Liu Xiaoxiao, Barber Claire E H, Katz Steven, Homik Joanne, Bertazzon Stefania, Patel Alka B, Robert Jill, Smith Christopher, Mosher Dianne, Marshall Deborah A
University of Calgary, Calgary, Alberta, Canada.
University of Calgary, Calgary, Alberta, Canada, and Arthritis Research Canada, Richmond, British Columbia, Canada.
ACR Open Rheumatol. 2021 May;3(5):324-332. doi: 10.1002/acr2.11251. Epub 2021 Apr 1.
Timely access to rheumatologists remains a challenge in Alberta, a Canadian province with vast rural areas, whereas rheumatologists are primarily clustered in metro areas. To address the goal of timely and equitable access to rheumatoid arthritis (RA) care, health planners require information at the regional and local level to determine the RA prevalence and the associated health care needs.
Using Alberta Health administrative databases, we identified RA-prevalent cases (April 1, 2015-March 31, 2016) on the basis of a validated case definition. Age- and sex-standardized prevalence rates per 1000 population members and the standardized rates ratio (SRR) were calculated. We applied Global Moran's I and Gi* hotspot analysis using three different weight matrices to explore the geospatial pattern of RA prevalence in Alberta.
Among 38 350 RA cases (68% female; n = 26 236), the prevalence rate was 11.81 cases per 1000 population members (95% confidence interval [CI] 11.80-11.81) after age and sex standardization. Approximately 60% of RA cases resided in metro (Calgary and Edmonton) and moderate metro areas. The highest rate was observed in rural areas (14.46; 95% CI 14.45-14.47; SRR 1.28), compared with the lowest in metro areas (10.69; 95% CI 10.68-10.69; SRR 0.82). The RA prevalence across local geographic areas ranged from 4.7 to 30.6 cases. The Global Moran's I index was 0.15 using three different matrices (z-score 3.96-4.24). We identified 10 hotspots in the south and north rural areas and 18 cold spots in metro and moderate metro Calgary.
The findings highlight notable rural-urban variation in RA prevalence in Alberta. Our findings can inform strategies aimed at reducing geographic disparities by targeting areas with high health care needs.
在加拿大艾伯塔省这个拥有广大农村地区的省份，及时就医于风湿病专家仍是一项挑战，因为风湿病专家主要集中在城市地区。为实现及时、公平地获得类风湿关节炎（RA）护理的目标，卫生规划者需要区域和地方层面的信息，以确定RA患病率及相关医疗保健需求。
利用艾伯塔省卫生管理数据库，我们基于经过验证的病例定义确定了RA流行病例（2015年4月1日至2016年3月31日）。计算了每1000名人口的年龄和性别标准化患病率以及标准化率比（SRR）。我们使用三种不同的权重矩阵应用全局莫兰指数（Global Moran's I）和Gi*热点分析，以探索艾伯塔省RA患病率的地理空间模式。
在38350例RA病例中（68%为女性；n = 26236），年龄和性别标准化后患病率为每1000名人口中有11.81例（95%置信区间[CI] 11.80 - 11.81）。约60%的RA病例居住在城市（卡尔加里和埃德蒙顿）及中等城市地区。农村地区患病率最高（14.46；95% CI 14.45 - 14.47；SRR 1.28），而城市地区最低（10.69；95% CI 10.68 - 10.69；SRR 0.82）。当地不同地理区域的RA患病率在4.7至30.6例之间。使用三种不同矩阵时全局莫兰指数为0.15（z分数3.96 - 4.24）。我们在南部和北部农村地区确定了10个热点，在卡尔加里的城市和中等城市地区确定了18个冷点。
研究结果突出了艾伯塔省RA患病率在城乡之间的显著差异。我们的研究结果可为旨在通过针对医疗保健需求高的地区来减少地理差异的策略提供参考。
