Does better availability mean better accessibility? Spatial inequalities in the care of acute myocardial infarction in Hungary (original) (raw)
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European journal of public health, 2016
Geographic and socioeconomic barriers may hinder fair access to healthcare. This study assesses geographic and socioeconomic disparities in access to reperfusion procedures in acute myocardial infarction (AMI) patients residing in Piedmont (Italy). Coronary Care Units (CCUs) were geocoded with a geographic information system (GIS) and the shortest drive time from CCUs to patients' residence was computed and categorized as 0 to <20, 20 to <40 and ≥40 min. Using data on AMI emergency hospitalizations in 2004-2012, we employed a log-binomial regression model to evaluate the relation between drive time and use of Percutaneous Transluminal Coronary Angioplasty (PTCA) occurring within 2 days after a hospitalization for an episode of AMI, and whether this relation varied depending on the period of hospitalization. A total of 29% of all cases with a diagnosis of AMI (n = 66 097), were revascularized within 2 days from the index admission. The further AMI patients lived from CCUs, ...
Changes in the spatial distribution of dominant IHD care providers over a 10 year period in Hungary
2016
Hungary has a single, unified healthcare reimbursement database which can be effectively used to analyze Ischemic Heart Disease (IHD) care patterns at various care centers. In this paper, we determined the dominant tertiary IHD provider for each municipal district on a single case vote basis in a 10 years long period between 2003 and 2013, covering the cases of 1,256,664 patients. We found that the number of providers increased from 10 to 18, resulting in a natural decrease from an average of 911,552 to 545,392 in the population treated by the greatest providers. We also performed a spatial analysis of the assignment of municipal districts to care providers in the countryside, separately for the first and second five years. This showed a characteristic decrease in the fragmentation of the patches that make up the regions belonging to the providers, resulting in much more compact areas.
Acute myocardial infarction: Does survival depend on geographical location and social background?
European Journal of Preventive Cardiology, 2019
Aims This study described the interplay between geographical and social inequalities in survival after incident acute myocardial infarction (AMI) and examined whether geographical variation in survival exists when accounting for sociodemographic characteristics of the patients and their neighbourhood. Methods Ringmap visualization and generalized linear models were performed to study post-AMI mortality. Three individual-level analyses were conducted: immediate case fatality, mortality between days 1 and 28 after admission and 365-day survival among patients who survived 28 days after admission. Results In total, 99,013 incident AMI cases were registered between 2005 and 2014 in Denmark. Survival after AMI tended to correlate with sociodemographic indicators at the municipality level. In individual-level models, geographical inequality in immediate case fatality was observed with high mortality in northern parts of Jutland after accounting for sociodemographic characteristics. In con...
BMJ Open, 2019
ObjectiveThis study examined whether geographical patterns in incident acute myocardial infarction (AMI) were explained by neighbourhood-level and individual-level sociodemographic characteristics.DesignAn open cohort study design of AMI-free adults (age ≥30 years) with a residential location in Denmark in 2005–2014 was used based on nationwide administrative population and health register data linked by the unique personal identification number. Poisson regression of AMI incidence rates (IRs) with a geographical random effect component was performed using a Bayesian approach. The analysis included neighbourhood-level variables on income, ethnic composition, population density and population turnover and accounted for individual-level age, sex, calendar year, cohabitation status, income and education.SettingResidents in Denmark (2005–2014).ParticipantsThe study population included 4 128 079 persons (33 907 796 person-years at risk) out of whom 98 265 experienced an incident AMI.Outc...
