Análise espacial e temporal da mortalidade por doença isquêmica do coração e o impacto da cobertura populacional da atenção primária no Estado de São Paulo

Resumo

BACKGROUND: Cardiovascular disease and particularly ischemic heart disease (IHD) remain a global health issue. Although IHD mortality has declined, substantial geographic variability and IHD mortality rates bottoming out have been reported. Advances in geospatial analytical tools have disentangled spatial patterns and the neighborhood effects on IHD mortality. However, the spatial dependency in IHD mortality in Sao Paulo has been unknown, as well as the factors that would explain the decreased mortality. OBJECTIVES: The aims of this study were: 1) to test the spatial dependency and the temporal trends of IHD mortality over time; 2) to disentangled potential hidden areas of clusters; and 3) to evaluate the factors related to IHD mortality in the state of Sao Paulo. METHOD: Secondary data on IHD mortality, census track, primary health care (PHC), private insurance population coverage, urbanization and formal work was obtained for each of the 645 counties of Sao Paulo, from 2000 to 2017. The temporal trends of standardized-mortality rates (SMR) per county and administrative aggregates were analyzed by using JoinPoint regression models. The SMR was tested for the spatial dependency after weighted matrix of neighborhood with global spatial autocorrelation and the presence of clusters was analyzed taking into consideration local indicators of spatial autocorrelation. Linear, spatial and geographically-weighted regression methods were undertaken to evaluate the factors associated with SMR. RESULTS: A total of 485,898 deaths due to IHD were reported in Sao Paulo from 2000 to 2017, thus resulting in an annual average of 26,994 ± 1,747. The SMR reduced 3.2% and 1.1% per year from 2000 to 2007, and from 2007 to 2017; respectively. The SMR distribution showed to have spatial dependency on statistically significant Moran´s I (p-value < 0.01). Moreover, significant clusters particularly expanding from Sao Paulo metropolitan area were reported. An increase in population coverage of PHC was associated with direct and indirect (spillover) effects on SMR of -10.8 and -4.8 (2007), -9.3 and -3.8 (2008), -8.9 and -4.6 (2010), -11.5 and -5.9 (2012) and -8.2 and -3.3 (2013), respectively, p-value< 0.05. CONCLUSIONS: Although IHD mortality rates demonstrated a consistent decrease from 2000 to 2017, there was evidence of rates bottoming out from 2007 to 2017. Additionally, a spatial dependency with cluster patterns of high and low rates of IHD reflecting geographic variation in the state over the years was demonstrated. The increase in population PHC coverage was spatially associated with SMR reduction with (local) direct and neighborhood indirect (spillover) effects.

Ficha do documento

Tipo

Dissertação

Ano

2020

Instituição

Fundação Getulio Vargas

Fonte

Repositório da FGV

Idioma

Português

Acesso

Acesso aberto

Identificador

oai:repositorio.fgv.br:10438/29770

Temas

DadosSaúde

Palavras-chave

MortalidadeDoença isquêmica do coraçãoAnálise espacialAtenção primária em saúdeIschemic heart diseaseMortalitySpatial analysisPrimary health careAdministração de empresasCoração - DoençasCoronariopatiasAnálise espacial (Estatística)Cuidados Primários de Saúde