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Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis
BACKGROUND: Coronary angiographies (CAs) are among the most common diagnostic procedures carried out in German hospitals, and substantial regional differences in their frequency of use have been documented. Given the heterogeneity with regard to the expected benefits and the varying scope for discre...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8882285/ https://www.ncbi.nlm.nih.gov/pubmed/35219312 http://dx.doi.org/10.1186/s12872-022-02513-z |
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author | Frank-Tewaag, Julia Bleek, Julian Günster, Christian Schneider, Udo Horenkamp-Sonntag, Dirk Marschall, Ursula Franke, Sebastian Schlößler, Kathrin Donner-Banzhoff, Norbert Sundmacher, Leonie |
author_facet | Frank-Tewaag, Julia Bleek, Julian Günster, Christian Schneider, Udo Horenkamp-Sonntag, Dirk Marschall, Ursula Franke, Sebastian Schlößler, Kathrin Donner-Banzhoff, Norbert Sundmacher, Leonie |
author_sort | Frank-Tewaag, Julia |
collection | PubMed |
description | BACKGROUND: Coronary angiographies (CAs) are among the most common diagnostic procedures carried out in German hospitals, and substantial regional differences in their frequency of use have been documented. Given the heterogeneity with regard to the expected benefits and the varying scope for discretion depending on the indication for the procedure, we hypothesized that the observed variation and the association of need and supply factors differs by indication for CA. METHODS: We investigated the correlation between supply factors and the regional rates of CAs in Germany while controlling for need using spatial‐autoregressive error models (SARE) and spatial cross-regressive models with autoregressive errors (SCRARE). The overall rates of CAs and the rates in specific patient subgroups, namely, patients with and without myocardial infarction (MI), were calculated based on a comprehensive set of nationwide routine data from three statutory health insurances at the district level. RESULTS: Although little variation was found in cases with MI, considerable variation was seen in the overall cases and cases without MI. The SARE models revealed a positive association between the number of hospitals with a cardiac catheterization laboratory per 10,000 population and the rates of overall cases and cases without MI, whereas no such relationship existed in cases with MI. Additionally, an association between regional deprivation and the rates of CAs was found in cases with MI, but no such association was seen in cases without MI. CONCLUSIONS: The results supported the hypothesis that the relative association of need and supply factors differed by the indication for CA. Although the regional differences in the frequency of use of CAs can only be explained in part by the factors examined in our study, it offers insight into patient access to and the provision of CA services and can provide a platform for further local research. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-022-02513-z. |
format | Online Article Text |
id | pubmed-8882285 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-88822852022-02-28 Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis Frank-Tewaag, Julia Bleek, Julian Günster, Christian Schneider, Udo Horenkamp-Sonntag, Dirk Marschall, Ursula Franke, Sebastian Schlößler, Kathrin Donner-Banzhoff, Norbert Sundmacher, Leonie BMC Cardiovasc Disord Research Article BACKGROUND: Coronary angiographies (CAs) are among the most common diagnostic procedures carried out in German hospitals, and substantial regional differences in their frequency of use have been documented. Given the heterogeneity with regard to the expected benefits and the varying scope for discretion depending on the indication for the procedure, we hypothesized that the observed variation and the association of need and supply factors differs by indication for CA. METHODS: We investigated the correlation between supply factors and the regional rates of CAs in Germany while controlling for need using spatial‐autoregressive error models (SARE) and spatial cross-regressive models with autoregressive errors (SCRARE). The overall rates of CAs and the rates in specific patient subgroups, namely, patients with and without myocardial infarction (MI), were calculated based on a comprehensive set of nationwide routine data from three statutory health insurances at the district level. RESULTS: Although little variation was found in cases with MI, considerable variation was seen in the overall cases and cases without MI. The SARE models revealed a positive association between the number of hospitals with a cardiac catheterization laboratory per 10,000 population and the rates of overall cases and cases without MI, whereas no such relationship existed in cases with MI. Additionally, an association between regional deprivation and the rates of CAs was found in cases with MI, but no such association was seen in cases without MI. CONCLUSIONS: The results supported the hypothesis that the relative association of need and supply factors differed by the indication for CA. Although the regional differences in the frequency of use of CAs can only be explained in part by the factors examined in our study, it offers insight into patient access to and the provision of CA services and can provide a platform for further local research. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-022-02513-z. BioMed Central 2022-02-26 /pmc/articles/PMC8882285/ /pubmed/35219312 http://dx.doi.org/10.1186/s12872-022-02513-z Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Frank-Tewaag, Julia Bleek, Julian Günster, Christian Schneider, Udo Horenkamp-Sonntag, Dirk Marschall, Ursula Franke, Sebastian Schlößler, Kathrin Donner-Banzhoff, Norbert Sundmacher, Leonie Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis |
title | Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis |
title_full | Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis |
title_fullStr | Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis |
title_full_unstemmed | Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis |
title_short | Regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis |
title_sort | regional variation in coronary angiography rates: the association with supply factors and the role of indication: a spatial analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8882285/ https://www.ncbi.nlm.nih.gov/pubmed/35219312 http://dx.doi.org/10.1186/s12872-022-02513-z |
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