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Kjærulff TM, Bihrmann K, Søndergaard J, Gislason G, Larsen ML, Ersbøll AK. Association between travel distance and face-to-face consultations with general practitioners before an incident acute myocardial infarction: a nationwide register-based spatial epidemiological study. BMJ Open 2024; 14:e079124. [PMID: 38272550 PMCID: PMC10824005 DOI: 10.1136/bmjopen-2023-079124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES This study examined the association between travel distance to the general practitioner's (GP) office and no face-to-face GP consultation within 1 year before an incident acute myocardial infarction (AMI). DESIGN A prospective cohort study using multilevel spatial logistic regression analysis of nationwide register data. SETTING Nationwide study including contacts to GPs in Denmark prior to an incident AMI in 2005-2017. PARTICIPANTS 121 232 adults (≥30 years) with incident AMI were included in the study. PRIMARY AND SECONDARY OUTCOMES MEASURES The primary outcome was odds of not having a face-to-face GP consultation within 1 year before an incident AMI. RESULTS In total, 13 108 (10.8%) of the 121 232 individuals with incident AMI had no face-to-face consultation with the GP within 1 year before the AMI. Population density modified the association between travel distance and no face-to-face GP consultation. Increased odds of no face-to-face GP consultation was observed for medium (25th-75th percentile/1123-5449 m) and long (>75th percentile/5449 m) compared with short travel distance (<25th percentile/1123 m) among individuals living in small cities (OR (95% credible intervals) of 1.19 (1.10 to 1.29) and 1.19 (1.06 to 1.33), respectively) and rural areas (1.46 (1.26 to 1.68) and 1.48 (1.29 to 1.68), respectively). No association was observed for individuals living in large cities and the capital. CONCLUSIONS Travel distance above approximately 1 km was significantly associated with no face-to-face GP consultation before an incident AMI among individuals living in small cities and rural areas. The structure of the healthcare system should consider the importance of geographical distance between citizens and the GP in remote areas.
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Affiliation(s)
- Thora Majlund Kjærulff
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Gunnar Gislason
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark
| | | | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Asikainen A, Korja M, Kaprio J, Rautalin I. Case Fatality of Aneurysmal Subarachnoid Hemorrhage Varies by Geographic Region Within Finland: A Nationwide Register-Based Study. Neurology 2023; 101:e1950-e1959. [PMID: 37775314 PMCID: PMC10662974 DOI: 10.1212/wnl.0000000000207850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Previous studies have reported a substantial between-country variation in the case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (SAH). However, contrary to comparisons among countries, nationwide comparisons within countries that focus on populations with equal access to health care and include out-of-hospital deaths in analyses are lacking. Thus, we aimed to investigate whether the SAH CFRs vary between geographic regions within Finland. METHODS We identified all hospitalized and nonhospitalized (sudden-death) cases with aneurysmal SAH in Finland during 1998-2017 through 2 externally validated nationwide registers. According to the municipality of residence, we divided the cases with SAH into 5 geographic regions: Southern, Central, Western, Northern, and Eastern Finland, each served by a University Central Hospital with a neurosurgical service. In addition to overall 30-day CFRs, we computed sudden death rates and 30-day CFRs after hospitalization for each region. Using logistic and Poisson regression models, we calculated regional age-adjusted, sex-adjusted, and year-adjusted odds ratios and annual percent changes with 95% CIs for CFRs. RESULTS During 1998-2017, we identified a total of 9,443 cases with SAH, of which 3,484 (36.9%) occurred in Southern Finland. In comparison with the overall 30-day CFR of Southern Finland (35.1%), the age-adjusted, sex-adjusted, and study year-adjusted odds of SAH death were 32% (16%-50%) higher in Central Finland (42.7%), 39% (23%-58%) higher in Eastern Finland (43.4%), and 52% (33%-74%) higher in Western Finland (47.1%). The regional differences were present among both sexes, in all age groups, in sudden death rates, and in 30-day CFRs after hospitalization. Between 1998 and 2017, the overall 30-day CFRs decreased in Central (2.4% [1.0%-3.8%] per year) and Southern (1.2% [0.2%-2.2%] per year) Finland, whereas CFRs remained stable in the other regions. In the last 4 years of the study period (2014-2017), Southern Finland had the lowest 30-day CFR (16.5%) among hospitalized patients. DISCUSSION SAH CFRs seem to vary significantly even within a country with relatively equal access to health care. Future studies with detailed individual-level data are needed to explore whether health inequities explain the reported findings.
