geographical distribution of incidence and fatality of coronary heart disease hospital admissions in...
TRANSCRIPT
Geographical Distribution of
Incidence and Fatality of Coronary
Heart Disease Hospital
Admissions in PortugalIntrodução à Medicina II
Class13
Adviser: Armando Teixeira Pinto, PhD
Faculdade de Medicina da Universidade do Porto
Mestrado Integrado em Medicina
2009/2010
Cardiovascular diseases are the most common cause of death in Europe. [1]
Among them, coronary heart disease (CHD) is the most frequent. [1]
Two million Europeans die from CHD each year, 21% men and 22% women. [2]
Regional variations in cardiovascular mortality have been observed both between and within countries in Europe. [3]
INTRODUCTION Importance
[1] World Health Organization <http://www.who.int/mediacentre/factsheets/fs310/en/index.html>
[2] The Women’s Health Resource < http://www.imaginis.com/heart-disease/cad_ov.asp>
[3] Tu J V, Nardi L, Willich S N. “An update on regional variation in cardiovascular mortality within Europe”. Heart J., May 2, 2008,
In PortugalIn Portugal
Stroke and ischemic heart disease are the leading
causes of hospitalization and death, as well as of morbidity,
disability, low quality of life and decrease in life expectancy. [4]
The analysis of regional variance in CHD is important
for the classification of regions in high- and low- risk regions. [3]
INTRODUCTION Importance
[4] Direcção geral de saúde. Actualização do Programa Nacional de Prevenção e Controlo das Doenças Cardiovasculares. 2006.
[3] Tu J V, Nardi L, Willich S N. “An update on regional variation in cardiovascular mortality within Europe”. Heart J., May 2, 2008,
INTRODUCTION Coronary Disease
[5] NATIONAL HEART, LUNG, AND BLOOD INSTITUTE - Coronary Artery Disease. < http://www.nlm.nih.gov/medlineplus/coronaryarterydisease.html>
Analyze the variation in the CHD hospital
admissions’ Fatality and Incidence in Portugal
(continental) both on a national and on a regional
level throughout the 2000-2007 year period.
AIM
Database
Data from all Portuguese Public Hospitals, from 2000 to 2007.
PARTICIPANTS AND METHODS Data collection
Extract of the GDH Database variables
Exclusion criteria
Ages above 112
Admissions from Açores and Madeira
Hospitalization Period (days) <1
(Patients with HP inferior to 1 day in case of death or transference to the hospital unit or discharge on personal demand were not excluded)
Admissions with undefined sex
PARTICIPANTS AND METHODS Statistical analysis
What did we study?
Geographical distribution of incidence and fatality
of CHD (hospital admissions).
Evolution of incidence and fatality of CHD (hospital
admissions) along the 2000-2007 period.
PARTICIPANTS AND METHODS Statistical analysis
INCIDENCE = number of hospital admissions from CHD number of habitants
FATALITY = number of hospital deaths from CHD number of hospital admissions from CHD
Maps construction of geographical distribution for incidence and fatality – R
Statistical analysis tool – SPSS Statistics 17.0
Maps construction of geographical distribution for incidence and fatality – R
Statistical analysis tool – SPSS Statistics 17.0
PARTICIPANTS AND METHODS Statistical analysis
Incidence adjusted rate = SIR * Incidence crude rate Incidence adjusted rate = SIR * Incidence crude rate
PARTICIPANTS AND METHODS Statistical analysis
SIR = Number of expected admissions by CHDNumber of observed admissions by CHD
SIR = Number of expected admissions by CHDNumber of observed admissions by CHD
PARTICIPANTS AND METHODS Statistical analysis
2000 2001 2002 2003 2004 2005 2006 2007
Portugal 281 286 284 287 291 289 277 281
Norte SIR 224 233 233 232 230 235 223 256
CIR 203 211 212 210 209 214 207 235
CentroSIR 162 175 174 185 192 199 197 192
CIR 177 191 191 203 210 217 207 209
Lisboa e Vale do TejoSIR 503 506 493 496 498 476 437 408
CIR 491 493 480 483 485 464 432 398
AlentejoSIR 204 194 197 198 207 213 228 253
CIR 244 234 237 238 249 255 275 300
Algarve SIR 241 217 254 242 259 238 241 261
CIR 264 236 264 262 279 255 261 278
Table 1: Comparison on age- and gender- standardized incidence rates (SIR) and crude incidence rates (CIR).
Importance of standardization
RESULTS Adjusted incidence rate
Figure 1: Age- and gender- adjusted rates of hospital admissions because of coronary heart disease per 100 000 population in Continental Portugal, 2000-2007.
RESULTS Adjusted fatality rate
Figure 2: Age- and gender- adjusted in-hospital case fatality rates among patients with coronary heart disease in Continental Portugal, 2000-2007.
RESULTS Adjusted incidence rate VS Adjusted fatality rate
Figure 3: Comparison on age- and gender- adjusted rates of hospital admissions because of coronary heart disease per 100 000 population and age- and gender- standardized in-hospital case fatality rates among patients with coronary heart disease in Continental Portugal, 2000-2007.
