Article Data

  • Views 2641
  • Dowloads 181

Original Research

Open Access

A ten-year comparative study of cardiovascular disease publications, health and socioeconomic indicators between European countries

  • Domagoj Markovic1
  • Josip Lukenda2
  • Visnja Kokic3
  • Petra Simac3
  • Piero Marin Zivkovic3
  • Ingrid Prkacin4
  • Viktor Culic1

1Clinic for heart and cardiovascular diseases, University hospital of Split, Croatia

2Clinic for internal medicine, Clinical hospital "Sveti Duh", Zagreb, Croatia

3Clinic for internal medicine, University hospital of Split, Croatia

4Department of internal medicine, Clinical hospital "Merkur", Zagreb, Croatia

DOI: 10.22514/sv.2021.053 Vol.17,Issue 3,May 2021 pp.95-102

Submitted: 18 December 2020 Accepted: 15 January 2021

Published: 08 May 2021

*Corresponding Author(s): Domagoj Markovic E-mail:


The aim of this study was to investigate and compare gross domestic product (GDP) per capita, the number of physicians per one million inhabitants, the number of cardiovascular disease (CVD) publications, standardized death rate (SDR) from ischemic heart disease (IHD) and CVD per 100 000 inhabitants per year between European countries. GDP per capita from the Eurostat database served as the socioeconomic indicator, whereas human resources in medicine were reported as the number of physicians per million inhabitants. PubMed was searched for CVD publications published between 2005 and 2014 for each country. The rate per million inhabitants and proportions of CVD publications in the MEDLINE database were calculated. Results showed that although Croatia was the only country with stagnation in GDP per capita and with a lower rate of physicians than Austria (P = 0.007) and the Czech Republic (P = 0.005), Croatia had a lower SDR from IHD and CVD than the European region (P = 0.05, P = 0.021; respectively), and had a continuous decrease in the average annual growth rate of IHD and CVD (-2.36%, -3.81%; respectively). In conclusion our study showed that Croatia, despite being the only country with the stagnation of GDP per capita and a relatively low rate of physicians, had a SDR from IHD and CVD that was lower than in the European region which continuously decreased during the study period.


Cardiovascular disease; Croatia; Gross domestic product; Publications; Health status indicators

Cite and Share

Domagoj Markovic,Josip Lukenda,Visnja Kokic,Petra Simac,Piero Marin Zivkovic,Ingrid Prkacin,Viktor Culic. A ten-year comparative study of cardiovascular disease publications, health and socioeconomic indicators between European countries. Signa Vitae. 2021. 17(3);95-102.


[1] Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet. 2012; 380: 2095-2128.

[2] Joseph P, Leong D, McKee M, Anand SS, Schwalm J, Teo K, et al. Reducing the global burden of cardiovascular disease, part 1. Circulation Research. 2017; 121: 677-694.

[3] World Health Organization. Cardiovascular diseases (CVDs). 2017. Available at: (Accessed: 08 January 2021).

[4] Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. European Heart Journal. 2014; 35: 2950-2959.

[5] Uemura K, Pisa Z. Trends in cardiovascular disease mortality in industrialized countries since 1950. World Health Statistics Quarterly. Rapport Trimestriel De Statistiques Sanitaires Mondiales. 1988; 41: 155-178.

[6] Bobak M, Marmot M. East-West mortality divide and its potential explanations: proposed research agenda. British Medical Journal. 1996; 312: 421-425.

[7] Forster DP, Józan P. Health in Eastern Europe. The Lancet. 1990; 335: 458-460.

[8] Soares GP, Brum JD, Oliveira GMMD, Klein CH, Silva NASE. Evolution of socioeconomic indicators and cardiovascular mortality in three Brazilian States. Arquivos Brasileiros De Cardiologia. 2013; 100: 147-156.

[9] Takei N. Geography of biomedical publications. The Lancet. 1999; 354: 516-517.

[10] Jurajda Š, Kozubek S, Münich D, Škoda S. Scientific publication performance in post-communist countries: still lagging far behind. Scientometrics. 2017; 112: 315-328.

[11] Tucker-Drob EM, Cheung AK, Briley DA. Gross domestic product, science interest, and science achievement: a person × nation interaction. Psychological Science. 2014; 25: 2047-2057.

