Int J Health Geogr - Spatial clustering of non-transported cardiac decedents: the results of a point pattern analysis and an inquiry into social environmental correlates.

Tópicos

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Resumo

CKGROUND: People who die from heart disease at home before any attempt at transport has been made may represent missed opportunities for life-saving medical intervention. In this study, we undertook a point-pattern spatial analysis of heart disease deaths occurring before transport in a large metropolitan area to determine whether there was spatial clustering of non-transported decedents and whether there were significant differences between the clusters of non-transported cardiac decedents and the clusters of transported cardiac decedents in terms of average travel distances to nearest hospital and area socioeconomic characteristics. These analyses were adjusted for individual predictors of transport status.METHODS: We obtained transport status from the place of death variable on the death certificate. We geocoded heart disease decedents to residential street addresses using a rigorous, multistep process with 97% success. Our final study population consisted of 11,485 adults aged 25-74 years who resided in a large metropolitan area in west-central Florida and died from heart disease during 1998-2002. We conducted a kernel density analysis to identify clusters of the residential locations of cardiac decedents where there was a statistically significant excess probability of being either transported or not transported prior to death; we controlled for individual-level covariates using logistic regression-derived probability estimates.RESULTS: The majority of heart disease decedents were married (53.4%), male (66.4%), white (85.6%), and aged 65-74 years at the time of death (54.7%), and a slight majority were transported prior to death (57.7%). After adjustment for individual predictors, 21 geographic clusters of non-transported heart disease decedents were observed. Contrary to our hypothesis, clusters of non-transported decedents were slightly closer to hospitals than clusters of transported decedents. The social environmental characteristics of clusters varied in the expected direction, with lower socioeconomic and household resources in the clusters of non-transported heart disease deaths.CONCLUSIONS: These results suggest that in this large metropolitan area unfavorable household and neighborhood resources played a larger role than distance to hospital with regard to transport status of cardiac patients; more research is needed in different geographic areas of the United States and in other industrialized nations.

Resumo Limpo

ckground peopl die heart diseas home attempt transport made may repres miss opportun lifesav medic intervent studi undertook pointpattern spatial analysi heart diseas death occur transport larg metropolitan area determin whether spatial cluster nontransport deced whether signific differ cluster nontransport cardiac deced cluster transport cardiac deced term averag travel distanc nearest hospit area socioeconom characterist analys adjust individu predictor transport statusmethod obtain transport status place death variabl death certif geocod heart diseas deced residenti street address use rigor multistep process success final studi popul consist adult age year resid larg metropolitan area westcentr florida die heart diseas conduct kernel densiti analysi identifi cluster residenti locat cardiac deced statist signific excess probabl either transport transport prior death control individuallevel covari use logist regressionderiv probabl estimatesresult major heart diseas deced marri male white age year time death slight major transport prior death adjust individu predictor geograph cluster nontransport heart diseas deced observ contrari hypothesi cluster nontransport deced slight closer hospit cluster transport deced social environment characterist cluster vari expect direct lower socioeconom household resourc cluster nontransport heart diseas deathsconclus result suggest larg metropolitan area unfavor household neighborhood resourc play larger role distanc hospit regard transport status cardiac patient research need differ geograph area unit state industri nation

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