There were regional differences on the distribution of the There were regional differences on the distribution of the incidence of CHD Continental Portugalincidence of CHD Continental Portugal
Gender and age only were not responsible for the regional variation
Lisboa e Vale do TejoLisboa e Vale do Tejo
Highest incidence rate of CHD, but fatality rate similar to the other regions
decrease on the incidence rate of CHD in the 2004-2007 period of the study
DISCUSSION
Other regions
The incidence and fatality of CHD in these regions were The incidence and fatality of CHD in these regions were very similar.very similar.
Centro presents the lowest incidence rate of CHD, but fatality rate similar to the other regions.
DISCUSSION
RESULTS Adjusted incidence rate VS Adjusted fatality rate
Figure 3: Comparison on age- and gender- adjusted rates of hospital admissions because of coronary heart disease per 100 000 population and age- and gender- standardized in-hospital case fatality rates among patients with coronary heart disease in Continental Portugal, 2000-2007.
Possible bias from errors in the database
Missing values: admissions that don’t include address, gender, age or hospitalization cause
Wrong data
Several hospitalizations for the same person
Hospital transferences
Choosing the main diagnosis as the inclusion criteria may create unexpected bias
Different data quality between regions
Non-inclusion of private inpatients
Non-inclusion of individuals with CHD who haven’t been hospitalized
DISCUSSION Limitations
Better classification of regions into high- and low- risk incidence and fatality of CHD
Improvement of healthcare at regional levels, decreasing incidence and fatality of CHD
Better use of available resources
Adoption of more preventive measures
Stimulation for further analysis and studies
DISCUSSION Value
Risk factors
Cultural factors
Lifestyles
Preventive measures of CHD
Evaluation of CHD treatment efficiency
DISCUSSIONFurther Studies
REFERENCES
[1] WORLD HEALTH ORGANIZATION - Top 10 causes of death. [Consult. 27 Out. 2009]. WWW: <http://www.who.int/mediacentre/factsheets/fs310/en/index.html>
[2] IMAGINUS: THE WOMEN’S HEALTH RESOURCE - Coronary Artery Disease (CAD) Overview.[Consult. 20 Out. 2009].WWW: <http://www.imaginis.com/heart-disease/cad_ov.asp>
[3] Tu J V, Nardi L, Fang J. Muller-Nordhorn J, Binting S, Roll S, Willich S N. “An update on regional variation in cardiovascular mortality within Europe”. Heart J., May 2, 2008; 29 (10): 1316 - 1326.
[4] DIRECÇÃO GERAL DE SAÚDE. MINISTÉRIO DA SAÚDE. Circular Normativa. Actualização do Programa Nacional de Prevenção e Controlo das Doenças Cardiovasculares. Ministério da Saúde 2006.
[5] NATIONAL HEART, LUNG, AND BLOOD INSTITUTE - Coronary Artery Disease. [Consult. 19 Out. 2009].WWW: <http://www.nlm.nih.gov/medlineplus/coronaryarterydisease.html#cat596>
[6] WORLD HEALTH ORGANIZATION - International Classification of Diseases (ICD). [Consult. 20 Out. 2009].WWW: http://www.who.int/classifications/icd/en/
[7] CENTERS FOR DISEASE CONTROL AND PREVENTION - International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). (1 Set. 2009). [Consult. 22 Out. 2009].
WWW: < http://www.cdc.gov/nchs/icd/icd9cm.htm>
[8] INSTITUTO NACIONAL DE ESTATÍSTICA. População residente (N.º) por Local de residência, Sexo e Grupo etário (Por ciclos de vida); Anual.
[9] “National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke”, 1994–2004. CMAJ. 2009;180:E118–25.
REFERENCES
[10] Johansen H, Bernier J, Finès P, Brien S, Ghali W, Wolfson M. “Variations by health region in treatment and survival after heart
attack”. Health Rep. 2009 Jun;20(2):29-34.[11] Tsiskaridze A, Djibuti M, van Melle G, Lomidze G, Apridonidze S, Gaurashvili I, Piechowski-Jozwiak B, Shakarishvili R, Bogousslavsky J. “Stroke Incidence and 30-Day Case-Fatality in a Suburb of Tbilisi” Stroke, 2004, 35:2523-2528.
[11] Wolfe C D A, Taub N A, Woodrow J, Richardson E, Warburton F G, Burney P G J. “Does the incidence, severity, or case fatality of stroke vary in southern England?”, Journal of Epidemiology and Community Health 1993; 47: 139-143
[12] Périssé G, Medronho R A, Escosteguy C C. “Urban space and mortality from ischemic heart disease in the elderly in Rio de
Janeiro.” Arq. Bras. Cardiol. Mar 05, 2010. [13] Lang T, Ducimetiere P, Arveiler D, et al. “Incidence, case fatality, risk factors of acute coronary heart disease and occupational categories in men aged 30-59 in France”. International Journal of Epidemiology 1997; 26: 47-57
[14] Bertoni A G, Kirk J K, Case L D, Kay C, Goff D C Jr, Narayan K M, Bell R A. “The effects of race and region on cardiovascular morbidity among elderly Americans with diabetes”. Diabetes Care. 2005 Nov;28(11):2620-5.
[15] Chaves A P, André C. “A percepção da qualidade de vida da pessoa com doença coronária referenciada à consulta de cardiologia do hospital distrital de Santarém”, EP. Out, 2008