An ecological study on the geographic patterns of ischaemic heart disease in Portugal and its association with demography, economic factors and health resources distribution

Abstract

ObjectivesBeing one of the main causes of morbidity and mortality in developed countries, ischaemic heart disease's (IHD) incidence and mortality present clear differences between and within countries. Several authors already proposed possible explanations based on the demography, environmental factors, diet and level of urbanisation. This study reflects the Portuguese reality concerning IHD, by analysing the geographical distribution of hospital admissions and mortality due to this condition, in Portugal, and its association with demography, economical factors and the distribution of healthcare resources at the regional level.DesignEcological study.SettingData from all Portuguese Public Hospitals were obtained using the National Registry of Hospital Admissions, between 2000 and 2007, and data on demography, economical factors and health resources distribution were obtained from the National Institute of Statistics.ParticipantsAggregated statistics on hospital admissions and mortality were computed for 278 counties based on almost 200 000 admissions.Primary and secondary outcome measuresMortality rate; hospital admissions rate.ResultsThe geographical distribution of non-adjusted mortality and hospital admission showed an inner/coastal pattern but no North/South gradient was clear. Counties with higher economical development had significantly higher mortality and admission rates. However, healthcare resources distribution was not significantly associated with IHD hospital admission and mortality. When adjusted for age, gender, economic development and health resources distribution, there was still unexplained geographical variation both in hospital admissions and mortality rates.ConclusionA pattern in the geographic distribution of incidence and mortality of IHD was clear even after the adjustment for age and gender. Economical variables were the ones presenting the strongest association. These types of analysis may be very helpful for the definition of health policies, in particular to identify priority regions for disease prevention and guidelines for healthcare resources distribution.

Development of a measure of multiple physical environmental deprivation. After United Kingdom and New Zealand, Portugal

“…[20][21][22][23] Nevertheless, the strong regional differences in diseases, such as coronary heart disease, remain partially unexplained, possibly due to the restricted diversity (mostly economic and health resources) of the explanatory variables that have been considered. 20 On the basis of the research from the UK and NZ, we aimed to develop a Portuguese measure of multiple environmental deprivation (PT-MEDIx). Our aim was also to assess how the choice of the environmental factors, datasets and methods of analysis should be adapted to the Portuguese idiosyncrasies without compromising comparability.…”

The SMILE Program: Does Timing and Dosing of Nurse Home Visits Matter in Reducing Adverse Birth Outcomes for African American Women

“…Understandably then, agencies such as the World Health Organization and policy initiatives like Healthy People 2020 now acknowledge that health is too complex a phenomenon to not be considered within the broader social, cultural, and economic environments in which people live, work, and play (Evans, Barer, & Marmor, 1994;Marmot, 2005;Solar & Irwin, 2010). Thus, the emergent trend is to examine how and to what extent the various psychosocial, economic and political, and biological pathways of social determinants of health synergistically influence health, both positively and adversely (Chin et al, 2012;Chin, Walters, Cook, & Huang, 2007;Colditz & Wei, 2012;Cummins, Stafford, Macintyre, Marmot, & Ellaway, 2005;Ferreira-Pinto LM, 2012;Ferrie, Martikainen, Shipley, & Marmot, 2005;Freudenberg, Klitzman, & Saegert, 2009;Gerend & Pai, 2008;Knutson, 2012;Kumari, Marmot, Rumley, & Lowe, 2005;Solar & Irwin, 2010;Vona-Davis & Rose, 2009).…”

Regional variation in coronary heart disease mortality trends in Portugal, 1981–2012

“…This report states that it is difficult to assess and monitor the extent of the health inequalities in Portugal, due to the lack of a monitoring system of health indicators by target population groups, owing, at least in part, to a narrow interpretation of the data confidentiality law. A recent ecological study showed geographic variation in hospital admissions and in-hospital mortality of patients admitted with ischemic heart disease in Portugal from 2000 to 2007, with the interior regions showing higher rates, not fully explained by socio-demographic, economical and health resource factors [9]. It is of interest to expand this observation to a longer period and to consider total mortality, in addition to in-hospital mortality.…”