Cardiovascular Diseases and Risk‐Factor Burden in Urban and Rural Communities in High‐, Middle‐, and Low‐Income Regions of China: A Large Community‐Based Epidemiological Study
Authors: Yan Ruohua , Li Wei , Yin Lu , Wang Yang , Bo Jian , Liu Lisheng , Liu Bing , Hu Bo , Chen Chunming , Guo Jin , Zhang Hongye , Chen Hui , Li Jian , Li Juan , Yang Jun , Wang Kean , Zhang Li , Deng Qing , Ren Bing , Chen Tao , Xu Tao , Wang Wei , Zhao Wenhua , Chang Xiaohong , Cheng Xiaoru , He Xinye , Hou Xixin , Wang Xingyu , Bai Xiulin , Zhao Xiuwen , Liu Xu , Jia Xuan , Sun Yi , Zhai Yi , Li Dong , Chen Di , Jin Hui , Tian Jiwen , Ma Yumin , Li Yindong , He Chao , You Kai , Zhang Songjian , Tian Xiuzhen , Xu Xu , Di Jinling , Wu Jianquan , Wang Mei , Zhou Qiang , Zhang Shiying , Han Aiying , Cao Minzhi , Wu Jianfang , Jiang Weiping , Qiang Deren , Qin Jing , Qian Shan , Shi Suyi , Zhou Yihong , Qian Zhenzhen , Liu Zhengrong , Dong Changlin , Wan Ming , Li Jun , Tang Jinhua , Mo Yongzhen , Bian Rongwen , Lou Qinglin , Lei Rensheng , Hu Lihua , Xiong Shuwei , Zhong Yan , Li Ning , Tang Xincheng , Ye Shuli , Liu Yu , Li Chunyi , Li Yujin , Fu Minfan , Wang Qiuyuan , Fu Xiaoli , Xing Xiaojie , Guo Baoxia , Feng Huilian , Xu Lihui , Yang Yuqing , Ma Haibin , Wu Ruiqi , Wang Yali , Ma Xiaolan , Liu Hongze , Ma Yurong , Liao Xiaoyang , Yuan Bo , Zhao Qian , Xu Guofan , He Hui , Liu Jiankang , Wang Xin , Chen Ming , Deng Wenqing , Lu Fanghong , Liu Zhendong , Zhang Hua , Sun Shangwen , Wang Shujian , Zhao Yingxin , Diao Yutao , Shi Xuezheng , Ren Debin , Wei Chuanrui , Zhang Liangqing , Wang Jufang , Fan Lianghou , Liu Guoqin , Hou Yan , Wu Cuiying , Ma Guilan , Wei Hua , Wang Junying , Bao Xiongfei , Tang Yue , Liu Tianlu , Zhi Yahong , Zhang Peng , Wang Ailing , Wang Huijuan , Liu Jianna , Liu Qinzhou , Wang Rong , Wu Jianguo , Aili Aideer , Wula Ayoufumiti , Bula Aibi , Yang Dongmei , Wen Qian , Xiao Yize , Shi Qingping , Shao Ying , He Jing , Li Kehua , Bai Wuba , Yang Jinkui , Jiang Yunchun , Liu Huaxing , Yang Shunyun 
Published: February 2017

Background
Most cardiovascular diseases occur in low‐ and middle‐income regions of the world, but the socioeconomic distribution within China remains unclear. Our study aims to investigate whether the prevalence of cardiovascular diseases differs among high‐, middle‐, and low‐income regions of China and to explore the reasons for the disparities.

Methods and Results

We enrolled 46 285 individuals from 115 urban and rural communities in 12 provinces across China between 2005 and 2009. We recorded their medical histories of cardiovascular diseases and calculated the
INTERHEART
Risk Score for the assessment of cardiovascular risk‐factor burden, with higher scores indicating greater burden. The mean
INTERHEART
Risk Score was higher in high‐ and middle‐income regions than in low‐income regions (9.47, 9.48, and 8.58, respectively,
P
<0.0001). By contrast, the prevalence of total cardiovascular disease (stroke, ischemic heart disease, and other heart diseases that led to hospitalization) was lower in high‐ and middle‐income regions than in low‐income regions (7.46%, 7.42%, and 8.36%, respectively,
P
trend
=0.0064). In high‐ and middle‐income regions, urban communities have higher
INTERHEART
Risk Score and higher prevalent rate than rural communities. In low‐income regions, however, the prevalence of total cardiovascular disease was similar between urban and rural areas despite the significantly higher
INTERHEART
Risk Score for urban settings.

Conclusions
We detected an inverse trend between risk‐factor burden and cardiovascular disease prevalence in urban and rural communities in high‐, middle‐, and low‐income regions of China. Such asymmetry may be attributed to the interregional differences in residents’ awareness, quality of healthcare, and availability and affordability of medical services.