Impact of place of residence on the presentation of cardiovascular events and all-cause mortality in a cohort with metabolic syndrome

Background: In order to clarify the relation between deprivation and morbillity and mortality, in function of different residence places, we design this study. Main objective is to analyze the influence of place of residence on the incidence of cardiovascular events (CVD) and general mortality from any cause, in a cohort with metabolic syndrome. Methods: Prospective study to determine the incidence of CVD according to the place of residence (rural, urban) in individuals with different combinations of clinical features of Metabolic Syndrome (MS). Setting: Primary Care, Catalonia (Spain). Subjects: between 35-75 years of age fulfilling SM criteria, without CVD at the beginning of follow-up (2009). The population was stratified according to the MEDEA index in rural, and within urban areas in 5 subcategories (urban1 - urban5), according to their level of deprivation. We performed descriptive statistics, variance analysis and survival curves (Kaplan-Meier and Cox methods) in order to contrast data from different categories. Results: We analyzed 401,743 subjects with MS (17.2% of the Catalan population); 20.1% resided in rural areas. Their average age ranged between 60.5 +/- 9.6 years in urban area 1 (most favored) and 59.6 +/- 10.4 years in urban area 5 (the most precarious). After 5 years of follow-up, the global incidence of CVD was 5.5%, being slightly lower in rural areas (5%) than in urban areas (between 5.5% -5.8%). On the other hand, mortality was higher in the rural area (859 deaths/100000 inhabitants-year) - than in the rest of the areas (minimum value in urban-3 (736 deaths/100000 inhabitants-year)). Conclusions: The place of residence is a risk marker, which is associated with the incidence of CVD but above all, with higher mortality from all causes in patients with MS. Undoubtedly and leaving aside the possible confounding factors, in the socioeconomically most disadvantaged areas, mortality is increased.