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Poppe A, Ansmann L, Meyer I, Pförtner TK. Spatial and Socioeconomic Patterns of Mental Health and Healthcare Utilization in Cologne, Germany. DAS GESUNDHEITSWESEN 2024. [PMID: 39159666 DOI: 10.1055/a-2326-6768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
BACKGROUND Children and adolescents are significantly tied to their family's socioeconomic position and living environment. Neighbourhood and the living environment have been identified as potential risk factors for mental disorders in this age group. AIM OF THE STUDY The aim of the study was to investigate the distribution of mental and behavioural disorders (prevalence) and the provision of mental health services for children and adolescents aged 0-19 years in the city of Cologne. In particular, the study aimed to examine the association of these factors with area deprivation and the availability of mental health services covered by statutory health insurance. Finally, possible spatial variations in these aspects were analysed. METHOD Claims data of children and adolescents aged 0 to 19 years included in four statutory health insurance of the year 2021 were analysed. A deprivation index using data on the level of the ZIP code area was calculated. Analyses were carried out descriptively, using ordinary least squares (OLS) and geographically weighted regression (GWR). RESULTS The prevalence of mental and behavioural disorders in children and adolescents varied across ZIP code areas, with higher rates in the northern, southern, and eastern parts of the city. The results indicated that the use of services by male children and adolescents with a prevalent diagnosis of mental and behavioural disorders was higher in areas with a higher density of healthcare providers. However, prevalence was on the whole lower in areas with a higher density of healthcare providers. In addition, the density of health care providers was higher in the city centre with comparatively lower deprivation. CONCLUSION These results indicate inadequate access to care for children and young people outside the city centre. However, due to the heterogeneity of the population in these areas, this study provides only preliminary insights. Data with a finer geographic resolution are needed for further research in order to analyse the association further.
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Affiliation(s)
- Adriana Poppe
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Germany
| | - Lena Ansmann
- Lehrstuhl für Medizinsoziologie, Universität zu Köln Institut für Medizinsoziologie Versorgungsforschung und Rehabilitationswissenschaft, Köln, Germany
| | - Ingo Meyer
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Germany
| | - Timo-Kolja Pförtner
- Arbeitsbereich Forschungsmethoden, Humanwissenschaftliche Fakultät und Medizinische Fakultät, Universität zu Köln, Köln, Germany
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Bentué-Martínez C, Mimbrero MR, Zúñiga-Antón M. Spatial patterns in sociodemographic factors explain to a large extent the prevalence of hypertension and diabetes in Aragon (Spain). Front Med (Lausanne) 2023; 10:1016157. [PMID: 36760398 PMCID: PMC9905822 DOI: 10.3389/fmed.2023.1016157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/11/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction The global burden of multi-morbidity has become a major public health challenge due to the multi stakeholder action required to its prevention and control. The Social Determinants of Health approach is the basis for the establishment of health as a cross-cutting element of public policies toward enhanced and more efficient decision making for prevention and management. Objective To identify spatially varying relationships between the multi-morbidity of hypertension and diabetes and the sociodemographic settings (2015-2019) in Aragon (a mediterranean region of Northeastern Spain) from an ecological perspective. Materials and methods First, we compiled data on the prevalence of hypertension, diabetes, and sociodemographic variables to build a spatial geodatabase. Then, a Principal Component Analysis (PCA) was performed to derive regression variables, i.e., aggregating prevalence rates into a multi-morbidity component (stratified by sex) and sociodemographic covariate into a reduced but meaningful number of factors. Finally, we applied Geographically Weighted Regression (GWR) and cartographic design techniques to investigate the spatial variability of the relationships between multi-morbidity and sociodemographic variables. Results The GWR models revealed spatial explicit relationships with large heterogeneity. The sociodemographic environment participates in the explanation of the spatial behavior of multi-morbidity, reaching maximum local explained variance (R2) of 0.76 in men and 0.91 in women. The spatial gradient in the strength of the observed relationships was sharper in models addressing men's prevalence, while women's models attained more consistent and higher explanatory performance. Conclusion Modeling the prevalence of chronic diseases using GWR enables to identify specific areas in which the sociodemographic environment is explicitly manifested as a driving factor of multi-morbidity. This is step forward in supporting decision making as it highlights multi-scale contexts of vulnerability, hence allowing specific action suitable to the setting to be taken.
