introdução à medicina ii class13 adviser: armando teixeira pinto, phd

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

TABLE OF CONTENTS

INTRODUCTION

AIM

PARTICIPANTS AND

METHODS

RESULTS

DISCUSSION

REFERENCES

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>

TABLE OF CONTENTS

INTRODUCTION

AIM

PARTICIPANTS AND

METHODS

RESULTS

DISCUSSION

REFERENCES

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

TABLE OF CONTENTS

INTRODUCTION

AIM

PARTICIPANTS AND

METHODS

RESULTS

DISCUSSION

REFERENCES

PARTICIPANTS AND METHODS Study design

Database

Data from all Portuguese Public Hospitals, from 2000 to 2007.

PARTICIPANTS AND METHODS Data collection

Extract of the GDH Database variables

PARTICIPANTS AND METHODS Study variables

PARTICIPANTS AND METHODS Study variables

NUTS II distribution performed in the study

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.


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


Incidence adjusted rate = SIR * Incidence crude rate Incidence adjusted rate = SIR * Incidence crude rate


SIR = Number of expected admissions by CHDNumber of observed admissions by CHD

SIR = Number of expected admissions by CHDNumber of observed admissions by CHD


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

TABLE OF CONTENTS

INTRODUCTION

AIM

PARTICIPANTS AND

METHODS

RESULTS

DISCUSSION

REFERENCES

2000

RESULTS Geographical distribution of SIR by NUTS II

2001


2002


2003


2004


2005


2006


2007



2000 2007

RESULTS Geographical distribution of SFR by NUTS II

2000


2001


2002


2003


2004


2005


2006


2007


2000 2007

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.

TABLE OF CONTENTS

INTRODUCTION

AIM

PARTICIPANTS AND

METHODS

RESULTS

DISCUSSION

REFERENCES

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

TABLE OF CONTENTS

INTRODUCTION

AIM

PARTICIPANTS AND

METHODS

RESULTS

DISCUSSION

REFERENCES

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

introdução à medicina ii class13 adviser: armando teixeira pinto, phd

Documents

coronary heart disease

methods data collectionextract

number of expected admissions

number of hospital deaths

ischemic heart disease

evolution of incidence

regional level

regional variations