Regional Disparity of Cardiovascular Mortality and Its Determinants

Kang, Hyeon Jin; Kwon, Soonman

Abstract

BACKGROUND
Many studies have explained regional disparities in health by socioeconomic status and healthcare resources, focusing on differences between urban and rural area. However some cities in Korea have the highest cardiovascular mortality, even though they have sufficient healthcare resources. So this study aims to confirm three hypotheses: (1) there are also regional health disparities between cities not only between urban and rural area, (2) it has different regional risk factors affecting cardiovascular mortality whether it is urban or rural area, (3) Besides socioeconomic and healthcare resources factors, there are remnant factors that affect regional cardiovascular mortality such as health behavior and physical environment.
METHODS
The subject of this study is 227 local authorities (si, gun, gu). They were categorized into city (gu and si consisting of urban area) and non-city (gun consisting of rural area), and the city group was subdivided into 3 parts to reflect relative different city status: city 1 (Seoul, Gyeonggi cities), city 2 (Gwangyeoksi cities), and city 3 (other cities). We compared their mortalities among four groups by using analysis of variance analysis. And we explored what had contributed to it in whole authorities, city and non-city group by using multiple regression analysis.
RESULTS
Cardiovascular mortality is highest in city 2 group, lowest in city 1 group and middle in non-city group. Socioeconomic status and current smoking significantly increase mortality regardless of group. Other than those things, in city, there are some factors associated with cardiovascular mortality: walking practice(-), weight control attempt(-), deficiency of sports facilities(+), and high rate of factory lot(+). In non-city, there are other factors different from those of city: obesity prevalence(+), self-perceiving obesity(-), number of public health institutions(-), and road ratio(-).
CONCLUSION
To reduce cardiovascular mortality and it's regional disparities, we need to consider differentiated approach, respecting regional character and different risk factors. Also, it is crucial to strengthen local government's capacity for practicing community health policy.