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Affiliation(s)
- Carmen Bentué-Martínez
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,*Correspondence: Carmen Bentué-Martínez, ✉
| | - Marcos Rodrigues Mimbrero
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,Institute of Research Into Environmental Sciences of the University of Zaragoza, Zaragoza, Spain
| | - María Zúñiga-Antón
- Department of Geography and Territorial Planning, University of Zaragoza, Zaragoza, Spain,Institute of Research Into Environmental Sciences of the University of Zaragoza, Zaragoza, Spain,Health Research Institute of Aragon, Zaragoza, Spain
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Augustin J, Bei der Kellen R, Behrendt CA, Magnussen C, Terschüren C, Ascone L, Kühn S, Wolf S, Augustin M, Andrees V. Associations between a Subjective Living Environment and Quality of Life among People with Arterial Hypertension-Results from the Hamburg City Health Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:180. [PMID: 36612502 PMCID: PMC9819795 DOI: 10.3390/ijerph20010180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
Hypertension is a global public health concern and an important contributor to cardiovascular disease. It remains disputed how important life circumstances are for the etiology of hypertension. Thus, the aim of this study is to assess the spatial variation of hypertension within an urban population and to investigate the association with the quality of life of city dwellers and their subjective evaluation of their residential district, as well as their home environment, using the example of Hamburg, Germany. In this cross-sectional study, the first 10,000 participants from the Hamburg City Health Study (HCHS) were analysed. Only participants who had resided at the current address for a minimum of five years were considered. In the descriptive analysis, participants with and without arterial hypertension were compared considering various parameters. The subjective quality of the living environment was obtained using an appropriate subjective living environment index. Quality of life was mapped using the EuroQol Group quality of life questionnaire (EQ-5D) score and the two (mental and physical health) scores of the Short Form Health Questionnaire SF-8. The Gini-coefficient was used to quantify the regional economic variation within Hamburg. Linear and logistic regression analyses were performed. Regional levels were 68 city district clusters in Hamburg. The analysis included n = 8192 participants living at least five years in Hamburg at the time of participation in the HCHS. There was a spatial variation in the prevalence of arterial hypertension within Hamburg. Prevalence rates between city district clusters ranged from 50.0% to 88.5%. The results showed that city district clusters with a worse subjective perception of the living environment were partly associated with an increased prevalence of arterial hypertension. Furthermore, a negative association was observed between arterial hypertension prevalence and the sociodemographic status of participants in the city district clusters. Thus, participants with a high level of education suffered less frequently from arterial hypertension than participants with a rather low level of education. The subjective living environment index and quality of life were significantly related to the occurrence of arterial hypertension; however, more extensive and detailed studies are necessary to derive possible clinical implications.
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Affiliation(s)
- Jobst Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Ramona Bei der Kellen
- Epidemiological Study Center, Hamburg City Health Study (HCHS), University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Christian-Alexander Behrendt
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
- Population Health Research Department, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), DZHK-Geschäftsstelle, 10785 Berlin, Germany
| | - Claudia Terschüren
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Leonie Ascone
- Clinic and Polyclinic for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Simone Kühn
- Clinic and Polyclinic for Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, 14195 Berlin, Germany
| | - Sandra Wolf
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
| | - Valerie Andrees
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), 20251 Hamburg, Germany
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Moon J, Jung I. A simulation study for geographic cluster detection analysis on population-based health survey data using spatial scan statistics. Int J Health Geogr 2022; 21:11. [PMID: 36085072 PMCID: PMC9463844 DOI: 10.1186/s12942-022-00311-6] [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: 04/13/2022] [Accepted: 08/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background In public health and epidemiology, spatial scan statistics can be used to identify spatial cluster patterns of health-related outcomes from population-based health survey data. Although it is appropriate to consider the complex sample design and sampling weight when analyzing complex sample survey data, the observed survey responses without these considerations are often used in many studies related to spatial cluster detection. Methods We conducted a simulation study to investigate which data type from complex survey data is more suitable for use by comparing the spatial cluster detection results of three approaches: (1) individual-level data, (2) weighted individual-level data, and (3) aggregated data. Results The results of the spatial cluster detection varied depending on the data type. To compare the performance of spatial cluster detection, sensitivity and positive predictive value (PPV) were evaluated over 100 iterations. The average sensitivity was high for all three approaches, but the average PPV was higher when using aggregated data than when using individual-level data with or without sampling weights. Conclusions Through the simulation study, we found that use of aggregate-level data is more appropriate than other types of data, when searching for spatial clusters using spatial scan statistics on population-based health survey data.
