Quarterly hotspot analysis of circulatory mortality shows persistent regional inequities 2022Q1 to 2025Q2
C G GarcianoAbstract
Background/Introduction
Heart failure burden is strongly shaped by the wider cardiovascular mortality landscape and service access. National-level reporting can obscure actionable regional inequities that may inform targeted prevention, early diagnosis, and optimisation of chronic heart failure care pathways.
Purpose
To quantify spatial and temporal inequities in circulatory-system mortality using quarterly nationwide data, and to identify persistent geographic hotspots relevant to heart failure service planning.
Methods
We analysed a national quarterly mortality dataset (2022Q1–2025Q2), stratified by county of residence and cause-of-death grouping. The primary outcome was deaths due to diseases of the circulatory system (I00–I99). County-level circulatory mortality burden was assessed using (1) circulatory deaths as a proportion of all-cause deaths and (2) an indirect standardised mortality ratio (SMR), calculated as observed circulatory deaths divided by expected deaths based on national quarterly circulatory mortality share. Counties were ranked by SMR and by persistent elevation across quarters. Seasonal patterns were evaluated by quarterly trends.
Results
Across the study period, 34,230 circulatory deaths occurred from 125,023 total deaths, representing 27.4% of all deaths. Circulatory deaths demonstrated a consistent seasonal peak in Q1, indicating recurrent winter pressure on cardiovascular and heart failure-related care pathways. Marked and persistent geographic inequities were observed. Mean county circulatory share ranged from 24.6% to 31.4% (absolute gap 6.8 percentage points). Several counties demonstrated sustained excess circulatory mortality versus national expectation, including Monaghan (SMR 1.15; 491 observed vs 428 expected), Roscommon (SMR 1.09), Mayo (SMR 1.07), Kerry (SMR 1.07) and Leitrim (SMR 1.07). Conversely, lower-than-expected burden was observed in Louth (SMR 0.90; 842 vs 937 expected) and Fingal (SMR 0.91). Inequity was not sporadic: in 2024Q3, county circulatory share varied by 17.1 percentage points between the highest and lowest counties (36.9% vs 19.9%), demonstrating potentially preventable regional divergence.
Conclusion(s)
Quarterly surveillance reveals large, persistent geographic inequities in circulatory mortality that are directly relevant to heart failure prevention and care delivery. A scalable hotspot approach can guide precision targeting of cardiovascular risk reduction, early heart failure detection, guideline-directed therapy optimisation, and strengthened transitional care pathways in consistently high-burden regions. This method supports evidence-driven allocation of community and specialist heart failure resources aligned with seasonal service demand.