Regional variations in cardiovascular mortality in Sweden--Structural vulnerability in the local community

The aim of this investigation was to study the connection between various phenomena in the local community and the number of deaths from ischemic heart disease (IHD) for both men and women in the 45-64 age group in the period 1979-1983. The result reveals considerable regional variation. Those areas with an above average male IHD mortality also tended to differ from the norm as regards labour market, and socioeconomic conditions. There was a tendency for unemployment to be higher, the level of employment to be lower, and the number of households with no or only one person gainfully employed larger; there also tended to be more people who had taken or been forced into early retirement, average incomes tended to be lower and there was an above average proportion of blue-collar workers and a below average proportion of white-collar workers. Furthermore, there proved to be a larger proportion of older men. The factors which did not seem to be related to the number of IHD deaths were the divorce rate in the community and the degree of population density. As regards women, there was a less marked connection between the various regional phenomena and the number of IHD deaths. The mortality rate proved to be related to only two factors: the level of unemployment in the community and the proportion of high-income earners. There was a tendency, albeit weak, that areas with an above average mortality also had an above average rate of unemployment and a lower than average proportion of high-income earners. When the effect of a number of independent variables on IHD mortality in men and women respectively was studied in a stepwise multiple regression analysis, a different picture emerged. It became apparent that only the factors 'proportion unemployed' and 'proportion of unskilled workers' were significantly related to the mortality rate. The links between each of the other phenomena and IHD was due to the connection between these phenomena and the factors mentioned above. For women, only the factor 'proportion unemployed' was significantly related to the mortality rate. The results are discussed in relation to the degree of vulnerability within the local community.