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Affiliation(s)
- Jisu Moon
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Kauhl B, Vietzke M, König J, Schönfelder M. Exploring regional and sociodemographic disparities associated with unenrollment for the disease management program for type 2 Diabetes Mellitus using Bayesian spatial modelling. RESEARCH IN HEALTH SERVICES & REGIONS 2022; 1:7. [PMID: 39177711 PMCID: PMC11281746 DOI: 10.1007/s43999-022-00007-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/21/2022] [Indexed: 08/24/2024]
Abstract
BACKGROUND The disease management program (DMP) for type 2 Diabetes Mellitus (T2DM) is the largest DMP in Germany. Our goal was to analyze regional differences in unenrollment rates, suggest areas for intervention and provide background information, which population groups in which locations are currently not enrolled in the DMP for T2DM. METHODS In this study, we used data of the 1.7 mil. insurants of the AOK Nordost health insurance. For the visualization of enrollment potential, we used the Besag-York-Mollie model (BYM). The spatial scan statistic (SaTScan) was used to detect areas of unusually high rates of unenrolled diabetics to prioritize areas for intervention. To explore sociodemographic associations, we used Bayesian spatial global regression models. A Spatially varying coefficient model (SVC) revealed in how far the detected associations vary over space. RESULTS The proportion of diabetics currently not enrolled in the DMP T2DM was 36.8% in 2019 and varied within northeastern Germany. Local clusters were detected mainly in Mecklenburg-West-Pomerania and Berlin. The main sociodemographic variables associated with unenrollment were female sex, younger age, being unemployed, foreign citizenship, small household size and the proportion of persons commuting to work outside their residential municipality. The SVC model revealed important spatially varying effects for some but not all associations. CONCLUSION Lower socioeconomic status and foreign citizenship had an ubiquitous effect on not being enrolled. The DMP T2DM therefore does currently not reach those population groups, which have a higher risk for secondary diseases and possible avoidable hospitalizations. Logically, future interventions should focus on these groups. Our methodology clearly suggests areas for intervention and points out, which population group in which locations should be specifically approached.
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Affiliation(s)
- B Kauhl
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany.
| | - M Vietzke
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | - J König
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
| | - M Schönfelder
- AOK Nordost - Die Gesundheitskasse, Potsdam, Germany
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Augustin J, Wolf S, Stephan B, Augustin M, Andrees V. Psoriasis comorbidities in Germany: A population-based study on spatiotemporal variations. PLoS One 2022; 17:e0265741. [PMID: 35316303 PMCID: PMC8939781 DOI: 10.1371/journal.pone.0265741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/04/2022] [Indexed: 11/19/2022] Open
Abstract
Psoriasis is a chronic disease with high impact on patients' health and their quality of life. Psoriasis often occurs along with other comorbidities, but it is not yet clear what role the comorbidities play in regional psoriasis prevalence. This study investigates the temporal and regional variation of the psoriasis comorbidities diabetes mellitus type II, obesity, hypertension, affective disorders in Germany and their association with psoriasis prevalence. This analysis based on the population set of ambulatory claims data (2010-2017) of the statutory health insurance (SHI) in Germany (approx. 70.3 million people in 2017). Psoriasis comorbidities rates were determined on county level. We performed descriptive spatiotemporal analyses of psoriasis comorbidity prevalence rates. In addition, we identified and compared spatial clusters and examined regional variations using spatial statistical methods. The results show strong regional variations (northeast to south gradient) and an increasing psoriasis prevalence (max. 28.8%) within the observation period. Considering the comorbidities, results indicate comparable spatial prevalence patterns for diabetes mellitus type II, obesity and hypertension. This means that the highest prevalence of comorbidities tends to be found where the psoriasis prevalence is highest. The spatiotemporal cluster analyses could once again confirm the results. An exception to this is to be found in the case of affective disorders with different spatial patterns. The results of the studies show the first spatiotemporal association between psoriasis prevalence and comorbidities in Germany. The causalities must be investigated in more detail in order to be able to derive measures for improved care.