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Affiliation(s)
- Aleksanteri Asikainen
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital, Finland; Department of Public Health (A.A.) and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland; and National Institute for Stroke and Applied Neurosciences (I.R.), Auckland University of Technology, New Zealand.
| | - Miikka Korja
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital, Finland; Department of Public Health (A.A.) and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland; and National Institute for Stroke and Applied Neurosciences (I.R.), Auckland University of Technology, New Zealand
| | - Jaakko Kaprio
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital, Finland; Department of Public Health (A.A.) and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland; and National Institute for Stroke and Applied Neurosciences (I.R.), Auckland University of Technology, New Zealand
| | - Ilari Rautalin
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital, Finland; Department of Public Health (A.A.) and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland; and National Institute for Stroke and Applied Neurosciences (I.R.), Auckland University of Technology, New Zealand
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3
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Wang T, Li Y, Zheng X. Association of socioeconomic status with cardiovascular disease and cardiovascular risk factors: a systematic review and meta-analysis. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023:1-15. [PMID: 36714072 PMCID: PMC9867543 DOI: 10.1007/s10389-023-01825-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023]
Abstract
Aim Cardiovascular disease (CVD) remains one of the leading causes of mortality worldwide, and several studies have indicated the association between socioeconomic status (SES) with CVD and cardiovascular risk factors (CVRFs). It is necessary to elucidate the association of SES and CVRFs with CVD. Subject and methods We searched PubMed, Embase, Web of Science, and the Cochrane Library for publications, using "socioeconomic status," "cardiovascular disease," and corresponding synonyms to obtain literature. The quality of studies was evaluated using the National Institutes of Health Quality Assessment Tool (NIH-QAT). All analyses were performed using Stata V.12.0. Results There were 31 eligible studies included in this meta-analysis. All studies presented a low risk of bias via NIH-QAT assessment. As for CVD incidence/mortality, pooled hazard ratios (HR) of low and middle vs. high income were [HR = 1.22 (1.17-1.28); HR = 1.12 (1.09-1.16)] and [HR = 1.37 (1.21-1.56); HR = 1.19 (1.06-1.34)]. The HR of education were [HR = 1.44 (1.28-1.63); HR = 1.2 (1.11-1.3)] and [HR = 1.5 (1.22-1.83); HR = 1.13 (1.05-1.22)]. The HR of deprivation were [HR = 1.28 (1.16-1.41); HR = 1.07 (1.03-1.11)] and [HR = 1.19 (1.11-1.29); HR = 1.1 (1.02-1.17)]. SES was negatively correlated with CVD outcomes. A subgroup analysis of gender and national income level also yielded a negative correlation, and additional details were also obtained. Conclusions SES is inversely correlated with CVD outcomes and the prevalence of CVRFs. As for CVD incidence, women may be more sensitive to income and education. In terms of CVD mortality, men may be more sensitive to income and education, and people from low- and middle-income countries are sensitive to income and education. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01825-4.
