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Geographic disparities and temporal changes in risk of death from myocardial infarction in Florida, 2000–2014
BACKGROUND: Identifying disparities in myocardial infarction (MI) burden and assessing its temporal changes are critical for guiding resource allocation and policies geared towards reducing/eliminating health disparities. Our objectives were to: (a) investigate the spatial distribution and clusters...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499995/ https://www.ncbi.nlm.nih.gov/pubmed/31053068 http://dx.doi.org/10.1186/s12889-019-6850-x |
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author | Odoi, Evah W. Nagle, Nicholas Roberson, Shamarial Kintziger, Kristina W. |
author_facet | Odoi, Evah W. Nagle, Nicholas Roberson, Shamarial Kintziger, Kristina W. |
author_sort | Odoi, Evah W. |
collection | PubMed |
description | BACKGROUND: Identifying disparities in myocardial infarction (MI) burden and assessing its temporal changes are critical for guiding resource allocation and policies geared towards reducing/eliminating health disparities. Our objectives were to: (a) investigate the spatial distribution and clusters of MI mortality risk in Florida; and (b) assess temporal changes in geographic disparities in MI mortality risks in Florida from 2000 to 2014. METHODS: This is a retrospective ecologic study with county as the spatial unit of analysis. We obtained data for MI deaths occurring among Florida residents between 2000 and 2014 from the Florida Department of Health, and calculated county-level age-adjusted MI mortality risks and Spatial Empirical Bayesian smoothed MI mortality risks. We used Kulldorff’s circular spatial scan statistics and Tango’s flexible spatial scan statistics to identify spatial clusters. RESULTS: There was an overall decline of 48% in MI mortality risks between 2000 and 2014. However, we found substantial, persistent disparities in MI mortality risks, with high-risk clusters occurring primarily in rural northern counties and low-risk clusters occurring exclusively in urban southern counties. MI mortality risks declined in both low- and high-risk clusters, but the latter showed more dramatic decreases during the first nine years of the study period. Consequently, the risk difference between the high- and low-risk clusters was smaller at the end than at the beginning of the study period. However, the rates of decline levelled off during the last six years of the study, and there are signs that the risks may be on an upward trend in parts of North Florida. Moreover, MI mortality risks for high-risk clusters at the end of the study period were on par with or above those for low-risk clusters at the beginning of the study period. Thus, high-risk clusters lagged behind low-risk clusters by at least 1.5 decades. CONCLUSION: Myocardial infarction mortality risks have decreased substantially during the last 15 years, but persistent disparities in MI mortality burden still exist across Florida. Efforts to reduce these disparities will need to target prevention programs to counties in the high-risk clusters. |
format | Online Article Text |
id | pubmed-6499995 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-64999952019-05-09 Geographic disparities and temporal changes in risk of death from myocardial infarction in Florida, 2000–2014 Odoi, Evah W. Nagle, Nicholas Roberson, Shamarial Kintziger, Kristina W. BMC Public Health Research Article BACKGROUND: Identifying disparities in myocardial infarction (MI) burden and assessing its temporal changes are critical for guiding resource allocation and policies geared towards reducing/eliminating health disparities. Our objectives were to: (a) investigate the spatial distribution and clusters of MI mortality risk in Florida; and (b) assess temporal changes in geographic disparities in MI mortality risks in Florida from 2000 to 2014. METHODS: This is a retrospective ecologic study with county as the spatial unit of analysis. We obtained data for MI deaths occurring among Florida residents between 2000 and 2014 from the Florida Department of Health, and calculated county-level age-adjusted MI mortality risks and Spatial Empirical Bayesian smoothed MI mortality risks. We used Kulldorff’s circular spatial scan statistics and Tango’s flexible spatial scan statistics to identify spatial clusters. RESULTS: There was an overall decline of 48% in MI mortality risks between 2000 and 2014. However, we found substantial, persistent disparities in MI mortality risks, with high-risk clusters occurring primarily in rural northern counties and low-risk clusters occurring exclusively in urban southern counties. MI mortality risks declined in both low- and high-risk clusters, but the latter showed more dramatic decreases during the first nine years of the study period. Consequently, the risk difference between the high- and low-risk clusters was smaller at the end than at the beginning of the study period. However, the rates of decline levelled off during the last six years of the study, and there are signs that the risks may be on an upward trend in parts of North Florida. Moreover, MI mortality risks for high-risk clusters at the end of the study period were on par with or above those for low-risk clusters at the beginning of the study period. Thus, high-risk clusters lagged behind low-risk clusters by at least 1.5 decades. CONCLUSION: Myocardial infarction mortality risks have decreased substantially during the last 15 years, but persistent disparities in MI mortality burden still exist across Florida. Efforts to reduce these disparities will need to target prevention programs to counties in the high-risk clusters. BioMed Central 2019-05-03 /pmc/articles/PMC6499995/ /pubmed/31053068 http://dx.doi.org/10.1186/s12889-019-6850-x Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Odoi, Evah W. Nagle, Nicholas Roberson, Shamarial Kintziger, Kristina W. Geographic disparities and temporal changes in risk of death from myocardial infarction in Florida, 2000–2014 |
title | Geographic disparities and temporal changes in risk of death from myocardial infarction in Florida, 2000–2014 |
title_full | Geographic disparities and temporal changes in risk of death from myocardial infarction in Florida, 2000–2014 |
title_fullStr | Geographic disparities and temporal changes in risk of death from myocardial infarction in Florida, 2000–2014 |
title_full_unstemmed | Geographic disparities and temporal changes in risk of death from myocardial infarction in Florida, 2000–2014 |
title_short | Geographic disparities and temporal changes in risk of death from myocardial infarction in Florida, 2000–2014 |
title_sort | geographic disparities and temporal changes in risk of death from myocardial infarction in florida, 2000–2014 |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499995/ https://www.ncbi.nlm.nih.gov/pubmed/31053068 http://dx.doi.org/10.1186/s12889-019-6850-x |
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