Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018
Background Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast‐developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small‐area level. Methods and Results We included data of 94 106 AMI d...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.029769 |
| _version_ | 1797799584688242688 |
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| author | Jie Chang Qiuju Deng Piaopiao Hu Moning Guo Feng Lu Yuwei Su Jiayi Sun Yue Qi Ying Long Jing Liu |
| author_facet | Jie Chang Qiuju Deng Piaopiao Hu Moning Guo Feng Lu Yuwei Su Jiayi Sun Yue Qi Ying Long Jing Liu |
| author_sort | Jie Chang |
| collection | DOAJ |
| description | Background Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast‐developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small‐area level. Methods and Results We included data of 94 106 AMI deaths during 2007 to 2018 from the Beijing Cardiovascular Disease Surveillance System in this ecological study. We estimated AMI mortality for 307 townships during consecutive 3‐year periods with a Bayesian spatial model. Township‐level health care accessibility was measured using an enhanced 2‐step floating catchment area method. Linear regression models were used to examine the association between health care accessibility and AMI mortality. During 2007 to 2018, median AMI mortality in townships declined from 86.3 (95% CI, 34.2–173.8) to 49.4 (95% CI, 30.5–73.7) per 100 000 population. The decrease in AMI mortality was larger in townships where health care accessibility increased more rapidly. Geographic inequality, defined as the ratio of the 90th to 10th percentile of mortality in townships, increased from 3.4 to 3.8. In total, 86.3% (265/307) of townships had an increase in health care accessibility. Each 10% increase in health care accessibility was associated with a −0.71% (95% CI, −1.08% to −0.33%) change in AMI mortality. Conclusions Geographic disparities in AMI mortality among Beijing townships are large and increasing. A relative increase in township‐level health care accessibility is associated with a relative decrease in AMI mortality. Targeted improvement of health care accessibility in areas with high AMI mortality may help reduce AMI burden and improve its geographic inequality in megacities. |
| first_indexed | 2024-03-13T04:21:07Z |
| format | Article |
| id | doaj.art-c30f7059a2f34c9ca7a6b39719cd755c |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T04:21:07Z |
| publishDate | 2023-06-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-c30f7059a2f34c9ca7a6b39719cd755c2023-06-20T10:12:27ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-06-01121210.1161/JAHA.123.029769Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018Jie Chang0Qiuju Deng1Piaopiao Hu2Moning Guo3Feng Lu4Yuwei Su5Jiayi Sun6Yue Qi7Ying Long8Jing Liu9Center for Clinical and Epidemiologic Research Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing ChinaCenter for Clinical and Epidemiologic Research Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing ChinaCenter for Clinical and Epidemiologic Research Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing ChinaBeijing Municipal Health Big Data and Policy Research Center Beijing Institute of Hospital Management Beijing ChinaBeijing Municipal Health Big Data and Policy Research Center Beijing Institute of Hospital Management Beijing ChinaSchool of Urban Design Wuhan University Wuhan ChinaCenter for Clinical and Epidemiologic Research Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing ChinaCenter for Clinical and Epidemiologic Research Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing ChinaSchool of Architecture and Hang Lung Center for Real Estate, Key Laboratory of Eco Planning & Green Building, Ministry of Education Tsinghua University Beijing ChinaCenter for Clinical and Epidemiologic Research Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, National Clinical Research Center of Cardiovascular Diseases, Beijing Municipal Key Laboratory of Clinical Epidemiology Beijing ChinaBackground Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast‐developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small‐area level. Methods and Results We included data of 94 106 AMI deaths during 2007 to 2018 from the Beijing Cardiovascular Disease Surveillance System in this ecological study. We estimated AMI mortality for 307 townships during consecutive 3‐year periods with a Bayesian spatial model. Township‐level health care accessibility was measured using an enhanced 2‐step floating catchment area method. Linear regression models were used to examine the association between health care accessibility and AMI mortality. During 2007 to 2018, median AMI mortality in townships declined from 86.3 (95% CI, 34.2–173.8) to 49.4 (95% CI, 30.5–73.7) per 100 000 population. The decrease in AMI mortality was larger in townships where health care accessibility increased more rapidly. Geographic inequality, defined as the ratio of the 90th to 10th percentile of mortality in townships, increased from 3.4 to 3.8. In total, 86.3% (265/307) of townships had an increase in health care accessibility. Each 10% increase in health care accessibility was associated with a −0.71% (95% CI, −1.08% to −0.33%) change in AMI mortality. Conclusions Geographic disparities in AMI mortality among Beijing townships are large and increasing. A relative increase in township‐level health care accessibility is associated with a relative decrease in AMI mortality. Targeted improvement of health care accessibility in areas with high AMI mortality may help reduce AMI burden and improve its geographic inequality in megacities.https://www.ahajournals.org/doi/10.1161/JAHA.123.029769acute myocardial infarctiongeographic variationhealth care accessibilitymortality |
| spellingShingle | Jie Chang Qiuju Deng Piaopiao Hu Moning Guo Feng Lu Yuwei Su Jiayi Sun Yue Qi Ying Long Jing Liu Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018 Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute myocardial infarction geographic variation health care accessibility mortality |
| title | Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018 |
| title_full | Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018 |
| title_fullStr | Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018 |
| title_full_unstemmed | Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018 |
| title_short | Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018 |
| title_sort | geographic variation in mortality of acute myocardial infarction and association with health care accessibility in beijing 2007 to 2018 |
| topic | acute myocardial infarction geographic variation health care accessibility mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.029769 |
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