Differences urban versus non-urban trends in mortality from ischemic heart disease and diabetes in Italy and Spain, 2003-2019

Aims In recent years, mortality from ischaemic heart disease and diabetes has decreased. There is an inequality in mortality reduction between urban and non-urban areas. This study aims to estimate the trend in mortality from ischaemic heart disease and diabetes mellitus in urban and non-urban areas in Italy and Spain throughout the first two decades of the 21st century. Methods and results Deaths and population data by age and sex, according to the area of residence, were obtained from the National Institute of Statistics of Italy and National Institute of Statistics of Spain. The annual age-standardized mortality rates from ischaemic heart disease and diabetes mellitus were calculated from 2003 to 2019 for each of the two areas of residence in both countries. The average annual percentage change (APC) in the mortality rate in each area was estimated using linear regression models and taking age-standardized mortality rates as a dependent variable. The mortality rates from both causes of death decreased between the beginning and the end of the period analysed. In Italy, the APC was −4.0 and −3.6% in the mortality rate from ischaemic heart disease and −1.5 and −1.3% in the mortality rate from diabetes mellitus in urban and non-urban areas, respectively. In Spain, the APC in was −4.4 and −3.7% in the mortality rate from ischaemic heart disease and −3.3 and −2.0% in the mortality rate from diabetes mellitus in urban and non-urban areas, respectively. Conclusion Mortality from both ischaemic heart disease and diabetes have shown a greater reduction in urban areas compared with non-urban areas since the first years of the 21st century in Spain and Italy.