## 3 Results
### Trends in Standardized Prevalence Rates of IHD from 1990 to 2017 According to Sex
#### 3.3.2 SPR of IHD for Males  
From 1990 to 2017, the AAPC of SPR of IHD for males significantly decreased: Slovenia by \(-\)0.87% 95% CI [\(-\)0.87, \(-\)0.87], Croatia by \(-\)0.72% 95% CI [\(-\)0.72, \(-\)0.72], Italy by \(-\)0.59% 95% CI [\(-\)0.60, \(-\)0.57], France by \(-\)0.39%, 95% CI [\(-\)0.40, \(-\)0.38], and Spain by \(-\)0.35%, 95% CI [\(-\)0.36, \(-\)0.35]. Trends per time periods are presented in Figure 6 and Table 6.  
Percentage changes in SPR from 1990 to 2017 were as follows: Spain \(-\)9%, France \(-\)10%, Italy \(-\)15%, Croatia \(-\)18%, and Slovenia \(-\)21%. The high-to-low ratio for 2017 was 1.74, Croatia 3134.45 vs. Spain 1798.03. The mean values of SPR for males in the ten last available years were as follows: Spain 1762.60, France 1789.96, Italy 2170.73, Slovenia 2751.98, and Croatia 3230.72. Croatia had a significantly higher mean rate than the other four countries (\(p\) < 0.001). France had a significantly lower mean rate than Italy and Slovenia (\(p\) < 0.001) and a non-significantly lower rate than Spain (\(p\) = 0.07). Italy had a significantly higher mean rate than Spain and significantly lower rate than Slovenia (\(p\) < 0.001). Spain had a significantly lower mean rate than Slovenia (\(p\) < 0.001). \begin{table}
\begin{tabular}{c c c c c c c c c c c c} \hline \hline
**Country** & **Period** & **APC** & **Period** & **APC** & **Period** & **APC** & **Period** & **APC** & **Period** & **APC** & **Period** & **APC** \\ \hline Spain & 1990-1995 & \(-\)0.98 * & 1995-2000 & \(-\)0.51 * & 2000-2005 & \(-\)0.72 * & 2005-2009 & \(-\)0.40 * & 2009-2013 & \(+\)0.25 * & 2013-2017 &  
From 2011 to 2019, the AAPC of CABG rate per 100,000 population significantly decreased in Spain and Italy: \(-1.54\%\), 95% CI [\(-2.45\), \(-0.62\)] and \(-1.77\%\), 95% CI [\(-2.25\), \(-1.29\)]. In France, the rate decreased by \(-0.21\%\), 95% CI [\(-0.49\), \(0.06\)]. Slovenia and Croatia had an increase of +0.92%, 95% CI [\(-1.39\), \(3.20\)], by +3.17%, with a 95% CI [\(-0.28\), \(6.78\)] (Figure 7, Table 7). For Croatia (57.46) vs. Spain (16.35), the high-to-low ratio for 2019 was 3.51. The mean values of CABG rates in the 2011-2019 period were as follows: Spain 17.18, France 29.02, Italy 35.55, Slovenia 38.76, and Croatia 58.75. Croatia had a significantly higher mean rate than the other four countries (\(p<0.001\)). France had a significantly lower mean rate than Italy and Slovenia (\(p<0.001\)) and a significantly higher rate than Spain (\(p<0.001\)). Italy had a significantly lower mean rate than Slovenia (\(p<0.04\)) and a significantly higher rate than Spain (\(p<0.001\)). Spain had a significantly lower mean rate than Slovenia (\(p<0.001\)). Spain had a significantly lower mean rate than Slovenia (\(p<0.001\)). From 2011 to 2019, the AAPC of the TCA rate per 100,000 population significantly increased in Italy by +1.71%, 95% CI [\(1.26\), \(2.15\)], in Slovenia by +4.06%, 95% CI [\(2.38\), \(5.76\)], \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Country** & **Period** & **APC** & **Period** & **APC** \\ \hline Spain & 2011–2019 & +0.61 & & \\ France & 2011–2019 & +5.00 * & & \\ Croatia & 2011–2017 & +14.95 * & 2017–2019 & +1.54 \\ Italy & 2011–2019 & +1.71 * & & \\ Slovenia & 2011–2019 & +4.06 * & & \\ \hline \hline \end{tabular}
\end{table} 
Table 8: Joinpoint analysis for TCA per 100,000 population (2011–2019). \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Country** & **Period** & **APC** & **Period** & **APC** \\ \hline Spain & 2011–2019 & +2.18 * & & \\ France & 2011–2013 & +1.81 & 2013–2019 & +6.25 * \\ Croatia & 2011–2019 & +8.92 * & & \\ Italy & 2011–2015 & +4.57 * & 2015–2019 & +2.50 * \\ Slovenia & 2011–2019 & +3.10 * & & \\ \hline \hline \end{tabular}
\end{table} 
Table 9: Joinpoint analysis for the TCA-CABG ratio from 2011 to 2019. Figure 9: TCA:CABG ratio (2011–2019). * \(p<0.05\). in France by +5.00%, 95% CI [4.57, 5.43], and in Croatia by +11.44%, 95% CI [9.97, 13.10].