Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná, BR.
Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR.
Glob Heart. 2021 Jan 20;16(1):5. doi: 10.5334/gh.770.
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.
To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil.
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 and lowest Akaike Information Criterion.
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: 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).
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.
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.
在过去的几年中，没有任何其他疾病像缺血性心脏病（IHD）那样导致更多人死亡。尽管心脏病学取得了进步，但由于缺乏医疗保健覆盖范围和获得转诊中心的机会，治疗的反应时间仍导致患者死亡。
分析巴西巴拉那州与 IHD 死亡率相关的空间差异。
使用巴西卫生信息部门 2013-2017 年的二级数据进行了生态研究，以验证 IHD 死亡率。使用全局 Moran 和局部空间关联指标（LISA）进行空间分析，以验证 IHD 死亡率的空间依赖性。最后，还使用普通最小二乘法和地理加权回归（GWR）开发了多变量空间回归模型，以确定与 IHD 死亡率显著相关的社会经济指标（老龄化、收入和文盲率）、检查覆盖率（导管插入术、血管成形术和血运重建术的比例）和获得卫生保健的机会（心脏病专家和化学再灌注中心的就诊指数）。所选模型基于 p < 0.05、最高调整 R 和最低 Akaike 信息准则。
2013-2017 年间，共有 22920 人死于 IHD。空间分析证实 IHD 死亡率存在正的全局空间自相关（Moran's I：0.633，p < 0.01）。LISA 分析确定了由 66 个城市组成的六个高-高模式集群（16.5%）。GWR 提出了最佳模型（调整后的 R：0.72），表明心脏病专家和化学再灌注中心的可及性以及血运重建和血管成形术的比率在地理上对 IHD 死亡率有不同的影响。老龄化和文盲率与 IHD 死亡率呈正相关，而收入比则呈负相关（p < 0.05）。
空间分析揭示了脆弱地区，社会人口统计学、检查覆盖率和获得卫生保健的机会变量对巴西巴拉那州的 IHD 死亡率有不同的影响。
缺血性心脏病死亡率的增加与地理差异有关。IHD 死亡率与社会经济因素、检查覆盖率和获得卫生保健的机会密切相关。化学再灌注中心的可及性较高并不一定能改善该州某些地区的患者预后。高死亡率集群位于心脏病专家、收入和教育程度较低的地区。
