Temporal changes in geographic disparities in access to emergency heart attack and stroke care: Are we any better today?

Busingye, Doreen; Pedigo, Ashley; Odoi, Agricola

doi:10.1016/j.sste.2011.07.010

Cited by 20 publications

(21 citation statements)

References 36 publications

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“…The decreasing temporal trend observed in stroke mortality could be due to public health interventions such as improved access to certified stroke centers since the number of centers have increased over time. Similar to mortality risks overall stroke hospitalization risks in the US have also decreased and may be attributed to advances in acute stroke care [ 29 ]. A study by Towfighi et al [ 30 ] reported a decline in stroke mortality rates from 1997 to 2006 among individuals aged 35 to 64 years and explained that this was partly due to better survival among women compared with men aged 35 to 54 years.…”

Section: Discussionmentioning

confidence: 99%

Does Place of Residence or Time of Year Affect the Risk of Stroke Hospitalization and Death? A Descriptive Spatial and Temporal Epidemiologic Study

et al. 2016

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BackgroundIdentifying geographic areas with significantly high risks of stroke is important for informing public health prevention and control efforts. The objective of this study was to investigate geographic and temporal patterns of stroke hospitalization and mortality risks so as to identify areas and seasons with significantly high burden of the disease in Florida. The information obtained will be useful for resource allocation for disease prevention and control.MethodsStroke hospitalization and mortality data from 1992 to 2012 were obtained from the Florida Agency for Health Care Administration. Age-adjusted stroke hospitalization and mortality risks for time periods 1992–94, 1995–97, 1998–2000, 2001–03, 2004–06, 2007–09 and 2010–12 were computed at the county spatial scale. Global Moran’s I statistics were computed for each of the time periods to test for evidence of global spatial clustering. Local Moran indicators of spatial association (LISA) were also computed to identify local areas with significantly high risks.ResultsThere were approximately 1.5 million stroke hospitalizations and over 196,000 stroke deaths during the study period. Based on global Moran’s I tests, there was evidence of significant (p<0.05) global spatial clustering of stroke mortality risks but no evidence (p>0.05) of significant global clustering of stroke hospitalization risks. However, LISA showed evidence of local spatial clusters of both hospitalization and mortality risks with significantly high risks being observed in the north while the south had significantly low risks of stroke deaths. There were decreasing temporal trends and seasonal patterns of both hospitalization and mortality risks with peaks in the winter.ConclusionsAlthough stroke hospitalization and mortality risks have declined in the past two decades, disparities continue to exist across Florida and it is evident from the results of this study that north Florida may, in fact, be part of the stroke belt despite not being in any of the traditional stroke belt states. These findings are useful for guiding public health efforts to reduce/eliminate inequities in stroke outcomes and inform policy decisions. There is need to continually identify populations with significantly high risks of stroke to better guide the targeting of limited resources to the highest risk populations.

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Section: Discussionmentioning

confidence: 99%

Does Place of Residence or Time of Year Affect the Risk of Stroke Hospitalization and Death? A Descriptive Spatial and Temporal Epidemiologic Study

et al. 2016

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“…Many southern counties are rural, impoverished, and medically underserved and experience other negative health outcomes . Although studies of access to health care began after the beginning of our study period, recent increases in cardiac services are clustered in metropolitan areas and thus may have increased rural–urban disparities in access to evidence‐based care and resulting heart disease death rates . Finally, risk factors (eg, smoking, diet, and diabetes) may also have a strong time‐varying geographic pattern.…”

Section: Discussionmentioning

confidence: 99%

“…Geographic disparities in heart disease mortality and other cardiovascular outcomes have been associated with factors related to heart disease treatment and prevention (eg, hospital quality, access to evidence-based health care) and measures of socioeconomic context (eg, rurality, poverty, occupational structure). 9,10,[38][39][40][41][42][43][44][45][46] Socioeconomic context provides a foundation for the potential success of prevention and treatment interventions. 47 Many southern counties are rural, impoverished, and medically underserved and experience other negative health outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…48,49 Although studies of access to health care began after the beginning of our study period, recent increases in cardiac services are clustered in metropolitan areas and thus may have increased rural-urban disparities in access to evidencebased care and resulting heart disease death rates. 40,42 Finally, risk factors (eg, smoking, diet, and diabetes) may also have a strong time-varying geographic pattern. The South, with high prevalence of smoking, diabetes, and obesity, has lagged behind the rest of the United States in improving these measures.…”