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Affiliation(s)
- Tao Wang
- School of Economics and Management, Southwest Petroleum University, NO. 8 Xindu Avenue, Xindu District, Chengdu City, Sichuan Province China
| | - Yilin Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaoqiang Zheng
- School of Economics and Management, Southwest Petroleum University, NO. 8 Xindu Avenue, Xindu District, Chengdu City, Sichuan Province China
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4
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Khanji MY, Chahal CAA, Ricci F, Akhter MW, Patel RS. Cardiopulmonary resuscitation training to improve out-of-hospital cardiac arrest survival: addressing potential health inequalities. Eur J Prev Cardiol 2022; 29:2275-2277. [PMID: 34907418 DOI: 10.1093/eurjpc/zwab214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,NIHR Biomedical Research Unit, William Harvey Research Institute, Queen Mary University of London, London, UK.,Department of Cardiology, Newham University Hospital, Glen Road, London E13 8SL, UK
| | - C Anwar A Chahal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55902, USA.,Department of Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,Department of Cardiology, WellSpan Center for Inherited Cardiovascular Diseases, WellSpan Health, York, PA, USA
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University, 66100 Chieti, Italy.,Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.,Department of Cardiology, Casa di Cura Villa Serena, Città Sant'Angelo, Pescara, Italy
| | | | - Riyaz S Patel
- Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.,Institute of Cardiovascular Sciences, University College London, London, UK
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5
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Socioeconomic inequity in incidence, outcomes and care for acute coronary syndrome: A systematic review. Int J Cardiol 2022; 356:19-29. [DOI: 10.1016/j.ijcard.2022.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
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6
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Fuglsang NA, Zinck E, Ersbøll AK, Ersbøll BK, Gislason GH, Kjærulff TM, Bihrmann K. Geographical inequalities in the decreasing 28-day mortality following incident acute myocardial infarction: a Danish register-based cohort study, 1987-2016. BMC Cardiovasc Disord 2022; 22:81. [PMID: 35246043 PMCID: PMC8896282 DOI: 10.1186/s12872-022-02519-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background Mortality following acute myocardial infarction (AMI) has decreased in western countries for decades; however, it remains unknown whether the decrease is distributed equally across the population independently of residential location. This study investigated whether the observed decreasing 28-day mortality following an incident AMI in Denmark from 1987 to 2016 varied geographically at municipality level after accounting for sociodemographic characteristics.
Methods A register-based cohort study design was used to investigate 28-day mortality among individuals with an incident AMI. Global spatial autocorrelation (within sub-periods) was analysed at municipality level using Moran's I. Analysis of spatio-temporal autocorrelation before and after adjusting for sociodemographic characteristics was performed using logistic regression and conditional autoregressive models with inference in a Bayesian setting.
Results In total, 368,839 individuals with incident AMI were registered between 1987 and 2016 in Denmark; 128,957 incident AMIs were fatal. The 28-day mortality decreased over time at national level with an odds ratio of 0.788 (95% credible interval (0.784, 0.792)) per 5-year period after adjusting for sociodemographic characteristics. The decrease in the 28-day mortality was geographically unequally distributed across the country and in a geographical region in northern Jutland, the 28-day mortality decreased significantly slower (4–12%) than at national level. Conclusions During the period from 1987 to 2016, the 28-day mortality following an incident AMI decreased substantially in Denmark. However, in a local geographical region, the 28-day mortality decreased significantly slower than in the rest of the country both before and after adjusting for sociodemographic differences. Efforts should be made to keep geographical trend inequalities in the 28-day mortality to a minimum. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02519-7.
