risk [8,9,10], since the smoking and obesity epidemics appeared later than in other wealthy countries [11,12,13]. The burden of cardiovascular disease could be lower in rural than in urban areas, since these lifestyles may have spread later among rural residents [14]

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