gesjGEOGRAPHY, ENVIRONMENT, SUSTAINABILITYGEOGRAPHY, ENVIRONMENT, SUSTAINABILITY2071-93882542-1565Russian Geographical Society10.24057/2071-9388-2020-06gesj-1039Research ArticleSpecial Issue "Spatiotemporal Analysis in Medical and Veterinary Geography"Mortality from cardiovascular diseases in the municipalities of mainland Portugal: spatiotemporal evolution between 1991 and 2017AlmendraRicardo

Department of Geography and Tourism, Faculty of Arts and Humanities of the University of Coimbra

ricardoalmendra85@gmail.comSantanaPaula

Department of Geography and Tourism, Faculty of Arts and Humanities of the University of Coimbra

CEGOT-Centre of Studies on Geography and Spatial PlanningPortugal202001042020131128133Copyright © Almendra R., Santana P., 20202020Almendra R., Santana P.Almendra R., Santana P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://ges.rgo.ru/jour/article/view/1039

During the last decades, important efforts have been taken to tackle cardiovascular diseases, which resulted in important mortality and disability decreases. Despite this, cardiovascular diseases are still one of the major causes of death in Portugal. Thus, the aim of this study is to analyse the evolution of the spatial pattern of deaths by cardiovascular diseases, between 1991 and 2017, identifying areas of high risk, and its variation, in the 278 municipalities of Continental Portugal.

Secondary data on annual resident population and deaths by cardiovascular diseases (International Classification of Diseases 10th revision: I00-I99) was collected from the Portuguese National Statistics for the municipalities of Portugal Mainland, from the period under analysis.

To identify areas with significant high and low risk of mortality by cardiovascular diseases, towards time and space, and areas with significantly high or low temporal trends, retrospective spatial-temporal cluster and a spatial variation in temporal trends analysis were conducted.

In the spatial-temporal analysis 3 clusters of high risk and two of low risk were identified; municipalities forming the clusters of high risk tend to have rural characteristics while the municipalities in the clusters of low risk are located in the two metropolitan areas. The majority of the municipalities forming the clusters of low risk also present higher decreasing trends than the country average.

The results presented can contribute to support the development of future interventions on cardiovascular mortality. 