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Affiliation(s)
- Jobst Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Sandra Wolf
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Brigitte Stephan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Valerie Andrees
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Okui T, Park J. Difference in the prevalence of hypertension and its risk factors depending on area-level deprivation in Japan. BMC Res Notes 2022; 15:37. [PMID: 35144673 PMCID: PMC8832789 DOI: 10.1186/s13104-022-05931-6] [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: 09/27/2021] [Accepted: 01/28/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Area-level deprivation is an important factor related to mortality or health behaviors; however, a study investigating differences in hypertension prevalence depending on area-level deprivation has not been conducted in Japan. We investigated differences in the prevalence of hypertension and its risk factors, i.e. obesity, smoking, alcohol consumption, and heavy alcohol drinking depending on area-level deprivation using nationwide health checkups data in 2018. Results Area-level deprivation was derived from census data. An analysis of the data by secondary medical areas revealed that the age-standardized proportions of individuals whose systolic blood pressure was ≥ 140 mmHg, those whose diastolic blood pressure was ≥ 90 mmHg, those whose body mass index was ≥ 25 or 30 kg/m2, smokers, and heavy alcohol drinkers showed an increasing trend with an increase in the deprivation level. The relative index of inequality, which can be interpreted as the ratio of the age-standardized proportion for the most deprived area compared with that for the least deprived area, was significantly greater than 1 for all proportions, except for the proportion of drinkers in women. Overall, there was a disparity in the prevalence of hypertension and its risk factors depending on area-level deprivation. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05931-6.
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Affiliation(s)
- Tasuku Okui
- Medical Information Center, Kyushu University Hospital, Maidashi3-1-1 Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan.
| | - Jinsang Park
- Department of Pharmaceutical Sciences, International University of Health and Welfare, Fukuoka, Japan
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Yang H, Hu X, Li M, Song H. Spatial deprivation: Impact on settlement intentions of eco‐migrants. INTERNATIONAL MIGRATION 2021. [DOI: 10.1111/imig.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Haijuan Yang
- Xinhua College Ningxia University Yinchuan China
| | - Xiwu Hu
- College of Economics and Management Qinghai Nationalities University Xining China
| | - Mingji Li
- School of Resources and Environment Ningxia University Yinchuan China
| | - HakJun Song
- College of Business Administration Pai Chai University Daejeon Republic of Korea
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Geospatial Analysis of Sodium and Potassium Intake: A Swiss Population-Based Study. Nutrients 2021; 13:nu13061798. [PMID: 34070444 PMCID: PMC8229307 DOI: 10.3390/nu13061798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022] Open
Abstract
Inadequate sodium and potassium dietary intakes are associated with major, yet preventable, health consequences. Local public health interventions can be facilitated and informed by fine-scale geospatial analyses. In this study, we assess the existence of spatial clustering (i.e., an unusual concentration of individuals with a specific outcome in space) of estimated sodium (Na), potassium (K) intakes, and Na:K ratio in the Bus Santé 1992–2018 annual population-based surveys, including 22,495 participants aged 20–74 years, residing in the canton of Geneva, using the local Moran’s I spatial statistics. We also investigate whether socio-demographic and food environment characteristics are associated with identified spatial clustering, using both global ordinary least squares (OLS) and local geographically weighted regression (GWR) modeling. We identified clear spatial clustering of Na:K ratio, Na, and K intakes. The GWR outperformed the OLS models and revealed spatial variations in the associations between explanatory and outcome variables. Older age, being a woman, higher education, and having a lower access to supermarkets were associated with higher Na:K ratio, while the opposite was seen for having the Swiss nationality. Socio-demographic characteristics explained a major part of the identified clusters. Socio-demographic and food environment characteristics significantly differed between individuals in spatial clusters of high and low Na:K ratio, Na, and K intakes. These findings could guide prioritized place-based interventions tailored to the characteristics of the identified populations.
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Gomes CS, Bernal RTI, Moreira AD, Teixeira RA, Cardoso LSDM, Ribeiro ALP, Malta DC. Estimates of hypertension and diabetes mellitus prevalence according to Health Vulnerability Index in Belo Horizonte, MG, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210015. [PMID: 33886888 DOI: 10.1590/1980-549720210015.supl.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/12/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalences of hypertension and diabetes for small areas in Belo Horizonte, according to the Health Vulnerability Index (HVI). METHODS Ecological study with data from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigitel) conducted in Belo Horizonte, from 2006 to 2013. The self-reported diagnosis of diabetes and hypertension were evaluated. The estimates of prevalence and the 95% confidence interval (95%CI) were calculated using the direct and indirect method by HVI grouped into four categories: low, medium, high and very high health risk. RESULTS During the period evaluated, 26% (95%CI 25.2 - 26.8) and 6.1% (95%CI 6.7 - 6.5) of the adult population from Belo Horizonte reported being hypertensive and diabetic, respectively. According to the indirect method to obtain estimates of hypertension and diabetes prevalences per HVI, it was found that areas of very high risk had a higher prevalence of adults with hypertension (38.6%; 95%CI 34.8 - 42.4) and diabetes (16.2%; 95%CI 13.1 - 19.3) when compared to the low risk (28.2%; 95%CI 27.0 - 29.4 and 6%; 95%CI 5.4 - 6.7, respectively). CONCLUSION The adult population living in areas at high risk for health had a higher prevalence of hypertension and diabetes compared to those with a lower risk.
