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BMC Medicine
Published in: BMC Medicine 1/2022

Open Access 01-12-2022 | Research article

Spatiotemporal trends and ecological determinants of cardiovascular mortality among 2844 counties in mainland China, 2006–2020: a Bayesian modeling study of national mortality registries

Authors: Wei Wang, Junming Li, Yunning Liu, Pengpeng Ye, Chengdong Xu, Peng Yin, Jiangmei Liu, Jinlei Qi, Jinling You, Lin Lin, Ziwei Song, Limin Wang, Lijun Wang, Yong Huo, Maigeng Zhou

Published in: BMC Medicine | Issue 1/2022

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Abstract

Background

Cardiovascular disease (CVD) is the leading cause of death in China. No previous study has reported CVD mortality at county-level, and little was known about the nonmedical ecological factors of CVD mortality at such small scale in mainland China. Understanding the spatiotemporal variations of CVD mortality and examining its nonmedical ecological factors would be of great importance to tailor local public health policies.

Methods

By using national mortality registration data in China, this study used hierarchical spatiotemporal Bayesian model to demonstrate spatiotemporal distribution of CVD mortality in 2844 counties during 2006 to 2020 and investigate how nonmedical ecological determinants have affected CVD mortality inequities from the spatial perspectives.

Results

During 2006–2020, the age-standardized mortality rate (ASMR) of CVD decreased from 284.77 per 100,000 in 2006 to 241.34 per 100,000 in 2020. Among 2844 counties, 1144 (40.22%) were hot spots counties with a higher CVD mortality risk compared to the national average and located mostly in northeast, north central, and westernmost regions; on the contrary, 1551 (54.53%) were cold spots counties and located mostly in south and southeast coastal counties. CVD mortality risk decreased from 2006 to 2020 was larger in counties where CVD mortality rate had been higher in 2006 in most of the counties, vice versa. Nationwide, nighttime light intensity (NTL) was the major influencing factor of CVD mortality, a higher NTL appeared to be negatively associated with a lower CVD mortality, with one unit increase in NTL, and the CVD mortality risk will decrease 11% (relative risk of NTL was estimated as 0.89 with 95% confidence interval of 0.83–0.94).

Conclusions

Substantial between-county discrepancies of CVD mortality distribution were observed during past 15 years in mainland China. Nonmedical ecological determinants were estimated to significantly explain the overall and local spatiotemporal patterns of this CVD mortality risk. Targeted considerations are needed to integrate primary care with clinical care through intensifying further strategies to narrow unequally distribution of CVD mortality at local scale. The approach to county-level analysis with small area models has the potential to provide novel insights into Chinese disease-specific mortality burden.
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Metadata
Title
Spatiotemporal trends and ecological determinants of cardiovascular mortality among 2844 counties in mainland China, 2006–2020: a Bayesian modeling study of national mortality registries
Authors
Wei Wang
Junming Li
Yunning Liu
Pengpeng Ye
Chengdong Xu
Peng Yin
Jiangmei Liu
Jinlei Qi
Jinling You
Lin Lin
Ziwei Song
Limin Wang
Lijun Wang
Yong Huo
Maigeng Zhou
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2022
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-022-02613-9

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