[12] Lukenda J, Kolaric B, Kolcic I, Pazur V, Biloglav Z. Cardiovascular diseases in Croatia and other transitional countries: comparative study of publications, clinical interventions, and burden of disease. Croatian Medical Journal. 2005; 46: 865-874.

[13] Lukenda J, Starcevic B, Delic Brkljacic D, Biloglav Z. An analysis of cardiologic interventional procedures in Croatia between 2010 and 2014: towards the establishment of a National Registry. Cardiologia Croatica. 2016; 11: 142-150.

[14] McKee M. Indicators of clinical performance. British Medical Journal. 1997; 315: 142-142.

[15] NCBI. PubMed. Available at: (Accessed: 15 February 2016).

[16] European Union. Eurostat-Data. Available at: http://appsso. (Accessed: 15 February 2016).

[17] World Health Organization. WHO Europe. Available at: http://www. (Accessed: 15 September 2016).

[18] Nacionalni inštitut za javno zdravje. NIJZ. Available at: http://www. (Accessed: 15 September 2016).

[19] Chain Base Method. eMathZone. 2014. Available at: http: // (Accessed: 05 July 2017).

[20] Danaei G, Singh GM, Paciorek CJ, Lin JK, Cowan MJ, Finucane MM, et al. The global cardiovascular risk transition associations of four metabolic risk factors with national income, urbanization, and western diet in 1980 and 2008. Circulation. 2013; 127: 1493-1502.

[21] Fuchs VR. The gross domestic product and health care spending. The New England Journal of Medicine. 2013; 369: 107-109.

[22] Gheorghe A, Griffiths U, Murphy A, Legido-Quigley H, Lamptey P, Perel P. The economic burden of cardiovascular disease and hypertension in low- and middle-income countries: a systematic review. BMC Public Health. 2018; 18: 975.

[23] Jacob JA. Greater health care spending may moderate recession’s negative health effects. Journal of the American Medical Association. 2016; 315: 237-239.

[24] Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Services Research. 2003; 38: 831-865.

[25] Menotti A, Puddu PE. Coronary heart disease differences across Europe. Journal of Cardiovascular Medicine. 2013; 14: 767-772.

[26] Moran AE, Forouzanfar MH, Roth GA, Mensah GA, Ezzati M, Flaxman A, et al. The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation. 2014; 129: 1493-1501.

[27] Jarman B, Gault S, Alves B, Hider A, Dolan S, Cook A, et al. Explaining differences in English hospital death rates using routinely collected data. British Medical Journal. 1999; 318: 1515-1520.

[28] Chai K-C, Zhang Y-B, Chang K-C. Regional disparity of medical resources and its effect on mortality rates in china. Frontiers Public Health. 2020; 8: 8.

[29] Kuhn EM, Hartz AJ, Gottlieb MS, Rimm AA. The relationship of hospital characteristics and the results of peer review in six large states. Medical Care. 1991; 29: 1028-1038.

[30] Anderson JJB, Nieman DC. Diet quality-the Greeks had it right! Nutrients. 2016; 8: 636.

[31] Guasch-Ferré M, Salas-Salvadó J, Ros E, Estruch R, Corella D, Fitó M, et al. The PREDIMED trial, Mediterranean diet and health outcomes: how strong is the evidence? Nutrition, Metabolism, and Cardiovascular Diseases. 2017; 27: 624-632.

[32] Medina-Ramon M, Schwartz J. Temperature, temperature extremes, and mortality: a study of acclimatisation and effect modification in 50 US cities. Occupational and Environmental Medicine. 2007; 64: 827-833.

[33] European Society of Cardiology. escardio. Available at: https: // (Accessed: 01 December 2017).

[34] Džakula A, Sagan A, Pavić N, Lonćčarek K, Sekelj-Kauzlarić K. Croatia: health system review. Health Systems in Transition. 2014; 16: xvii-x162.

[35] Solic I, Stipcic A, Pavlicevic I, Marusic A. Transparency and public accessibility of clinical trial information in Croatia: how it affects patient participation in clinical trials. Biochemia Medica. 2017; 27: 259-269.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time