Regional disparities in temporal trends in sudden cardiac death in the young
R Bork Dinesen, C J Hansen, B Winkel, C Torp-Pedersen, J Tfelt-HansenAbstract
Background
Sudden cardiac death (SCD) in the young (age ≤35 years) remains a major public health concern. The incidence of SCD in the young has declined markedly in recent decades. Regional disparities in all-cause mortality (ACM) and SCD have been reported in the general population, with higher rates in rural areas, but evidence among younger individuals is limited.
Purpose
To investigate regional differences in temporal trends of SCD and ACM in a nationwide population of young individuals in Denmark.
Methods
All individuals aged ≤35 years residing in Denmark during 2000–2019 were included (annual at-risk populations were defined on 1 January each year). All Danish municipalities (n = 98) were classified as rural, suburban, or urban using the Eurostat Degree of Urbanization tool. SCD cases were identified and adjudicated from autopsy reports, death certificates, and medical files by two physicians. All additional data including ACM was ascertained from national registries. Annual direct standardised rates (DSR) were calculated, and temporal trends were assessed using log-linear regression to estimate percentage change annualized (PCA).
Results
A total of 1,041 SCD cases (rural 340, suburban 364, urban 337) occurred over 47.3 million person-years – see Table.1. Age and sex distributions were similar across regions (median 28–29 years; 69–70% male). Declining DSRs of ACM were found in all regions: PCA –3.25% (95% CI –3.84 to –2.66) rural, –3.91% (–4.52 to –3.29) suburban, –4.77% (–5.18 to –4.37) urban. The decline of ACM was significantly greater in urban vs rural (p < 0.001) and urban vs suburban (p = 0.021). DSRs of SCD also declined: PCA –1.19% (–2.91 to 0.56) rural, –4.87% (–6.65 to –3.05) suburban and –4.73% (–6.19 to –3.25) urban – see Figure.1. The decline of SCD was significantly greater in suburban and urban areas compared with rural (p = 0.004 and p = 0.002, respectively).
Conclusion
Over the two decades, SCD rates among the young declined across all regions, but the decline was significantly smaller in rural areas. These findings highlight persistent regional disparities in SCD trends, suggesting the need for targeted preventive efforts in rural populations.Figure.1 - Temporal Trends of SCD & ACMTable.1 - Baseline Characteristics