Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil

Abstract

ObjectiveThe aim of this observational cross-sectional study was to analyse the spatial distribution of major lower limb amputation (MLLA) rates and associate them to socioeconomic, demographic and public healthcare access-related variables in the State of Paraná, Brazil, from 2012 to 2017.MethodData on MLLA, revascularisation surgeries, diagnostic exams and healthcare coverage were obtained from the Brazilian Public Hospital Information System. Socioeconomic data were obtained from the Brazilian Institute of Geography and Statistics. Spatial autocorrelation of the MLLA rates was tested using Moran’s I method. Multivariate spatial regression models using ordinary least squares regression (OLS) and geographically weighted regression (GWR) were used to identify the variables significantly correlated with MLLA.ResultsA total of 5270 MLLA were included in the analysis. Mean MLLA rates were 24.32 (±18.22)/100 000 inhabitants, showing a positive global spatial autocorrelation (Moran’s I=0.66; p<0.001). Queen contiguity matrix demonstrates that MLLA rates ranged from 7.6 to 46.6/100 000 with five large clusters of high MLLA rates. OLS showed that four of the nine studied variables presented significant spatial correlation with MLLA rates. Colour Doppler ultrasound showed a negative association (p<0.001), while revascularisation surgeries and illiteracy showed a positive correlation (p<0.01). GWR presented the best model (adjusted R2=0.77) showing that the predictors differentially affect the MLLA rates geographically.ConclusionThe high MLLA rates in some regions of the state are influenced by the high rate of illiteracy and low utilisation rate of colour Doppler, indicating a social problem and difficulty in accessing health. On the other hand, the high rates of revascularisation surgeries are related to higher MLLA rates, possibly due to delayed access to specialised hospitals. This indicates that attention must be given to population access to public healthcare in the State of Paraná in order to ensure proper and timely medical attention.

The spatial and temporal trends of severe periodontitis burden in Asia, 1990–2019: A population‐based epidemiological study

“…The global autocorrelation was assessed using Global Moran's I to characterize the overall spatial pattern as clustered or random, which ranged from −1 to 1, with a positive value indicating that a given country has similar pattern to the surrounding countries, a negative value indicating that a given country had inverse pattern compared with the surrounding countries, with Moran's I of 0 indicating a random distribution. [21][22][23] The significance of Moran's I was evaluated by the Z statistic and P value. However, the global autocorrelation could not identify where the clusters were located or what types of spatial autocorrelation was occurring.…”

“…Therefore, we used the global and local spatial autocorrelation analysis to evaluate spatial characteristics of severe periodontitis in Asian countries. The global autocorrelation was assessed using Global Moran's I to characterize the overall spatial pattern as clustered or random, which ranged from −1 to 1, with a positive value indicating that a given country has similar pattern to the surrounding countries, a negative value indicating that a given country had inverse pattern compared with the surrounding countries, with Moran's I of 0 indicating a random distribution 21–23 . The significance of Moran's I was evaluated by the Z statistic and P value.…”

High Level of Unwarranted Clinical Variation in the Use of Lower Extremity Revascularisation Procedures in Hungary (2013–2017)

“…8 Although vascular guidelines make an effort to standardise the service of lower extremity revascularisations, 9,10 differences in practice exist. Reports on regional variations of lower extremity open vascular or endovascular revascularisation procedures have been provided from the United States, 11,12 Canada, 13 Norway, 14 and Brazil 15 focusing on different study populations. These reports only presented the existence of regional variations, expressed by a simple metric, 11,14 or they tried to explore an association with amputation activity.…”

“…These reports only presented the existence of regional variations, expressed by a simple metric, 11,14 or they tried to explore an association with amputation activity. 12,13,15 However, additional aspects have not yet been addressed. These include (1) whether the spatial variation in lower extremity revascularisation practice is higher than randomly expected, (2) how to measure and interpret the magnitude of such a variation, and (3) how to assess whether the spatial variation exceeds that which could be accounted for differences in patient demographics, comorbidities, or preferences (acceptable or understandable sources of variations).…”