Mortality Trends in Ischaemic Heart Disease and Diabetes: Urban vs Non-Urban Italy and Spain 2003–2019

Overview

This study analyzed mortality trends from ischaemic heart disease and diabetes mellitus in urban and non-urban areas of Italy and Spain from 2003 to 2019. Results showed a consistent decline in mortality rates for both diseases in both countries, with a greater reduction observed in urban areas compared to non-urban areas.

Background

Ischaemic heart disease and diabetes mellitus are leading causes of death in high-income countries, but mortality rates have declined due to reduced risk factors and improved treatments. Previous studies in countries like the USA and Australia have shown higher mortality and slower declines in non-urban areas compared to urban areas. However, data on these trends in European countries, particularly by urbanization level, have been limited. This study addresses this gap by examining mortality trends in Italy and Spain over nearly two decades.

Data Highlights

Key Findings

• Mortality rates from ischaemic heart disease and diabetes mellitus decreased significantly in both urban and non-urban areas of Italy and Spain between 2003 and 2019.
• The average annual percentage decline in mortality was consistently greater in urban areas compared to non-urban areas for both diseases and countries.
• In Italy, the APC for ischaemic heart disease was -4.0% in urban areas versus -3.6% in non-urban areas; for diabetes, -1.5% versus -1.3%, respectively.
• In Spain, the APC for ischaemic heart disease was -4.4% in urban areas versus -3.7% in non-urban areas; for diabetes, -3.3% versus -2.0%, respectively.
• Initially, non-urban areas had a mortality advantage, but by the end of the study period, this advantage disappeared or reversed, with higher mortality in non-urban areas.
• The study highlights persistent inequalities in mortality reduction between urban and non-urban populations in Southern Europe.

Clinical Implications

Clinicians and public health professionals should recognize that despite overall mortality improvements, residents in non-urban areas remain at higher risk for ischaemic heart disease and diabetes mortality. Targeted interventions and resource allocation are needed to address these disparities and improve outcomes in non-urban populations. Monitoring trends by area of residence can guide effective prevention and management strategies.

Conclusion

Mortality from ischaemic heart disease and diabetes has declined in both Italy and Spain from 2003 to 2019, but reductions have been greater in urban areas. This has led to a narrowing and reversal of the initial mortality advantage seen in non-urban areas, underscoring the need to address geographic health inequalities.

References

1. Comparative Analysis of Mortality Trends from Ischaemic Heart Disease and Diabetes in Urban and Rural Regions of Italy and Spain, 2003–2019
2. Editorial Comment by M. Ferrini, 2021 -- To live in the country or in town? Not an easy choice