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(Stroke. 1997;28:922-928.)
© 1997 American Heart Association, Inc.

Articles

Socioeconomic Level, Sedentary Lifestyle, and Wine Consumption as Possible Explanations for Geographic Distribution of Cerebrovascular Disease Mortality in Spain

Fernando Rodríguez Artalejo, MD, PhD; Pilar Guallar-Castillón, MD; Juan Luis Gutiérrez-Fisac, MD, PhD; José Ramón Banegas, MD, PhD; Juan del Rey Calero, MD, PhD

From the Department of Preventive Medicine and Public Health, University of the Basque Country (F.R.A.), Vitoria; Department of Preventive Medicine and Public Health, Autonomous University of Madrid (F.R.A., P.G.C., J.L.G.-F., J.R.B., J. del R.C.); Directorate General for Public Health, Ministry of Health (J.L.G-F.); and Cardiovascular Epidemiology Unit, National Center for Epidemiology, Institute of Public Health "Carlos III," Ministry of Health (J.R.B.), Madrid, Spain.

Correspondence to Dr Fernando Rodríguez Artalejo, Departamento de Medicina Preventiva y Salud Pública, Universidad Autónoma de Madrid, Avda, Arzobispo Morcillo s/n, 28029 Madrid, Spain.

Background and Purpose The geographic distribution of cerebrovascular disease (CVD) mortality in Spain spans a wide range, from provinces where mortality is low (70/100 000) and close to that of the United States and other Anglo-Saxon countries, to others where mortality is high (180/100 000) and more akin to that of Portugal and the Mediterranean and central European countries. This report seeks to identify the socioeconomic and lifestyle factors that most contribute to the geographic pattern of CVD mortality in Spain.

Methods We performed a study using data collected at a provincial level. Mortality data were taken from official vital statistics, and data on risk factors were obtained from surveys of representative large Spanish population samples. Correlation and multiple linear regression analyses were performed on standardized CVD mortality ratios and potential determinants of mortality for the period 1989 to 1993.

Results CVD mortality, unemployment and illiteracy rates, blond cigarette smoking, and sedentary lifestyle proved substantially higher in the south and east (Mediterranean coast) of Spain. Saturated fatty acid intake and wine consumption were both lower in these regions, however. Illiteracy, wine consumption, sedentary lifestyle, high blood pressure, blond cigarette smoking, prevalence of diabetes, and body mass index 30 explained 59% of the variation in CVD mortality. Only illiteracy, sedentary lifestyle, and wine consumption registered a statistically significant relationship (P<.05) with CVD mortality. Whereas lower consumption of wine showed a negative association with CVD mortality, higher consumption revealed a positive association.

Conclusions Socioeconomic level, as measured by illiteracy, sedentary lifestyle, and wine consumption, may partly explain the higher CVD mortality registered for regions situated in the south and east of Spain.

Key Words: epidemiology • geography • mortality • Spain

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