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The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis
BACKGROUND: No other disease has killed more than ischemic heart disease (IHD) for the past few years globally. Despite the advances in cardiology, the response time for starting treatment still leads patients to death because of the lack of healthcare coverage and access to referral centers. OBJECT...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Ubiquity Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824986/ https://www.ncbi.nlm.nih.gov/pubmed/33598385 http://dx.doi.org/10.5334/gh.770 |
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author | de Carvalho Dutra, Amanda Silva, Lincoln Luís Pedroso, Raíssa Bocchi Tchuisseu, Yolande Pokam da Silva, Mariana Teixeira Bergamini, Marcela Scheidt, João Felipe Hermann Costa Iora, Pedro Henrique do Lago Franco, Rogério Staton, Catherine Ann Vissoci, João Ricardo Nickenig Nihei, Oscar Kenji de Andrade, Luciano |
author_facet | de Carvalho Dutra, Amanda Silva, Lincoln Luís Pedroso, Raíssa Bocchi Tchuisseu, Yolande Pokam da Silva, Mariana Teixeira Bergamini, Marcela Scheidt, João Felipe Hermann Costa Iora, Pedro Henrique do Lago Franco, Rogério Staton, Catherine Ann Vissoci, João Ricardo Nickenig Nihei, Oscar Kenji de Andrade, Luciano |
author_sort | de Carvalho Dutra, Amanda |
collection | PubMed |
description | BACKGROUND: No other disease has killed more than ischemic heart disease (IHD) for the past few years globally. Despite the advances in cardiology, the response time for starting treatment still leads patients to death because of the lack of healthcare coverage and access to referral centers. OBJECTIVES: To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil. METHODS: An ecological study using secondary data from Brazilian Health Informatics Department between 2013–2017 was performed to verify the IHD mortality. An spatial analysis was performed using the Global Moran and Local Indicators of Spatial Association (LISA) to verify the spatial dependency of IHD mortality. Lastly, multivariate spatial regression models were also developed using Ordinary Least Squares and Geographically Weighted Regression (GWR) to identify socioeconomic indicators (aging, income, and illiteracy rates), exam coverage (catheterization, angioplasty, and revascularization rates), and access to health (access index to cardiologists and chemical reperfusion centers) significantly correlated with IHD mortality. The chosen model was based on p < 0.05, highest adjusted R(2) and lowest Akaike Information Criterion. RESULTS: A total of 22,920 individuals died from IHD between 2013–2017. The spatial analysis confirmed a positive spatial autocorrelation global between IDH mortality rates (Moran’s I: 0.633, p < 0.01). The LISA analysis identified six high-high pattern clusters composed by 66 municipalities (16.5%). GWR presented the best model (Adjusted R(2): 0.72) showing that accessibility to cardiologists and chemical reperfusion centers, and revascularization and angioplasty rates differentially affect the IHD mortality rates geographically. Aging and illiteracy rate presented positive correlation with IHD mortality rate, while income ratio presented negative correlation (p < 0.05). CONCLUSION: Regions of vulnerability were unveiled by the spatial analysis where sociodemographic, exam coverage and accessibility to health variables impacted differently the IHD mortality rates in Paraná state, Brazil. HIGHLIGHTS: The increase in ischemic heart disease mortality rates is related to geographical disparities. The IHD mortality is differentially associated to socioeconomic factors, exam coverage, and access to health. Higher accessibility to chemical reperfusion centers did not necessarily improve patient outcomes in some regions of the state. Clusters of high mortality rate are placed in regions with low amount of cardiologists, income and schooling. |
format | Online Article Text |
id | pubmed-7824986 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Ubiquity Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-78249862021-02-16 The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis de Carvalho Dutra, Amanda Silva, Lincoln Luís Pedroso, Raíssa Bocchi Tchuisseu, Yolande Pokam da Silva, Mariana Teixeira Bergamini, Marcela Scheidt, João Felipe Hermann Costa Iora, Pedro Henrique do Lago Franco, Rogério Staton, Catherine Ann Vissoci, João Ricardo Nickenig Nihei, Oscar Kenji de Andrade, Luciano Glob Heart Original Research BACKGROUND: No other disease has killed more than ischemic heart disease (IHD) for the past few years globally. Despite the advances in cardiology, the response time for starting treatment still leads patients to death because of the lack of healthcare coverage and access to referral centers. OBJECTIVES: To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil. METHODS: An ecological study using secondary data from Brazilian Health Informatics Department between 2013–2017 was performed to verify the IHD mortality. An spatial analysis was performed using the Global Moran and Local Indicators of Spatial Association (LISA) to verify the spatial dependency of IHD mortality. Lastly, multivariate spatial regression models were also developed using Ordinary Least Squares and Geographically Weighted Regression (GWR) to identify socioeconomic indicators (aging, income, and illiteracy rates), exam coverage (catheterization, angioplasty, and revascularization rates), and access to health (access index to cardiologists and chemical reperfusion centers) significantly correlated with IHD mortality. The chosen model was based on p < 0.05, highest adjusted R(2) and lowest Akaike Information Criterion. RESULTS: A total of 22,920 individuals died from IHD between 2013–2017. The spatial analysis confirmed a positive spatial autocorrelation global between IDH mortality rates (Moran’s I: 0.633, p < 0.01). The LISA analysis identified six high-high pattern clusters composed by 66 municipalities (16.5%). GWR presented the best model (Adjusted R(2): 0.72) showing that accessibility to cardiologists and chemical reperfusion centers, and revascularization and angioplasty rates differentially affect the IHD mortality rates geographically. Aging and illiteracy rate presented positive correlation with IHD mortality rate, while income ratio presented negative correlation (p < 0.05). CONCLUSION: Regions of vulnerability were unveiled by the spatial analysis where sociodemographic, exam coverage and accessibility to health variables impacted differently the IHD mortality rates in Paraná state, Brazil. HIGHLIGHTS: The increase in ischemic heart disease mortality rates is related to geographical disparities. The IHD mortality is differentially associated to socioeconomic factors, exam coverage, and access to health. Higher accessibility to chemical reperfusion centers did not necessarily improve patient outcomes in some regions of the state. Clusters of high mortality rate are placed in regions with low amount of cardiologists, income and schooling. Ubiquity Press 2021-01-20 /pmc/articles/PMC7824986/ /pubmed/33598385 http://dx.doi.org/10.5334/gh.770 Text en Copyright: © 2021 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Research de Carvalho Dutra, Amanda Silva, Lincoln Luís Pedroso, Raíssa Bocchi Tchuisseu, Yolande Pokam da Silva, Mariana Teixeira Bergamini, Marcela Scheidt, João Felipe Hermann Costa Iora, Pedro Henrique do Lago Franco, Rogério Staton, Catherine Ann Vissoci, João Ricardo Nickenig Nihei, Oscar Kenji de Andrade, Luciano The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis |
title | The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis |
title_full | The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis |
title_fullStr | The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis |
title_full_unstemmed | The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis |
title_short | The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis |
title_sort | impact of socioeconomic factors, coverage and access to health on heart ischemic disease mortality in a brazilian southern state: a geospatial analysis |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824986/ https://www.ncbi.nlm.nih.gov/pubmed/33598385 http://dx.doi.org/10.5334/gh.770 |
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