Cardiovascular diseases mortalityspace–time clusteringSpatial variation in temporal trendsPortugalRicardo Almendra, and Paula Santana are members of CEGOT, which is supported by European Regional Development Funds through COMPETE 2020—Operational Programme “Competitiveness and Internationalization”, under Grant POCI–01–0145– FEDER–006891, and by National Funds through the FCT under Grant UID/GEO/04084/2013.ReferencesAbreu D., Sousa P., Matias-Dias C., Pinto F.J.(2018). Cardiovascular disease and high blood pressure trend analyses from 2002 to 2016: after the implementation of a salt reduction strategy. BMC Public Health 18, 722. DOI: 10.1186/s12889-018-5634-z.Abreu D., Sousa P., Matias-Dias C., Pinto F.J.(2018). Cardiovascular disease and high blood pressure trend analyses from 2002 to 2016: after the implementation of a salt reduction strategy. BMC Public Health 18, 722. DOI: 10.1186/s12889-018-5634-z.Åkesson A., Weismayer C., Newby P.K., Wolk A. (2007). Combined Effect of Low-Risk Dietary and Lifestyle Behaviors in Primary Prevention of Myocardial Infarction in Women. Arch. Intern. Med. 167, 2122. DOI: 10.1001/archinte.167.19.2122.Åkesson A., Weismayer C., Newby P.K., Wolk A. (2007). Combined Effect of Low-Risk Dietary and Lifestyle Behaviors in Primary Prevention of Myocardial Infarction in Women. Arch. Intern. Med. 167, 2122. DOI: 10.1001/archinte.167.19.2122.Almendra R., Santana P., Vasconcelos J., Freire E. (2015). Seasonal mortality patterns due to diseases of the circulatory system in Portugal. Geogr. Environ. Sustain. 1, 71-77, DOI: 10.24057/2071-9388-2015-8-1-71-78.Almendra R., Santana P., Vasconcelos J., Freire E. (2015). Seasonal mortality patterns due to diseases of the circulatory system in Portugal. Geogr. Environ. Sustain. 1, 71-77, DOI: 10.24057/2071-9388-2015-8-1-71-78.Almendra R., Santana P., Vasconcelos J. (2017). Evidence of social deprivation on the spatial patterns of excess winter mortality. Int. J. Public Health 62, 849-856. DOI: 10.1007/s00038-017-0964-7.Almendra R., Santana P., Vasconcelos J. (2017). Evidence of social deprivation on the spatial patterns of excess winter mortality. Int. J. Public Health 62, 849-856. DOI: 10.1007/s00038-017-0964-7.Almendra R., Perelman J., Vasconcelos J., Santana P. (2019). Excess winter mortality and morbidity before, during, and after the Great Recession: the Portuguese case. Int. J. Biometeorol. 63, 873-883. DOI: 10.1007/s00484-019-01700-6.Almendra R., Perelman J., Vasconcelos J., Santana P. (2019). Excess winter mortality and morbidity before, during, and after the Great Recession: the Portuguese case. Int. J. Biometeorol. 63, 873-883. DOI: 10.1007/s00484-019-01700-6.Barton H. (2017). City of well-being : a radical guide to planning, Routledge. ed. New York. Bhatnagar A. (2017). Environmental Determinants of Cardiovascular Disease. Circ. Res. 121, 162-180. DOI: 10.1161/CIRCRESAHA.117.306458.Barton H. (2017). City of well-being : a radical guide to planning, Routledge. ed. New York. Bhatnagar A. (2017). Environmental Determinants of Cardiovascular Disease. Circ. Res. 121, 162-180. DOI: 10.1161/CIRCRESAHA.117.306458.Brook R.D., Rajagopalan S., Pope C.A., Brook J.R. et. al. (2010). Particulate Matter Air Pollution and Cardiovascular Disease. Circulation 121, 2331-2378. DOI: 10.1161/CIR.0b013e3181dbece1.Brook R.D., Rajagopalan S., Pope C.A., Brook J.R. et. al. (2010). Particulate Matter Air Pollution and Cardiovascular Disease. Circulation 121, 2331-2378. DOI: 10.1161/CIR.0b013e3181dbece1.Casper M., Kramer M.R., Quick H., Schieb L.J. et al. (2016). Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010. Circulation 133, 1171-80. DOI: 10.1161/CIRCULATIONAHA.115.018663.Casper M., Kramer M.R., Quick H., Schieb L.J. et al. (2016). Changes in the Geographic Patterns of Heart Disease Mortality in the United States: 1973 to 2010. Circulation 133, 1171-80. DOI: 10.1161/CIRCULATIONAHA.115.018663.Chaix B., Rosvall M., Merlo J. (2007). Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort. J. Epidemiol. Community Heal. 61, 349-355. DOI: 10.1136/jech.2006.047597.Chaix B., Rosvall M., Merlo J. (2007). Assessment of the magnitude of geographical variations and socioeconomic contextual effects on ischaemic heart disease mortality: a multilevel survival analysis of a large Swedish cohort. J. Epidemiol. Community Heal. 61, 349-355. DOI: 10.1136/jech.2006.047597.Chum A., O’Campo P. (2015). Cross-sectional associations between residential environmental exposures and cardiovascular diseases. BMC Public Health 15, 438. DOI: 10.1186/s12889-015-1788-0.Chum A., O’Campo P. (2015). Cross-sectional associations between residential environmental exposures and cardiovascular diseases. BMC Public Health 15, 438. DOI: 10.1186/s12889-015-1788-0.Correia M., Silva M.R., Matos I., Magalhães R. et al. (2004). Prospective community-based study of stroke in Northern Portugal: Incidence and case fatality in rural and urban populations. Stroke 35, 2048-2053. DOI: 10.1161/01.STR.0000137606.34301.13.Correia M., Silva M.R., Matos I., Magalhães R. et al. (2004). Prospective community-based study of stroke in Northern Portugal: Incidence and case fatality in rural and urban populations. Stroke 35, 2048-2053. DOI: 10.1161/01.STR.0000137606.34301.13.Direção-Geral da Saúde (2017). Programa Nacional para as Doenças Cérebro-Cardiovasculares. Lisbon.Direção-Geral da Saúde (2017). Programa Nacional para as Doenças Cérebro-Cardiovasculares. Lisbon.Doetsch J., Pilot E., Santana P., Krafft T. (2017). Potential barriers in healthcare access of the elderly population influenced by the economic crisis and the troika agreement: A qualitative case study in Lisbon, Portugal. Int. J. Equity Health 16, 184. DOI: 10.1186/s12939-017-0679-7.Doetsch J., Pilot E., Santana P., Krafft T. (2017). Potential barriers in healthcare access of the elderly population influenced by the economic crisis and the troika agreement: A qualitative case study in Lisbon, Portugal. Int. J. Equity Health 16, 184. DOI: 10.1186/s12939-017-0679-7.Harding S., Teyhan A., Rosato M., Santana P. (2008). All cause and cardiovascular mortality in African migrants living in Portugal: evidence of large social inequalities. Eur. J. Cardiovasc. Prev. Rehabil. 15, 670-676, DOI: 10.1097/HJR.0b013e32830fe6ce.Harding S., Teyhan A., Rosato M., Santana P. (2008). All cause and cardiovascular mortality in African migrants living in Portugal: evidence of large social inequalities. Eur. J. Cardiovasc. Prev. Rehabil. 15, 670-676, DOI: 10.1097/HJR.0b013e32830fe6ce.Hedlund E., Kaprio J., Lange A., Koskenvuo M. et al. (2007). Migration and coronary heart disease: A study of Finnish twins living in Sweden and their co-twins residing in Finland. Scand. J. Public Health 35, 468-474, DOI: 10.1080/14034940701256875.Hedlund E., Kaprio J., Lange A., Koskenvuo M. et al. (2007). Migration and coronary heart disease: A study of Finnish twins living in Sweden and their co-twins residing in Finland. Scand. J. Public Health 35, 468-474, DOI: 10.1080/14034940701256875.Huxley R.R., Woodward M. (2011). Cigarette smoking as a risk factor for coronary heart disease in women compared with men: A systematic review and meta-analysis of prospective cohort studies. Lancet 1297-1305. DOI: 10.1016/S0140-6736(11)60781-2.Huxley R.R., Woodward M. (2011). Cigarette smoking as a risk factor for coronary heart disease in women compared with men: A systematic review and meta-analysis of prospective cohort studies. Lancet 1297-1305. DOI: 10.1016/S0140-6736(11)60781-2.Hvidtfeldt U.A., Geels C., Sørensen M., Ketzel M. et. al. (2019). Long-term residential exposure to PM2.5 constituents and mortality in a Danish cohort. Environ. Int. 133, 105268. DOI: 10.1016/j.envint.2019.105268.Hvidtfeldt U.A., Geels C., Sørensen M., Ketzel M. et. al. (2019). Long-term residential exposure to PM2.5 