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Affiliation(s)
- Niels Asp Fuglsang
- DTU Compute, Technical University of Denmark, Kgs Lyngby, Denmark.,National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Elisabeth Zinck
- DTU Compute, Technical University of Denmark, Kgs Lyngby, Denmark.,National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | | | - Gunnar Hilmar Gislason
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.,Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Thora Majlund Kjærulff
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
| | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
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Measuring the Effect of Place, Socioeconomic Status, and Racism on Coronary Heart Disease: Recent Trends and Missed Opportunities. CURR EPIDEMIOL REP 2021. [DOI: 10.1007/s40471-021-00281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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8
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Bihrmann K, Gislason G, Larsen ML, Ersbøll AK. Joint mapping of cardiovascular diseases: comparing the geographic patterns in incident acute myocardial infarction, stroke and atrial fibrillation, a Danish register-based cohort study 2014-15. Int J Health Geogr 2021; 20:41. [PMID: 34461900 PMCID: PMC8404297 DOI: 10.1186/s12942-021-00294-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disease mapping aims at identifying geographic patterns in disease. This may provide a better understanding of disease aetiology and risk factors as well as enable targeted prevention and allocation of resources. Joint mapping of multiple diseases may lead to improved insights since e.g. similarities and differences between geographic patterns may reflect shared and disease-specific determinants of disease. The objective of this study was to compare the geographic patterns in incident acute myocardial infarction (AMI), stroke and atrial fibrillation (AF) using the unique, population-based Danish register data. METHODS Incident AMI, stroke and AF was modelled by a multivariate Poisson model including a disease-specific random effect of municipality modelled by a multivariate conditionally autoregressive (MCAR) structure. Analyses were adjusted for age, sex and income. RESULTS The study included 3.5 million adults contributing 6.8 million person-years. In total, 18,349 incident cases of AMI, 28,006 incident cases of stroke, and 39,040 incident cases of AF occurred. Estimated municipality-specific standardized incidence rates ranged from 0.76 to 1.35 for AMI, from 0.79 to 1.38 for stroke, and from 0.85 to 1.24 for AF. In all diseases, geographic variation with clusters of high or low risk of disease after adjustment was seen. The geographic patterns displayed overall similarities between the diseases, with stroke and AF having the strongest resemblances. The most notable difference was observed in Copenhagen (high risk of stroke and AF, low risk of AMI). AF showed the least geographic variation. CONCLUSION Using multiple-disease mapping, this study adds to the results of previous studies by enabling joint evaluation and comparison of the geographic patterns in AMI, stroke and AF. The simultaneous mapping of diseases displayed similarities and differences in occurrence that are non-assessable in traditional single-disease mapping studies. In addition to reflecting the fact that AF is a strong risk factor for stroke, the results suggested that AMI, stroke and AF share some, but not all environmental risk factors after accounting for age, sex and income (indicator of lifestyle and health behaviour).
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Affiliation(s)
- Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.
| | - Gunnar Gislason
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark.,Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen, Denmark
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9
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Strömberg U, Parkes BL, Baigi A, Bonander C, Holmén A, Peterson S, Piel FB. Small-area data on socioeconomic status and immigrant groups for evaluating equity of early cancer detection and care. Acta Oncol 2021; 60:347-352. [PMID: 33523773 DOI: 10.1080/0284186x.2021.1878550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ulf Strömberg
- School of Public Health, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Brandon L. Parkes
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Amir Baigi
- School of Public Health, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - Carl Bonander
- School of Public Health, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Anders Holmén
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | | | - Frédéric B. Piel
- UK Small Area Health Statistics Unit (SAHSU), Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment & Health, School of Public Health, Imperial College London, London, UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Environmental Exposures and Health, Imperial College London, London, UK
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10
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Svendsen MT, Bøggild H, Skals RK, Mortensen RN, Kragholm K, Hansen SM, Riddersholm SJ, Nielsen G, Torp-Pedersen C. Uncertainty in classification of death from fatal myocardial infarction: A nationwide analysis of regional variation in incidence and diagnostic support. PLoS One 2020; 15:e0236322. [PMID: 32716962 PMCID: PMC7384617 DOI: 10.1371/journal.pone.0236322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/02/2020] [Indexed: 11/04/2022] Open
Abstract
AIMS The usefulness of mortality statistics relies on the validity of death certificate diagnosis. However, diagnosing the causal sequence of conditions leading to death is not simple. We examined diagnostic support for fatal acute myocardial infarction (AMI) and investigated its association with regional variation. METHODS AND RESULTS From Danish nationwide registers, we identified the study population (N = 3,244,051) of whom 36,669 individuals were recorded with AMI as the underlying cause-of-death between 2002 and 2015. We included clinical diagnoses, procedures, and claimed prescriptions related to atherosclerotic disease to evaluate the level of diagnostic support for fatal AMI in three diagnostic groups (Definite; Plausible; Uncertain). Adjusted mortality rates, rate ratios, and odds ratios were estimated for each AMI category, stratified by hospital region using multivariable regression models. More than one-third (N = 12,827, 35%) of deaths reported as fatal AMI had uncertain diagnostic support. The largest regional variation in AMI mortality rate ratios, varying from 1.16 (95%CI:1.02;1.31) to 1.62 (95%CI:1.43;1.83), was found among cases with uncertain diagnostic supportive data. Substantial inter-regional differences in the degree to which death occurs outside hospital [OR: 1.01 (95%CI:0.92;1.12) - 1.49 (95%CI:1.36;1.63)] and general practitioners determining the cause-of-death at home were present. Minor regional differences [OR: 0.96 (95%CI:0.85;1.07) - 1.16 (95%CI:1.04;1.29)] in in-hospital AMI mortality were observed. CONCLUSION There is significant regional variation associated with recording AMI as a cause-of-death. This variation is predominately based on death certificate diagnoses without diagnostic supportive evidence. Studies of fatal AMI should include a stratification on supportive evidence of the diagnosis.
