Regional variations in cardio-cerebrovascular diseases mortality in South Korea from a geographic perspective

Objectives; Ecological study design was used to investigate regional variations in cardio-cerebrovascular diseases(CCVD) mortality of 253-county regions in South Korea. Methods; The authors analyzed the county-level cardiac disease (ICD10 code 120-152) and cerebrovascular disease (ICD10 code 160-169) mortality data from 2006 to 2008. Spatial clustering disease mapping, and spatial regression using generalized additive model was used to analyze the spatial distribution for CCVD mortality. Moran's I and LISA (Localized Indicators of Spatial Association) for spatial correlation was calculated to test for evidence of spatial clustering. Results; Standardized mortality rates for cardiac disease mortality gap between the lowest and highest regions was 4.1 times, and that for cerebrovascular disease mortality was 3.7 times. Moran's I was 0.58 for cardiac disease mortality, 0.45 for cerebrovascular disease mortality. Thus, it could be considered that if one region has high mortality than neighboring villages also have high spatial correlation. Spatial multivariate regression analysis demonstrated that higher cardiac mortality rate was significantly associated with high sex ratio(the ratio of males to females), high unemployment rate, high ratio of household that receive basic living security income and low inequality income of households. And higher stroke mortality rate was significantly associated with high unemployment rate, low degree of moderate physical activity, low inequality income of households, low financial independence. Conclusions; Clustering regions of spatial analysis show there were regional differences in CCVD mortality and suggest that causes of spatial heterogeneity have influenced CCVD mortality.