A Global Perspective on Determinants of Cardiovascular Mortality: Linear Regression Model of 183 Countries on Nationwide Cardiovascular Policies, Socioeconomic Disparities, Universal Health Coverage and Tobacco

Background Cardiovascular (CV) diseases remain the leading cause of mortality worldwide. Various determinants has been indicated contributing in CV mortality, spanning from health policy, universal health coverage (UHC), tobacco and socioeconomic diversity. To date, no quantitative regression model has been established to exhibit the magnitude and prediction of CV mortality. We aimed to formulate a linear regression model of CV determinants involving healthcare insurance coverage and national policy, economic status, smoking prevalence, gender and subregional variety.

A linear regression model was employed, with the percentage of cardiovascular deaths as the dependent variable. Independent variables were Universal Health Coverage (UHC), World Bank income classifications, availability of national policy on CV, gender, availability of national CV guideline, CV risk stratification in primary healthcare, smoking and sub-regions. Data were gathered from World Health Organization and The World Bank dataset.

A total of 2,385 data points from 2015 to 2019 was acquired constituting 183 countries. More extensive UHC (β = -0.052, t = -3.663, p <0.001) and high-income countries (-0.060, t = -2.756, p <0.001) exhibited lower predicted CV mortality. Smoking prevalence was strongly correlated with higher mortality (β = 0.128, t = 8.408, p <0.001). Regional disparities were observed, with Eastern Europe presenting highest mortality rate (β = 0.685, t = 32.686, p <0.001). Compared to male, female showed higher cardiovascular death (β = 0.047, t = 4.017, p <0.001). The availability of national policies in cardiovascular health were associated with lower mortality (β = -0.031, t = -3.211, p = 0.001). CV national guideline was the only non-significant CV determinant.

The development of a quantitative regression model for cardiovascular mortality incorporating multifaceted determinants was expected to promote comprehensive public health strategies, policy reforms, and national health system strengthening, which are essential to reduce the global burden of cardiovascular diseases. Competing Interest Statement The authors have declared no competing interest. Clinical Trial This study does not require registration with a recognized trial registry because it is not a clinical trial. Funding Statement No external funding was received for this work. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The research described in this preprint was determined to be exempt from Institutional Review Board (IRB) review because it involved the analysis of a publicly available data, and did not involve direct interaction with human subjects. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Jl. Letjen S. Parman No.87, Kota Bambu Utara, Kec. Palmerah, Kota Jakarta Barat, Daerah Khusus Ibukota Jakarta 11420, Indonesia, Email: iwandakota{at}gmail.com Jl. Letjen S. Parman No.87, Kota Bambu Utara, Kec. Palmerah, Kota Jakarta Barat, Daerah Khusus Ibukota Jakarta 11420, Indonesia, Email: taofan.siddiq{at}gmail.com Jl. Letjen S. Parman No.87, Kota Bambu Utara, Kec. Palmerah, Kota Jakarta Barat, Daerah Khusus Ibukota Jakarta 11420, Indonesia, Email: suci_fkui02{at}yahoo.com Jl. Letjen S. Parman No.87, Kota Bambu Utara, Kec. Palmerah, Kota Jakarta Barat, Daerah Khusus Ibukota Jakarta 11420, Indonesia, Email: dr.ruth.grace.aurora{at}gmail.com Jl. Letjen S. Parman No.87, Kota Bambu Utara, Kec. Palmerah, Kota Jakarta Barat, Daerah Khusus Ibukota Jakarta 11420, Indonesia, Email: sukoadiarto{at}gmail.com Data Availability Statement: Data used in this study is available upon request. Funding Statement: This research was funded by no one. Conflict of Interest: None declared. Ethics Approval: Ethical approval for each included studies were acquired in the respective ethics board. Patient Consent: Not applicable. Clinical Trial Registration: Not applicable.