Time trends, cohort effect and spatial distribution of cerebrovascular disease mortality in Spain

Study objective: This study describes mortality due to cerebrovascular dise ase (CVD) in Spain, based on time-series analysis in the period 1951-1995 b y age, sex, and cohort of birth; spatial distribution observed for the five -year period 1991-1995, and time-spatial analysis in the period 1992-1995 v s. 1988-1991. Special attention is paid to risk of medium aged population. Design: Longitudinal and cross-sectional observational study. Setting and p articipants: Spanish population. All mortality data used were taken from of ficial statistics. Time trends and spatial distribution were analyzed using log-linear Poisson regression models. Main results: CVD mortality declined over the last two decades of the study period (1974-1995) by an annual ave rage of 4.16% (95% CI: 3.95-4.36) and 4.00% (95% CI: 3.77-4.24) in men and women, respectively. The downward trends were accelerated in last decade. A n excess of male mortality was in evidence. For all age groups mortality de clined with more recent cohorts, but the decline was less marked among ages 35-64. Spatial distribution of CVD mortality revealed a north-south patter n, but this is being difuminated by increasing rates in the lower risk prov inces. Internationally, Spain ranks midway to low in terms of its overall C VD mortality. Conclusions: Efforts to reduce CVD incidence and case fatalit y are the essential prerequisite for any long-term improvement in mortality . Accordingly, further research is called for into current disease morbidit y and the risk factors to be targeted at a general population level, nation wide.