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Affiliation(s)
- Majbritt Tang Svendsen
- Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark
| | - Henrik Bøggild
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Regitze Kuhr Skals
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Steen Møller Hansen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Signe Juel Riddersholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Anesthesia and Intensive care, Aalborg University Hospital, Aalborg, Denmark
| | - Gitte Nielsen
- Department of Cardiology, North Denmark Regional Hospital, Hjørring, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hilleroed, Denmark
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11
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Søvsø MB, Huibers L, Bech BH, Christensen HC, Christensen MB, Christensen EF. Acute care pathways for patients calling the out-of-hours services. BMC Health Serv Res 2020; 20:146. [PMID: 32106846 PMCID: PMC7045402 DOI: 10.1186/s12913-020-4994-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/14/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In Western countries, patients with acute illness or injury out-of-hours (OOH) can call either emergency medical services (EMS) for emergencies or primary care services (OOH-PC) in less urgent situations. Callers initially choose which service to contact; whether this choice reflect the intended differences in urgency and severity is unknown. Hospital diagnoses and admission rates following an OOH service contact could elucidate this. We aimed to investigate and compare the prevalence of patient contacts, subsequent hospital contacts, and the age-related pattern of hospital diagnoses following an out-of-hours contact to EMS or OOH-PC services in Denmark. METHODS Population-based observational cohort study including patients from two Danish regions with contact to EMS or OOH-PC in 2016. Hospital contacts were defined as short (< 24 h) or admissions (≥24 h) on the date of OOH service contact. Both regions have EMS, whereas the North Denmark Region has a general practitioner cooperative (GPC) as OOH-PC service and the Capital Region of Copenhagen the Medical Helpline 1813 (MH-1813), together representing all Danish OOH service types. Calling an OOH service is mandatory prior to a hospital contact outside office hours. RESULTS OOH-PC handled 91% (1,107,297) of all contacts (1,219,963). Subsequent hospital contacts were most frequent for EMS contacts (46-54%) followed by MH-1813 (41%) and GPC contacts (9%). EMS had more admissions (52-56%) than OOH-PC. For both EMS and OOH-PC, short hospital contacts often concerned injuries (32-63%) and non-specific diagnoses (20-45%). The proportion of circulatory disease was almost twice as large following EMS (13-17%) compared to OOH-PC (7-9%) in admitted patients, whereas respiratory diseases (11-14%), injuries (15-22%) and non-specific symptoms (22-29%) were more equally distributed. Generally, admitted patients were older. CONCLUSIONS EMS contacts were fewer, but with a higher percentage of hospital contacts, admissions and prevalence of circulatory diseases compared to OOH-PC, perhaps indicating that patients more often contact EMS in case of severe disease. However, hospital diagnoses only elucidate severity of diseases to some extent, and other measures of severity could be considered in future studies. Moreover, the socio-demographic pattern of patients calling OOH needs exploration as this may play an important role in choice of entrance.
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Affiliation(s)
- Morten Breinholt Søvsø
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Linda Huibers
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | | | | | - Erika Frischknecht Christensen
- Department of Clinical Medicine, Centre for Prehospital and Emergency Research, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark
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