Federal Institute for Population Research

New Article in “Preventive Medicine” • 13.02.2024More Heart Attacks in Rural Areas than in Cities

In Germany, more people die of myocardial infarction (i.e. heart attacks) in rural areas than in cities. This, however, cannot be explained by the so-called case fatality rate, which is the proportion of people who die as a result of a myocardial infarction. According to a recent study published in the journal “Preventive Medicine”, the excess mortality in rural areas is due to a higher incidence of heart attacks, meaning more people have heart attacks.

For this study, Marcus Ebeling from the MPIDR, along with Michael Mühlichen and Sebastian Klüsener from our REDIM team, Mats Talbäck from the Swedish Karolinska Institute, Roland Rau from the University of Rostock, and Alexander Goedel from the Technical University of Munich, analysed data at district level, including all hospital admissions, cause-specific deaths, and population figures for the German population at ages 65+ for the years 2012 to 2018.

They found out that rural regions in Germany show systematically higher death rates and incidence related to myocardial infarction at ages 65+ compared to urban regions. This higher mortality level is primarily the result of higher disease incidence in rural regions, while case fatality is largely similar. Moreover, the authors estimated that the rural excess in death rates from myocardial infarction would be nullified and 1 out of 6 deaths from myocardial infarction in rural regions could be prevented if rural regions in Germany would have at least the median incidence of urban regions.

They conclude that the incidence of myocardial infarction and not the case fatality drives the rural disadvantage in mortality from myocardial infarction in Germany. Higher incidence points towards potential regional variation in the effectiveness of disease prevention. The findings highlight that improving disease prevention at the patient level carries larger opportunities for reducing regional inequalities in mortality from myocardial infarction in Germany.

Ebeling, Marcus; Mühlichen, Michael; Talbäck, Mats; Rau, Roland; Goedel, Alexander; Klüsener, Sebastian (2024): Disease incidence and not case fatality drives the rural disadvantage in myocardial-infarction-related mortality in Germany. Preventive Medicine 179(107833).

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