constituents and mortality in a Danish cohort. Environ. Int. 133, 105268. DOI: 10.1016/j.envint.2019.105268.Jackson J.K., MacDonald-Wicks L.K., McEvoy M.A., Forder P.M. et. al. (2019). Better diet quality scores are associated with a lower risk of hypertension and non-fatal CVD in middle-aged Australian women over 15 years of follow-up. Public Health Nutr. 1-12. DOI: 10.1017/ S1368980019002842.Jackson J.K., MacDonald-Wicks L.K., McEvoy M.A., Forder P.M. et. al. (2019). Better diet quality scores are associated with a lower risk of hypertension and non-fatal CVD in middle-aged Australian women over 15 years of follow-up. Public Health Nutr. 1-12. DOI: 10.1017/ S1368980019002842.Jimenez M.P., Wellenius G.A., Subramanian S.V., Buka S. et. al. (2019). Longitudinal associations of neighborhood socioeconomic status with cardiovascular risk factors: A 46-year follow-up study. Soc. Sci. Med. 241, 112574. DOI: 10.1016/j.socscimed.2019.112574.Jimenez M.P., Wellenius G.A., Subramanian S.V., Buka S. et. al. (2019). Longitudinal associations of neighborhood socioeconomic status with cardiovascular risk factors: A 46-year follow-up study. Soc. Sci. Med. 241, 112574. DOI: 10.1016/j.socscimed.2019.112574.Kamphuis C.B.M., Turrell G., Giskes K., Mackenbach J.P., van Lenthe F.J. (2012). Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up. BMC Public Health 12, 1045. DOI: 10.1186/1471-2458-12-1045Kamphuis C.B.M., Turrell G., Giskes K., Mackenbach J.P., van Lenthe F.J. (2012). Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up. BMC Public Health 12, 1045. DOI: 10.1186/1471-2458-12-1045Kulldorff M. (1997). A spatial scan statistic. Commun. Stat. – Theory Methods 26, 1481-1496. DOI: 10.1080/03610929708831995.Kulldorff M. (1997). A spatial scan statistic. Commun. Stat. – Theory Methods 26, 1481-1496. DOI: 10.1080/03610929708831995.Loureiro A., Santana P., Nunes C., Almendra R. (2019). The Role of Individual and Neighborhood Characteristics on Mental Health after a Period of Economic Crisis in the Lisbon Region (Portugal): A Multilevel Analysis. Int. J. Environ. Res. Public Health 16, 1-16.Loureiro A., Santana P., Nunes C., Almendra R. (2019). The Role of Individual and Neighborhood Characteristics on Mental Health after a Period of Economic Crisis in the Lisbon Region (Portugal): A Multilevel Analysis. Int. J. Environ. Res. Public Health 16, 1-16.Mahmood S.S., Levy D., Vasan R.S., Wang T.J. (2014). The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet 383, 999–1008. DOI: 10.1016/S0140-6736(13)61752-3.Mahmood S.S., Levy D., Vasan R.S., Wang T.J. (2014). The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet 383, 999–1008. DOI: 10.1016/S0140-6736(13)61752-3.Malkhazova S.M., Linsheng Y., Wuyi W., Orlov D.S., Shartova N.V. et. al. (2014). HEALTH OF URBAN POPULATION IN MOSCOW AND BEIJING AGGLOMERETIONS. Geogr. Environ. Sustain. 7, 41-53. DOI: 10.24057/2071-9388-2014-7-4-41-53.Malkhazova S.M., Linsheng Y., Wuyi W., Orlov D.S., Shartova N.V. et. al. (2014). HEALTH OF URBAN POPULATION IN MOSCOW AND BEIJING AGGLOMERETIONS. Geogr. Environ. Sustain. 7, 41-53. DOI: 10.24057/2071-9388-2014-7-4-41-53.Matthews C.E., George S.M., Moore S.C., Bowles H.R. et. al. (2012). Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am. J. Clin. Nutr. 95, 437-445. DOI: 10.3945/ajcn.111.019620.Matthews C.E., George S.M., Moore S.C., Bowles H.R. et. al. (2012). Amount of time spent in sedentary behaviors and cause-specific mortality in US adults. Am. J. Clin. Nutr. 95, 437-445. DOI: 10.3945/ajcn.111.019620.Mitsakou C., Dimitroulopoulou S., Heaviside C., Katsouyanni K. et. al. (2019). Environmental public health risks in European metropolitan areas within the EURO-HEALTHY project. Sci. Total Environ. 658, 1630-1639. DOI: 10.1016/J.SCITOTENV.2018.12.130.Mitsakou C., Dimitroulopoulou S., Heaviside C., Katsouyanni K. et. al. (2019). Environmental public health risks in European metropolitan areas within the EURO-HEALTHY project. Sci. Total Environ. 