The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis
Amanda de Carvalho Dutra,
Lincoln Luís Silva,
Raíssa Bocchi Pedroso,
Yolande Pokam Tchuisseu,
Mariana Teixeira da Silva,
Marcela Bergamini,
João Felipe Hermann Costa Scheidt,
Pedro Henrique Iora,
Rogério do Lago Franco,
Catherine Ann Staton,
João Ricardo Nickenig Vissoci,
Oscar Kenji Nihei,
Luciano de Andrade
Affiliations
Amanda de Carvalho Dutra
Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná; Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná
Lincoln Luís Silva
Post-Graduation Program in Biosciences and Physiopathology, State University of Maringá, Maringá, Paraná; Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná
Raíssa Bocchi Pedroso
Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná
Yolande Pokam Tchuisseu
Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR; Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
Mariana Teixeira da Silva
Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná; Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná
Marcela Bergamini
Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná; Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná
João Felipe Hermann Costa Scheidt
Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná; Department of Medicine, State University of Maringá, Maringá, Paraná
Pedro Henrique Iora
Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná; Department of Medicine, State University of Maringá, Maringá, Paraná
Rogério do Lago Franco
Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná; Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná
Catherine Ann Staton
Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina
João Ricardo Nickenig Vissoci
Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná; Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná, BR; Duke Global Health Institute, Duke University, Durham, North Carolina
Oscar Kenji Nihei
Education, Letters and Health Center, State University of the West of Paraná, Foz do Iguaçu, Paraná
Luciano de Andrade
Post-Graduation Program in Health Sciences, State University of Maringá, Maringá, Paraná; Study Group on Digital Technologies and Geoprocessing in Health (GETS), State University of Maringá Maringá, Paraná; Department of Medicine, State University of Maringá, Maringá, Paraná
Background: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. Objectives:To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil. Methods: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 R² and lowest Akaike Information Criterion. Results: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 R²: 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). Conclusion: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. Highlights 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.