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Affiliation(s)
- Crizian Saar Gomes
- Postgraduate Program, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Regina Tomie Ivata Bernal
- Postgraduate Program, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Alexandra Dias Moreira
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Renato Azeredo Teixeira
- Postgraduate Program, School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | - Antonio Luiz Pinho Ribeiro
- Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | - Deborah Carvalho Malta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
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Higher prevalence of heart failure in rural regions: a population-based study covering 87% of German inhabitants. Clin Res Cardiol 2019; 108:1102-1106. [DOI: 10.1007/s00392-019-01444-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/18/2019] [Indexed: 01/13/2023]
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Lee H, Park S, Kim HC. Temporal and Geospatial Trends of Hypertension Management in Korea: a Nationwide Study 2002-2016. Korean Circ J 2019; 49:514-527. [PMID: 30808085 PMCID: PMC6554585 DOI: 10.4070/kcj.2018.0358] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/26/2018] [Accepted: 01/04/2019] [Indexed: 11/27/2022] Open
Abstract
Background and Objectives Geographic distribution of hypertension management in Korea has never been reported. We investigated temporal and regional trends of hypertension management in Korea. Methods For each calendar year from 2002 to 2016, we identified 2,423,245 to 7,549,989 persons aged ≥30 years treated for hypertension (total 80,564,109 cases). We calculated yearly age-sex standardized rates for medication adherence, combination therapy, blood test, and urine test according to geographic regions. We then used multivariate logistic regression to calculate odds ratios for hypertension management adjusted for individual-level sociodemographic factors. Results Adherence rates have markedly increased from 24.4% (2002) to 71.6% (2016) nationwide. Regional difference was prominent in 2002 (highest, 31.7% in Seoul; lowest, 14.4% in Jeonbuk), but has become less noticeable over 15 years (highest, 73.1% in Daejeon; lowest, 69.0% in Jeonnam, 2016). Combination therapy rates increased from 42.8% (2002) to 61.0% (2011), but are in decreasing trend after 2011. Blood test rates were 58.8% in 2016, whereas urine test rates have been stagnant below 50% across all regions. Geographic variations of combination therapy and complication screening rates were not profound. Results from multivariable logistic regression, adjusted for age and sex, were in agreement with trends observed by standardized rates. The odds ratios remained unchanged when the models were further adjusted for employment status and household income. Conclusions Regional difference in hypertension management was evident in the past, but has become less apparent over the last 15 years in Korea.
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Affiliation(s)
- Hokyou Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Big Data Steering Department, National Health Insurance Service, Wonju, Korea.
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Who is where at risk for Chronic Obstructive Pulmonary Disease? A spatial epidemiological analysis of health insurance claims for COPD in Northeastern Germany. PLoS One 2018; 13:e0190865. [PMID: 29414997 PMCID: PMC5802453 DOI: 10.1371/journal.pone.0190865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/21/2017] [Indexed: 11/19/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) has a high prevalence rate in Germany and a further increase is expected within the next years. Although risk factors on an individual level are widely understood, only little is known about the spatial heterogeneity and population-based risk factors of COPD. Background knowledge about broader, population-based processes could help to plan the future provision of healthcare and prevention strategies more aligned to the expected demand. The aim of this study is to analyze how the prevalence of COPD varies across northeastern Germany on the smallest spatial-scale possible and to identify the location-specific population-based risk factors using health insurance claims of the AOK Nordost. Methods To visualize the spatial distribution of COPD prevalence at the level of municipalities and urban districts, we used the conditional autoregressive Besag–York–Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific ecological risk factors for COPD. Results The sex- and age-adjusted prevalence of COPD was 6.5% in 2012 and varied widely across northeastern Germany. Population-based risk factors consist of the proportions of insurants aged 65 and older, insurants with migration background, household size and area deprivation. The results of the GWR model revealed that the population at risk for COPD varies considerably across northeastern Germany. Conclusion Area deprivation has a direct and an indirect influence on the prevalence of COPD. Persons ageing in socially disadvantaged areas have a higher chance of developing COPD, even when they are not necessarily directly affected by deprivation on an individual level. This underlines the importance of considering the impact of area deprivation on health for planning of healthcare. Additionally, our results reveal that in some parts of the study area, insurants with migration background and persons living in multi-persons households are at elevated risk of COPD.
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