Expanding catheterisation laboratory density and cardiovascular burden reduction in indonesia: A nationwide subnational analysis

Abstract Background and Aims Indonesia has implemented strategic initiatives to improve its catheterization laboratory (cath lab) density in recent years. While international benchmarks advocate for 1.67–2.0 laboratories per million population, the population-level impact of this expansion on the national cardiovascular burden remains uncharacterized. This study evaluated the association between provincial growth in cath lab density and subsequent reductions in cardiovascular mortality and disability-adjusted life years (DALYs). Methods We conducted a nationwide ecological analysis across 34 Indonesian provinces. Growth in cath lab density (2016–2022) was analyzed against cardiovascular outcomes (2017–2023) using a one-year lag to account for facility operationalization. Multivariable regression adjusted for cardiologist density, national health insurance (JKN) coverage, hospital capacity, and regional domestic product (GRDP) per capita. Results From 2016 to 2022, mean provincial cath lab density rose from 0.61±0.73 to 1.07±1.34 per million population. Higher growth was independently associated with significant reductions in cardiovascular mortality (R=0.439, p=0.004), DALYs (R=0.436, p=0.005), and years of life lost (YLL) (R=0.437, p=0.005). Each additional lab per million population was associated with 4.66 fewer deaths per 100,000 and 108.24 DALYs averted per province. No significant association was identified for years lived with disability (p=0.108). Conclusion Expanded provincial cath lab density is associated with reduced cardiovascular mortality, years living with disability and premature life loss in Indonesia. These findings provide empirical support for targeted expansion of interventional capacity alongside secondary prevention to address residual morbidity of cardiovascular disease.Figure 1.Linear regression models predicting CVD mortality, DALY, YLL and YLD according to the development of cardiovascular infrastructures over 2016 to 2022. X1: catheterization laboratory growth in 2016-2022; density of cardiologist; X3: proportion of universal health coverage in provinces; X4: hospital bed ratio; X5: Gross Regional Domestic Product (GDRP); DALY: disability-adjusted life years; YLD: years of life lost.