Background: The aims of this study were to determine the geographic and time variation of social determinants of\nhealth (SDH) and cardiovascular disease (CVD) mortality in Panama from 2012 to 2016, and to identify which of the\nSDH has the strongest correlation with a socioeconomic index (SEI).\nMethods: We conducted an ecological study obtaining mortality from the National Mortality Register and\nsocioeconomic variables derived from the National Household Survey (NHS). The International Classification of\nDiseases 10th revision codes I20-I25 and I60-I69 were used for ischemic heart disease (IHD) and stroke, respectively.\nStandardized age-adjusted mortality rates were calculated by direct method. Mortality rates and socioeconomic\nvariables were evaluated together in a panel data model. A SEI was developed from factorial analysis by principal\ncomponents with a polychoric correlation matrix. Provinces and regions were categorized in tertiles according to\nmedian value of the SEI score. Results: The NHS evaluated an average of 15,919 households per year. The mean of age throughout the study\nperiod was 41 years. The average monthly income increased, from US$ (SD) 331.94 (5.38) in 2012, to 406.24 (5.81) in\n2016, whereas the social security health coverage remained in a range of 57-58%. The mean number of school\nyears was twelve. Significant geographical and temporal variations in social determinants and mortality rates were\nobserved throughout the country. Colon, categorized in the middle tertile according to the SEI, presented higher\nIHD mortality rates. Darién (in the lowest SEI tertile) Colón and Herrera had higher stroke mortality rates. The SEI\ncategorized indigenous territories in the lowest tertile. Total years of education was the strongest correlated\nvariable with the SEI, when we excluded the population living in indigenous territories. However, when this\npopulation was included, social security coverage had the strongest correlation with the SEI.\nConclusion: We observed geographical and temporal disparities in SDH and CVD mortality rates. Further epidemiological\nstudies are warranted in the provinces of Colón, Darien, Herrera and Los Santos to explore in-depth the higher CVD\nmortality rates observed in these provinces.
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