Geographic disparities and temporal changes in risk of death from myocardial infarction in Florida, 2000–2014

Abstract

Background Identifying disparities in myocardial infarction (MI) burden and assessing its temporal changes are critical for guiding resource allocation and policies geared towards reducing/eliminating health disparities. Our objectives were to: (a) investigate the spatial distribution and clusters of MI mortality risk in Florida; and (b) assess temporal changes in geographic disparities in MI mortality risks in Florida from 2000 to 2014. Methods This is a retrospective ecologic study with county as the spatial unit of analysis. We obtained data for MI deaths occurring among Florida residents between 2000 and 2014 from the Florida Department of Health, and calculated county-level age-adjusted MI mortality risks and Spatial Empirical Bayesian smoothed MI mortality risks. We used Kulldorff’s circular spatial scan statistics and Tango’s flexible spatial scan statistics to identify spatial clusters. Results There was an overall decline of 48% in MI mortality risks between 2000 and 2014. However, we found substantial, persistent disparities in MI mortality risks, with high-risk clusters occurring primarily in rural northern counties and low-risk clusters occurring exclusively in urban southern counties. MI mortality risks declined in both low- and high-risk clusters, but the latter showed more dramatic decreases during the first nine years of the study period. Consequently, the risk difference between the high- and low-risk clusters was smaller at the end than at the beginning of the study period. However, the rates of decline levelled off during the last six years of the study, and there are signs that the risks may be on an upward trend in parts of North Florida. Moreover, MI mortality risks for high-risk clusters at the end of the study period were on par with or above those for low-risk clusters at the beginning of the study period. Thus, high-risk clusters lagged behind low-risk clusters by at least 1.5 decades. Conclusion Myocardial infarction mortality risks have decreased substantially during the last 15 years, but persistent disparities in MI mortality burden still exist across Florida. Efforts to reduce these disparities will need to target prevention programs to counties in the high-risk clusters.

Disparities in Temporal and Geographic Patterns of Myocardial Infarction Hospitalization Risks in Florida

“…Since MI is a life-threatening health condition requiring immediate catherization within 90 min of first medical contact [100], MI hospitalization risk may serve as a proxy for morbidity, in which case our results showing a clustering of low MI hospitalization risks in rural counties in Northwest Florida between 2005–2010 would suggest low MI morbidity risks in Northwest Florida during that period. This contradicts the persistent clustering of high MI mortality risks we recently observed throughout a majority of northern Florida rural counties between 2000 and 2014 [11]. Therefore, the clustering of low MI hospitalization risks we observed in rural counties in Northwest Florida during the first six years of study does not imply lower MI morbidity or more favorable cardiovascular health for residents in those counties.…”

“…Moreover, the spatial patterns for MI hospitalization risks we observed in this study generally mirror the patterns of clustering previously observed for stroke, heart disease, diabetes, and hypertension rates in various county-level ecologic studies in the U.S. [10,13,14,23,69,70]. The spatial location of clusters with persistently low or high MI hospitalization risks are also remarkably similar to the location of persistent MI mortality risk clusters we identified in Florida between 2000–2014 [11]. The only notable discrepancies between MI hospitalization and mortality clusters were the persistent clustering of MI hospitalization risks in South Central Florida and the lack of persistent clustering of high MI hospitalization risks in Northwest Florida.…”

“…Moreover, the reversal of the favorable temporal trends in the high-risk cluster in North Central Florida in the latter four years of study threatens to undo the progress made in reducing the MI burden in the last decades. We observed remarkably similar temporal patterns for MI mortality risks in Florida between 2000–2014 [11].…”

“…Extant literature shows that cardiovascular events tend to cluster persistently in certain populations defined by geography or demographic characteristics [10,11,12,13,14]. Additionally, the burden of major cardiovascular disease (CVD) risk factors, such as obesity, diabetes, and smoking are disproportionately higher in certain geographic regions, particularly rural areas in the Southern and Southeastern U.S. states [15,16,17].…”

Health service inequalities during the COVID-19 pandemic among elderly people living in large urban and non-urban areas in Florida, US

“…Our findings confirmed deficiency in providing health care to elderly people living outside of large or medium metropolitan areas (Casper et al, 2016;Singh et al, 2019). Elderly people living in small towns or rural areas were known for lacking adequate health care (Odoi, Nagle, Roberson, & Kintziger, 2019). In the time of emerging epidemic such as COVID-19, such problems may be aggravated when health care resources were under pressure of a run.…”