658, 1630-1639. DOI: 10.1016/J.SCITOTENV.2018.12.130.Naimi A.I., Paquet C., Gauvin L., Daniel M. (2009). Associations between area-level unemployment, body mass index, and risk factors for cardiovascular disease in an urban area. Int. J. Environ. Res. Public Health 6, 3082-96, DOI: 10.3390/ijerph6123082.Naimi A.I., Paquet C., Gauvin L., Daniel M. (2009). Associations between area-level unemployment, body mass index, and risk factors for cardiovascular disease in an urban area. Int. J. Environ. Res. Public Health 6, 3082-96, DOI: 10.3390/ijerph6123082.Nogueira H.G. (2010). Deprivation amplification and health promoting resources in the context of a poor country. Soc. Sci. Med. 70, 1391-1395. DOI: 10.1016/j.socscimed.2010.01.011.Nogueira H.G. (2010). Deprivation amplification and health promoting resources in the context of a poor country. Soc. Sci. Med. 70, 1391-1395. DOI: 10.1016/j.socscimed.2010.01.011.Ogunmoroti O., Osibogun O., McClelland R.L., Burke G.L. et al. (2019). Alcohol and ideal cardiovascular health: The Multi–Ethnic Study of Atherosclerosis. Clin. Cardiol. 42, 151-158. DOI: 10.1002/clc.23125.Ogunmoroti O., Osibogun O., McClelland R.L., Burke G.L. et al. (2019). Alcohol and ideal cardiovascular health: The Multi–Ethnic Study of Atherosclerosis. Clin. Cardiol. 42, 151-158. DOI: 10.1002/clc.23125.Patterson R., McNamara E., Tainio M., de Sá T.H., Smith A.D. et. al. (2018). Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur. J. Epidemiol. 33, 811-829. DOI: 10.1007/s10654-018-0380-1.Patterson R., McNamara E., Tainio M., de Sá T.H., Smith A.D. et. al. (2018). Sedentary behaviour and risk of all-cause, cardiovascular and cancer mortality, and incident type 2 diabetes: a systematic review and dose response meta-analysis. Eur. J. Epidemiol. 33, 811-829. DOI: 10.1007/s10654-018-0380-1.Pekka, P., Pirjo, P., Ulla, U. (2002). Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme--experiences from Finland. Public Health Nutr. 5, 245-51.Pekka, P., Pirjo, P., Ulla, U. (2002). Influencing public nutrition for non-communicable disease prevention: from community intervention to national programme--experiences from Finland. Public Health Nutr. 5, 245-51.Peters S.A.E., Huxley R.R., Woodward M. (2013). Smoking as a risk factor for stroke in women compared with men: A systematic review and meta-analysis of 81 cohorts, including 3 980 359 individuals and 42 401 strokes. Stroke 44, 2821-2828. DOI: 10.1161/STROKEAHA.113.002342.Peters S.A.E., Huxley R.R., Woodward M. (2013). Smoking as a risk factor for stroke in women compared with men: A systematic review and meta-analysis of 81 cohorts, including 3 980 359 individuals and 42 401 strokes. Stroke 44, 2821-2828. DOI: 10.1161/STROKEAHA.113.002342.Rehm J., Shield K.D., Roerecke M., Gmel G. (2016). Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview. BMC Public Health 16, 363. DOI: 10.1186/s12889-016-3026-9Rehm J., Shield K.D., Roerecke M., Gmel G. (2016). Modelling the impact of alcohol consumption on cardiovascular disease mortality for comparative risk assessments: an overview. BMC Public Health 16, 363. DOI: 10.1186/s12889-016-3026-9Robertson T.L., Kato H., Rhoads G.G., Kagan A. et. al. (1977). Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: Incidence of myocardial infarction and death from coronary heart disease. Am. J. Cardiol. 39, 239-243. DOI: 10.1016/S0002-9149(77)80197-5.Robertson T.L., Kato H., Rhoads G.G., Kagan A. et. al. (1977). Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: Incidence of myocardial infarction and death from coronary heart disease. Am. J. Cardiol. 39, 239-243. DOI: 10.1016/S0002-9149(77)80197-5.Roth G.A., Johnson C., Abajobir A., et al. (2017). Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J. Am. Coll. Cardiol. 