Geographic inequalities in cardiologist distribution and cardiovascular disease mortality in the Greek National Health System: a geo-epidemiological study

Abstract This study aimed to assess geographic variation in cardiologist supply within the Greek National Health System (NHS) and to examine its geographic distribution alongside regional cardiovascular disease (CVD) mortality across Greece, using an ecological epidemiological design. Population-based CVD mortality data for 2022, and socioeconomic and geographical data at the prefecture level were obtained from the Hellenic Statistical Authority. Cardiologist counts in public hospitals were collected from national professional registries. Crude and indirectly age-standardized CVD mortality ratios (SMR) were calculated overall and by sex. Cardiologist availability was expressed per 100,000 inhabitants and standardized relative to the national average. For the population aged ≥ 40 years, mortality rates were expressed relative to the national mean, while cardiologist availability was standardized relative to the national median. Prefectures were subsequently classified into four categories according to their relative position in these two indices. Differences in socioeconomic and geographical characteristics across prefecture categories were assessed using the Kruskal–Wallis test and Pearson’s Chi-square test of independence. Geographic variation was visualized were visualized using geographic information systems. Marked geographic inequalities were observed in both CVD mortality and cardiologist distribution. Several prefectures exhibited excess age-standardized CVD mortality alongside lower-than-expected cardiologist availability. Significant differences between prefecture categories were observed in tertiary education levels and degree of urbanization, while insularity was significantly associated with category classification. Substantial spatial disparities between cardiovascular health needs and public-sector cardiologist supply persist in Greece. These findings highlight the demand for needs-based health workforce planning to reduce inequities and improve cardiovascular outcomes within the NHS.