Gorgas Memorial Institute for Health Studies, Panama City, Panama.
National Secretariat for Science and Technology, Panama City, Panama.
BMC Public Health. 2019 Feb 15;19(1):199. doi: 10.1186/s12889-019-6508-8.
The aims of this study were to determine the geographic and time variation of social determinants of health (SDH) and cardiovascular disease (CVD) mortality in Panama from 2012 to 2016, and to identify which of the SDH has the strongest correlation with a socioeconomic index (SEI).
We conducted an ecological study obtaining mortality from the National Mortality Register and socioeconomic variables derived from the National Household Survey (NHS). The International Classification of Diseases 10th revision codes I20-I25 and I60-I69 were used for ischemic heart disease (IHD) and stroke, respectively. Standardized age-adjusted mortality rates were calculated by direct method. Mortality rates and socioeconomic variables were evaluated together in a panel data model. A SEI was developed from factorial analysis by principal components with a polychoric correlation matrix. Provinces and regions were categorized in tertiles according to median value of the SEI score.
The NHS evaluated an average of 15,919 households per year. The mean of age throughout the study period was 41 years. The average monthly income increased, from US$ (SD) 331.94 (5.38) in 2012, to 406.24 (5.81) in 2016, whereas the social security health coverage remained in a range of 57-58%. The mean number of school years was twelve. Significant geographical and temporal variations in social determinants and mortality rates were observed throughout the country. Colon, categorized in the middle tertile according to the SEI, presented higher IHD mortality rates. Darién (in the lowest SEI tertile) Colón and Herrera had higher stroke mortality rates. The SEI categorized indigenous territories in the lowest tertile. Total years of education was the strongest correlated variable with the SEI, when we excluded the population living in indigenous territories. However, when this population was included, social security coverage had the strongest correlation with the SEI.
We observed geographical and temporal disparities in SDH and CVD mortality rates. Further epidemiological studies are warranted in the provinces of Colón, Darien, Herrera and Los Santos to explore in-depth the higher CVD mortality rates observed in these provinces.
本研究旨在确定 2012 年至 2016 年期间巴拿马的社会决定因素（SDH）和心血管疾病（CVD）死亡率的地理和时间变化，并确定哪些 SDH 与社会经济指数（SEI）相关性最强。
我们进行了一项生态研究，从国家死亡率登记处获得死亡率数据，从国家家庭调查（NHS）中获得社会经济变量。使用国际疾病分类第 10 次修订版 I20-I25 和 I60-I69 代码分别用于缺血性心脏病（IHD）和中风。通过直接法计算标准化年龄调整死亡率。在面板数据模型中同时评估死亡率和社会经济变量。使用主成分因子分析从因子分析中开发出一个 SEI，并使用偏相关矩阵。根据 SEI 得分中位数将各省和地区分为三分位。
NHS 每年评估平均 15919 户家庭。整个研究期间的平均年龄为 41 岁。月平均收入从 2012 年的 331.94 美元（标准差为 5.38）增加到 2016 年的 406.24 美元（标准差为 5.81），而社会保障健康覆盖范围保持在 57-58%之间。在校年数平均为 12 年。在全国范围内观察到社会决定因素和死亡率的显著地理和时间变化。科隆根据 SEI 被归类为中间三分位，其 IHD 死亡率较高。达连（SEI 最低三分位）科隆和埃雷拉的中风死亡率较高。SEI 将土著领土归类为最低三分位。当我们排除居住在土著领土内的人口时，受教育总年数是与 SEI 相关性最强的变量。然而，当包括这部分人口时，社会保障覆盖率与 SEI 的相关性最强。
我们观察到 SDH 和 CVD 死亡率的地理和时间差异。需要在科隆、达连、埃雷拉和洛斯桑托斯等省进行进一步的流行病学研究，以深入探讨这些省份观察到的较高 CVD 死亡率。