Modelling spatial accessibility to medical care. Case study of the North-Eastern Region of Romania
Providing the entire population with the same accessibility to services of general interest is among the priorities of EU policy. Among these services, those concerned with medical treatment occupy a special place due to their social and economic importance. The study raises the issue of modelling the population’s spatial accessibility to medical services in the North-Eastern Region of Romania. A trans-scalar methodology that has been tailored to the specific features of the Romanian medical system was employed for computing indexes of accessibility. The methodology brings together into one synthetic indicator five hierarchical levels of analysis, the geographical proximity of service centres, their degree of attractiveness and the potential need for medical services at local level. The results highlight areas with different levels of accessibility to medical services and their dysfunctionalities according to each variable employed in the analysis. - See more at: http://www.humangeographies.org.ro/volume-9-issue-2-2015/923-abstract#sthash.TKxhIUeM.dpuf
Regional inequalities in the Hungarian health system
Geoforum, 1990
The starting point of this paper which studies regional inequalities is the fact that public health is embedded in the socio-economic environment. Thus present inequalities in the Hungarian public health system are an element of the intertwined crisis in the economic and political spheres. The trend in the life expectancy of the Hungarian population deviates away from that in advanced Western countries and is accompanied by increasing social and regional differences in mortality. This phenomenon can be interpreted as a 'social cost' of post-1945 socio-economic development. This paper explores inequalities in the structure and mechanisms of the health system and the effects of the health system upon inequalities outside health care. The aim is to show that overcentralized health care administration and the rigid, overcentralized regional-functional structure of services constitute part of the inequalities of health care interpreted in a broad sense. These phenomena express the unequal power position of certain groups, spheres of society, or certain actors in health care in terms of command over resources. The system of political institutions evolved by state socialism in the early 1950s is the root cause of inequalities in the health care system. * Sources: Demogr&jiai lhkiinyv (Demographic Yearbook) 1984. KSH, Budapest; and Halandb-s&i vizsgdlatok (Mortality Surveys), 4, xiv. In 1984 the total number of deaths was 146,709. t Age-standardized mortality in 1980. $ Age-standardized mortality.
Geographical accessibility and Kentucky's heart-related hospital services
Applied Geography, 2007
Cardiovascular diseases (CVDs) are a leading cause of mortality in the US. Rates of mortality vary spatially and demographically, influenced not only by individual patient characteristics but also by levels of accessibility to hospital services and facilities. In 2000, Kentucky ranked third in the nation for heart-related deaths. The purpose of this paper is to assess geographical accessibility and service utilization related to ambulatory care sensitive CVDs in Kentucky. This study utilizes the Kentucky Hospital Discharge Database to evaluate service utilization and the Compressed Mortality File to examine mortality related to CVDs. A spatial statistical comparison of the geographical distribution of service usage and travel time to hospitals assists in assessing the relationship between accessibility and health. Our findings suggest that the distribution of utilization and mortality is geographically variable. People living in rural areas travel further to services; populations residing more than 45 min from health facilities are more likely to be socially and economically marginalized. Spatial clustering of high rates of hospital utilization occurs in areas with lower accessibility. r
Socio-spatial disparities in access to emergency health care—A Scandinavian case study
PLOS ONE, 2021
Having timely access to emergency health care (EHC) depends largely on where you live. In this Scandinavian case study, we investigate how accessibility to EHC varies spatially in order to reveal potential socio-spatial disparities in access. Distinct measures of EHC accessibility were calculated for southern Sweden in a network analysis using a Geographical Information System (GIS) based on data from 2018. An ANOVA test was carried out to investigate how accessibility vary for different measures between urban and rural areas, and negative binominal regression modelling was then carried out to assess potential disparities in accessibility between socioeconomic and demographic groups. Areas with high shares of older adults show poor access to EHC, especially those in the most remote, rural areas. However, rurality alone does not preclude poor access to EHC. Education, income and proximity to ambulance stations were also associated with EHC accessibility, but not always in expected wa...
Spatial and Spatio-temporal Epidemiology, 2016
Objectives: To examine the geographical patterns in AMI and characterize individual and neighborhood sociodemographic factors for persons living inside versus outside AMI clusters. Methods: The study population comprised 3,515,670 adults out of whom 74,126 persons experienced an incident AMI (2005-2011). Kernel density estimation and global and local clustering methods were used to examine the geographical patterns in AMI. Median differences and frequency distributions of sociodemographic factors were calculated for persons living inside versus outside AMI clusters. Results: Global clustering of AMI occurred in Denmark. Throughout the country, 112 significant clusters with high risk of incident AMI were identified. The relative risk of AMI in significant clusters ranged from 1.45 to 47.43 (median = 4.84). Individual and neighborhood socioeconomic position was markedly lower for persons living inside versus outside AMI clusters. Conclusions: AMI is geographically unequally distributed throughout Denmark and determinants of these geographical patterns might include individual-and neighborhood-level sociodemographic factors.