Campos Letícia Nunes, Bryce-Alberti Mayte, Hill Sarah K, Del Valle Diana D, Zaigham Mehreen, Rábago Alberto de la Rosa, Dey Tanujit, Juran Sabrina, Uribe-Leitz Tarsicio
Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
Faculty of Medical Sciences, Universidade de Pernambuco, Recife, PE, Brazil.
Lancet Reg Health Am. 2023 Sep 7;26:100586. doi: 10.1016/j.lana.2023.100586. eCollection 2023 Oct.
Accessibility to surgical services can impact earthquake preparedness and response. We aimed to estimate the population with timely access to surgical care in Guerrero, a Mexican state with high tectonic activity, and identify populations at risk in the event of an earthquake.
We conducted an ecological study using open government data. We extracted data from Guerrero municipalities regarding their earthquake risk, social vulnerability, social inequality, marginalisation, and resilience indices. The latest combines municipalities' resistance to unexpected events and capacity to maintain optimal functionality without immediate federal or international support. Geographical coordinates of active public and private surgical facilities in Guerrero were combined with ancillary spatial data on roads and municipalities' population density to estimate population coverage within 30-min and 1-h driving time to surgical facilities in Redivis. We built an ordered beta regression model for each driving time estimate.
We identified 25 public and 16 private facilities capable of providing surgical care in Guerrero. The population with access to facilities with surgical capacity within 30 min and 1-h driving times were 48.4% and 69.1%, respectively. We found that municipalities with very high levels of earthquake risk, social vulnerability, social inequality, and marginalisation, and very low levels of resilience had decreased coverage. In the multivariable analysis, the resilience index was statistically significant only for the 30-min model, with an effect size of 0.524 (95% CI 0.082, 1.089).
Access to surgical care remains unequally distributed in Guerrero municipalities at the highest risk for earthquakes. Municipalities' resilience was the most significant predictor of higher surgical care coverage in 30-min driving time. Our study provides insights on how surgical system strengthening can enhance earthquake emergency disaster planning.
No funding.
获得外科服务的机会会影响地震的防范和应对。我们旨在估算墨西哥高构造活动州格雷罗州能及时获得外科护理的人口数量，并确定地震发生时的高危人群。
我们利用公开的政府数据进行了一项生态研究。我们从格雷罗州各市政当局提取了有关其地震风险、社会脆弱性、社会不平等、边缘化和恢复力指数的数据。最新数据综合了各市政当局对意外事件的抵御能力以及在没有联邦或国际即时支持的情况下维持最佳功能的能力。将格雷罗州活跃的公立和私立外科设施的地理坐标与道路及市政当局人口密度的辅助空间数据相结合，以估算在30分钟和1小时驾车时间内到达雷迪维斯外科设施的人口覆盖率。我们为每个驾车时间估算值建立了有序β回归模型。
我们在格雷罗州确定了25家公立和16家私立能够提供外科护理的设施。在30分钟和1小时驾车时间内能够使用具备手术能力设施的人口分别为48.4%和69.1%。我们发现，地震风险、社会脆弱性、社会不平等和边缘化程度非常高且恢复力水平非常低的市政当局覆盖率较低。在多变量分析中，恢复力指数仅在30分钟模型中具有统计学意义，效应大小为0.524（95%置信区间0.082，1.089）。
在地震风险最高的格雷罗州各市政当局中，获得外科护理的机会仍然分布不均。市政当局的恢复力是30分钟驾车时间内更高外科护理覆盖率的最显著预测因素。我们的研究为加强外科系统如何能改进地震应急灾害规划提供了见解。
无资金。