70, 1-25. DOI: 10.1016/J.JACC.2017.04.052.Roth G.A., Johnson C., Abajobir A., et al. (2017). Global, Regional, and National Burden of Cardiovascular Diseases for 10 Causes, 1990 to 2015. J. Am. Coll. Cardiol. 70, 1-25. DOI: 10.1016/J.JACC.2017.04.052.Santana P. (2005). Geografias da Saúde e do Desenvolvimento. Evolução e Tendências em Portugal, Almedina. ed. Coimbra. Santana P. (2014). A saúde dos portugueses, in: Simões, J. (Ed.), 40 Anos de Abril Na Saúde. Almedina, Coimbra, 69-92.Santana P. (2005). Geografias da Saúde e do Desenvolvimento. Evolução e Tendências em Portugal, Almedina. ed. Coimbra. Santana P. (2014). A saúde dos portugueses, in: Simões, J. (Ed.), 40 Anos de Abril Na Saúde. Almedina, Coimbra, 69-92.Santana P., Costa C., Cardoso G., Loureiro A., Ferrão J. (2015a). Suicide in Portugal: Spatial determinants in a context of economic crisis. Heal. Place 35, 85-94. DOI: 10.1016/j.healthplace.2015.07.001.Santana P., Costa C., Cardoso G., Loureiro A., Ferrão J. (2015a). Suicide in Portugal: Spatial determinants in a context of economic crisis. Heal. Place 35, 85-94. DOI: 10.1016/j.healthplace.2015.07.001.Santana P., Costa C., Marí-Dell’Olmo M., Gotsens M., Borrell C. (2015b). Mortality, material deprivation and urbanization: exploring the social patterns of a metropolitan area. Int. J. Equity Health 14, p. 55. DOI: 10.1186/s12939-015-0182-y.Santana P., Costa C., Marí-Dell’Olmo M., Gotsens M., Borrell C. (2015b). Mortality, material deprivation and urbanization: exploring the social patterns of a metropolitan area. Int. J. Equity Health 14, p. 55. DOI: 10.1186/s12939-015-0182-y.Santana P., Almendra R. (2018). The health of the Portuguese over the last four decades. Méditerranée. DOI: 10.4000/mediterranee.10348.Santana P., Almendra R. (2018). The health of the Portuguese over the last four decades. Méditerranée. DOI: 10.4000/mediterranee.10348.Stewart J., Manmathan G., Wilkinson P. (2017). Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc. Dis. 6. DOI: 10.1177/2048004016687211.Stewart J., Manmathan G., Wilkinson P. (2017). Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc. Dis. 6. DOI: 10.1177/2048004016687211.Vardoulakis S., Dear K., Hajat S., Heaviside C., Eggen B. (2014). Comparative Assessment of the Effects of Climate Change on Heat- and Cold-Related Mortality in the United Kingdom and Australia. Environ. Health Perspect. DOI: 10.1289/ehp.1307524.Vardoulakis S., Dear K., Hajat S., Heaviside C., Eggen B. (2014). Comparative Assessment of the Effects of Climate Change on Heat- and Cold-Related Mortality in the United Kingdom and Australia. Environ. Health Perspect. DOI: 10.1289/ehp.1307524.Vasconcelos J., Freire E., Morais J., MacHado J.R., Santana P. (2011). The health impacts of poor housing conditions and thermal discomfort. Procedia Environ. Sci. 4, 158-164. DOI: 10.1016/j.proenv.2011.03.019.Vasconcelos J., Freire E., Morais J., MacHado J.R., Santana P. (2011). The health impacts of poor housing conditions and thermal discomfort. Procedia Environ. Sci. 4, 158-164. DOI: 10.1016/j.proenv.2011.03.019.WHO (2017). Fact sheet on Cardiovascular diseases [https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)].WHO (2017). Fact sheet on Cardiovascular diseases [https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)].WHO Fact sheet. Wilkins E., Wickramasinghe K. (2017). European Cardiovascular Disease Statistics 2017 edition, European Heart Network. Brussels.WHO Fact sheet. Wilkins E., Wickramasinghe K. (2017). European Cardiovascular Disease Statistics 2017 edition, European Heart Network. Brussels.Winkleby M., Sundquist K., Cubbin C. (2007). Inequities in CHD incidence and case fatality by neighborhood deprivation. Am. J. Prev. Med. 32, 97-106. DOI: 10.1016/j.amepre.2006.10.002.Winkleby M., Sundquist K., Cubbin C. (2007). Inequities in CHD incidence and case fatality by neighborhood deprivation. Am. J. Prev. Med. 32, 97-106. DOI: 10.1016/j.amepre.2006.10.002.

The authors declare that there are no conflicts of interest present.