Geographic Disparity in Chronic Obstructive Pulmonary Disease (COPD) Mortality Rates among the Taiwan Population

Abstract

Chronic obstructive pulmonary disease (COPD) causes a high disease burden among the elderly worldwide. In Taiwan, the long-term temporal trend of COPD mortality is declining, but the geographical disparity of the disease is not yet known. Nationwide COPD age-adjusted mortality at the township level during 1999–2007 is used for elucidating the geographical distribution of the disease. With an ordinary least squares (OLS) model and geographically weighted regression (GWR), the ecologic risk factors such as smoking rate, area deprivation index, tuberculosis exposure, percentage of aborigines, density of health care facilities, air pollution and altitude are all considered in both models to evaluate their effects on mortality. Global and local Moran’s I are used for examining their spatial autocorrelation and identifying clusters. During the study period, the COPD age-adjusted mortality rates in males declined from 26.83 to 19.67 per 100,000 population, and those in females declined from 8.98 to 5.70 per 100,000 population. Overall, males’ COPD mortality rate was around three times higher than females’. In the results of GWR, the median coefficients of smoking rate, the percentage of aborigines, PM10 and the altitude are positively correlated with COPD mortality in males and females. The median value of density of health care facilities is negatively correlated with COPD mortality. The overall adjusted R-squares are about 20% higher in the GWR model than in the OLS model. The local Moran’s I of the GWR’s residuals reflected the consistent high-high cluster in southern Taiwan. The findings indicate that geographical disparities in COPD mortality exist. Future epidemiological investigation is required to understand the specific risk factors within the clustering areas.

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Examining the Effect of the Environment and Commuting Flow from/to Epidemic Areas on the Spread of Dengue Fever

“…The geographically weighted regression model (GWR) is a modeling technique that reveals the spatial heterogeneity among the independent and dependent variables, allowing the estimation of the regression coefficient to vary with location [49][50][51]. It has been widely used in disease mapping [46,[52][53][54]. GWR is originally developed assuming a Gaussian distribution of the dependent variable, so it cannot be applied for count data such as DF cases.…”

Inequidades geográficas y tuberculosis en Costa Rica, 2008-2012

“…Las correlaciones con indicadores socioeconómicos y de calidad del aire fueron significativas y relevantes para explicar el comportamiento territorial (Chan et al, 2014).…”

“…Se utiliza el concepto de vulnerabilidad social para enfocarse en ciertos grupos de personas, como la etnia, la condición socioeconómica (Pasipanodya et al, 2012), o que tienen modos de vida en sus espacios laborales y domésticos que favorecen la transmisión de la enfermedad y dificultan el acceso a la atención (Goldberg, 2012). El comportamiento espacial de la morbilidad y la mortalidad de las enfermedades respiratorias se ha asociado también con la contaminación ambiental y la privación material en el caso de la Enfermedad Pulmonar Obstructiva Crónica (EPOC) (Chan, Chian, Ming Daw, Hsuan-wen, y Shi-yung Liu, 2014) Las barreras geográficas y socioeconómicas para el acceso al tratamiento determina la prevalencia de la tuberculosis en primer lugar, pero también nuevos casos y su letalidad (Mauch et al, 2011). El estudio del comportamiento geográfico de la enfermedad se ha considerado fundamental para orientar la vigilancia epidemiológica y el control del riesgo en Estados Unidos (Penman Aguilar, McDavid, y Hazel, 2013).…”