Geographic Variations of Stroke Hospitalization across France: A Diachronic Cluster Analysis

Lachkhem, Yacine; Minvielle, Étienne; Rican, Stéphane

doi:10.1155/2018/1897569

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…The observed geographic disparities are also consistent with findings from the REGARDS study which reported presence of geographic disparities of stroke mortality as a result of disparities in stroke incidence and case fatality rates [32]. A number of other studies have also reported geographic disparities and spatial clusters of stroke [12,33–35]. The observed high prevalence clusters in northcentral Florida are consistent with reports by Siegel et al [8], who suggested that north Florida is part of the stroke belt.…”

Section: Discussionsupporting

confidence: 87%

An exploratory investigation of geographic disparities of stroke prevalence in Florida using circular and flexible spatial scan statistics

et al. 2019

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Background Stroke is a major public health concern due to the morbidity and mortality associated with it. Identifying geographic areas with high stroke prevalence is important for informing public health interventions. Therefore, the objective of this study was to investigate geographic disparities and identify geographic hotspots of stroke prevalence in Florida. Materials and methods County-level stroke prevalence data for 2013 were obtained from the Florida Department of Health’s Behavioral Risk Factor Surveillance System (BRFSS). Geographic clusters of stroke prevalence were investigated using the Kulldorff’s circular spatial scan statistics (CSSS) and Tango’s flexible spatial scan statistics (FSSS) under Poisson model assumption. Exact McNemar’s test was used to compare the proportion of cluster counties identified by each of the two methods. Both Cohen’s Kappa and bias adjusted Kappa were computed to assess the level of agreement between CSSS and FSSS methods of cluster detection. Goodness-of-fit of the models were compared using Cluster Information Criterion. Identified clusters and selected stroke risk factors were mapped. Results Overall, 3.7% of adults in Florida reported that they had been told by a healthcare professional that they had suffered a stroke. Both CSSS and FSSS methods identified significant high prevalence stroke spatial clusters. However, clusters identified using CSSS tended to be larger than those identified using FSSS. The FSSS had a better fit than the CSSS. Most of the identified clusters are explainable by the prevalence distributions of the known risk factors assessed. Conclusions Geographic disparities of stroke risk exists in Florida with some counties having significant hotspots of high stroke prevalence. This information is important in guiding future research and control efforts to address the problem. Kulldorff’s CSSS and Tango’s FSSS are complementary to each other and should be used together to provide a more complete picture of the distributions of spatial clusters of health outcomes.

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Section: Discussionsupporting

confidence: 87%

An exploratory investigation of geographic disparities of stroke prevalence in Florida using circular and flexible spatial scan statistics

et al. 2019

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“…Local Poisson GWR models can be a valuable tool to explore the complex relationships between stroke (or other chronic diseases) and risk factors, when previous studies demonstrated spatial variability [ 20 ]. Using ordinary models for women, we found that the stroke incidence was equally distributed in the study area, whatever the degree of urbanization or the level of deprivation of the census blocks.…”

Section: Discussionmentioning

confidence: 99%

“…For men, the stroke incidence was not equally distributed, suggesting that ordinary Poisson models are less accurate and reliable and would provide bias results. GWR models bring significant improvement taking into account the presence of non-stationarity [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Gender difference of geographic distribution of the stroke incidence affected by socioeconomic, clinical and urban-rural factors: an ecological study based on data from the Brest stroke registry in France

et al. 2021

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Background Mapping the spatial distribution of disease occurrence is a strategy to identify contextual factors that could be useful for public health policies. The purpose of this ecological study was to examine to which extent the socioeconomic deprivation and the urbanization level can explain gender difference of geographic distribution in stroke incidence in Pays de Brest, France between 2008 and 2013. Methods Stroke cases aged 60 years or more were extracted from the Brest stroke registry and combined at the census block level. Contextual socioeconomic, demographic, and geographic variables at the census block level come from the 2013 national census. We used spatial and non-spatial regression models to study the geographic correlation between socioeconomic deprivation, degree or urbanization and stroke incidence. We generated maps using spatial geographically weighted models, after longitude and latitude smoothing and adjustment for covariates. Results Stroke incidence was comparable in women and men (6.26 ± 3.5 vs 6.91 ± 3.3 per 1000 inhabitants-year, respectively). Results showed different patterns of the distribution of stroke risk and its association with deprivation or urbanisation across gender. For women, stroke incidence was spatially homogeneous over the entire study area, but was associated with deprivation level in urban census blocks: age adjusted risk ratio of high versus low deprivation = 1.24, [95%CI 1.04–1.46]. For men, three geographic clusters were identified. One located in the northern rural and deprived census blocks with a 9–14% increase in the risk of stroke. Two others clusters located in the south-eastern (mostly urban part) and south-western (suburban and rural part) with low deprivation level and associated with higher risk of stroke incidence between (3 and 8%) and (8.5 and 19%) respectively. There were no differences in profile of cardiovascular risk factors, stroke type and stroke severity between clusters, or when comparing clusters cases to the rest of the study population. Conclusions Understanding whether and how neighborhood and patient’s characteristics influence stroke risk may be useful for both epidemiological research and healthcare service planning.

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“…In the French context, previous literature have suggested that, Brittany (western part of France) has the highest ischemic stroke incidence observed in 2014 (137.9 / 100,000) (14) and demonstrated geographic variations in France with one cluster located in Brittany (15). Easy access to primary care could determine these geographic variations of incidence.…”

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confidence: 97%

Geographic differences in relationship between socioeconomic, clinical, urban-rural factors and stroke incidence in France

Padilla

Foucault

Grimaud

et al. 2019

Preprint

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Background: Stroke remains a devastating disease in Europe and geographic disparities persist. Mapping spatial distributions of disease occurrence can serve as a useful tool for identifying exposures of public health concern. The purpose of this study was to investigate geographic differences in relationship between socioeconomic, clinical, urban-rural factors and stroke incidence in Pays de Brest (Western France) between 2008 and 2013.Methods: We used cases and patient’s characteristics from the Brest stroke registry, and sociodemographic, urban –rural indicators constructed at the census blocks level. We generated maps using Poisson geographic weighted regression models, smoothing on longitude and latitude while adjusting for covariates. Results: Women living in more deprived census blocks evidenced a significantly higher age standardized stroke incidence risk 1.24, [95%CI 1.09-1.39] and 1.21, [95%CI 1.04-1.49], in rural and urban census blocks respectively. For men, three clusters of census blocks with high stroke incidence risk were detected, one in rural and deprived and two in urban and low deprived census bocks. Conclusions: Understand whether and how neighborhood and patient’s characteristics influence stroke risk, may be useful for both epidemiological research and health services planning.

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Geographic Variations of Stroke Hospitalization across France: A Diachronic Cluster Analysis

Cited by 6 publications

References 29 publications

An exploratory investigation of geographic disparities of stroke prevalence in Florida using circular and flexible spatial scan statistics

An exploratory investigation of geographic disparities of stroke prevalence in Florida using circular and flexible spatial scan statistics

Gender difference of geographic distribution of the stroke incidence affected by socioeconomic, clinical and urban-rural factors: an ecological study based on data from the Brest stroke registry in France

Geographic differences in relationship between socioeconomic, clinical, urban-rural factors and stroke incidence in France

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