Section: Discussionmentioning

confidence: 99%

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Disparities in Temporal and Geographic Patterns of Declining Heart Disease Mortality by Race and Sex in the United States, 1973–2010

Vaughan

Quick

Pathak

et al. 2015

JAHA

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BackgroundExamining small‐area differences in the strength of declining heart disease mortality by race and sex provides important context for current racial and geographic disparities and identifies localities that could benefit from targeted interventions. We identified and described temporal trends in declining county‐level heart disease mortality by race, sex, and geography between 1973 and 2010.Methods and ResultsUsing a Bayesian hierarchical model, we estimated age‐adjusted mortality with diseases of the heart listed as the underlying cause for 3099 counties. County‐level percentage declines were calculated by race and sex for 3 time periods (1973–1985, 1986–1997, 1998–2010). Strong declines were statistically faster or no different than the total national decline in that time period. We observed county‐level race–sex disparities in heart disease mortality trends. Continual (from 1973 to 2010) strong declines occurred in 73.2%, 44.6%, 15.5%, and 17.3% of counties for white men, white women, black men, and black women, respectively. Delayed (1998–2010) strong declines occurred in 15.4%, 42.0%, 75.5%, and 76.6% of counties for white men, white women, black men, and black women, respectively. Counties with the weakest patterns of decline were concentrated in the South.ConclusionsSince 1973, heart disease mortality has declined substantially for these race–sex groups. Patterns of decline differed by race and geography, reflecting potential disparities in national and local drivers of these declines. Better understanding of racial and geographic disparities in the diffusion of heart disease prevention and treatment may allow us to find clues to progress toward racial and geographic equity in heart disease mortality.

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“…The mixture of unfavourable environmental and social situations can be referred collectively as the person's socioeconomic status (SES) and comprises a different breed of determinants (Cox et al, 2006), which includes education (Avendaño et al, 2004;Lambert et al, 2013;Wu et al, 2013), professional occupation (Mendes, 1988;Franks et al, 1991;Hayashi et al, 1996;Kunst et al, 1998;Cesana et al, 2001) and also income and material ownership (Engström et al, 2001;Li et al, 2008). In a more strict sense, environmental determinants include exposure to air pollution and distance to hospital units (Busingye et al, 2011;Labarthe, 2011). Links between SES and stroke have thus been identified, but the precise measure of the pathways through which SES affects stroke is still controversial (Cox et al, 2006;Addo et al, 2012).…”

Section: Determinants Of Strokementioning

confidence: 99%

Spatiotemporal analysis of the relationship between socioeconomic factors and stroke in the Portuguese mainland population under 65 years old

et al. 2015

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Stroke risk has been shown to display varying patterns of geographic distribution amongst countries but also between regions of the same country. Traditionally a disease of older persons, a global 25% increase in incidence instead was noticed between 1990 and 2010 in persons aged 20-≤64 years, particularly in low-and medium-income countries. Understanding spatial disparities in the association between socioeconomic factors and stroke is critical to target public health initiatives aiming to mitigate or prevent this disease, including in younger persons. We aimed to identify socioeconomic determinants of geographic disparities of stroke risk in people 65 years old, in municipalities of mainland Portugal, and the spatiotemporal variation of the association between these determinants and stroke risk during two study periods (1992-1996 and 2002-2006). Poisson and negative binomial global regression models were used to explore determinants of disease risk. Geographically weighted regression (GWR) represents a distinctive approach, allowing estimation of local regression coefficients. Models for both study periods were identified. Significant variables included education attainment, work hours per week and unemployment. Local Poisson GWR models achieved the best fit and evidenced spatially varying regression coefficients. Spatiotemporal inequalities were observed in significant variables, with dissimilarities between men and women. This study contributes to a better understanding of the relationship between stroke and socioeconomic factors in the population <65 years of age, one age group seldom analysed separately. It can thus help to improve the targeting of public health initiatives, even more in a context of economic crisis.

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Temporal changes in geographic disparities in access to emergency heart attack and stroke care: Are we any better today?

Cited by 20 publications

References 36 publications

Does Place of Residence or Time of Year Affect the Risk of Stroke Hospitalization and Death? A Descriptive Spatial and Temporal Epidemiologic Study

Does Place of Residence or Time of Year Affect the Risk of Stroke Hospitalization and Death? A Descriptive Spatial and Temporal Epidemiologic Study

Disparities in Temporal and Geographic Patterns of Declining Heart Disease Mortality by Race and Sex in the United States, 1973–2010

Spatiotemporal analysis of the relationship between socioeconomic factors and stroke in the Portuguese mainland population under 65 years old

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