Clinical Scorecard: Comparative Analysis of Mortality Trends from Ischaemic Heart Disease and Diabetes in Urban and Rural Regions of Italy and Spain, 2003–2019

At a Glance

Key Highlights

• Mortality rates from ischaemic heart disease and diabetes decreased from 2003 to 2019 in both urban and non-urban areas of Italy and Spain.
• Greater reductions in mortality were observed in urban areas compared to non-urban areas in both countries.
• The initial mortality advantage in non-urban areas disappeared by the end of the study period, with some evidence of higher mortality in non-urban areas.

Guideline-Based Recommendations

Diagnosis

• Use International Classification of Diseases 10th revision codes I20–I25 for ischaemic heart disease and E10–E14 for diabetes mellitus to classify cause of death.

Management

• Focus on reducing modifiable risk factors such as smoking, obesity, physical inactivity, and excessive alcohol consumption.
• Ensure availability and accessibility of pharmacological treatments to reduce incidence and fatality.

Monitoring & Follow-up

• Calculate annual age-standardized mortality rates using standard populations (e.g., 2013 European Standard Population).
• Monitor mortality trends separately by urban and non-urban residence, sex, and age groups (<75 and ≥75 years).
• Use linear regression models to estimate average annual percentage change in mortality rates.

Risks

• Higher mortality risk persists in non-urban areas due to slower decline in mortality rates.
• Potential increased inequalities in mortality between urban and non-urban populations.

Patient & Prescribing Data

General population in urban and non-urban areas of Italy and Spain affected by ischaemic heart disease and diabetes mellitus

Pharmacological treatments contribute to mortality reduction; however, disparities in mortality decline suggest possible differences in treatment access or effectiveness between urban and non-urban areas.

Clinical Best Practices

• Implement targeted public health interventions to address risk factors especially in non-urban populations.
• Enhance healthcare access and treatment adherence in non-urban areas to reduce mortality disparities.
• Use standardized mortality data and statistical methods to monitor trends and guide resource allocation.
• Consider demographic factors such as age and sex when analyzing mortality trends and planning interventions.

References

• Editorial comment: To live in the country or in town? Not an easy choice