Abstract
Introduction: A better understanding of the dynamics of the spatial relationships between myocardial infarction (MI) hospitalization risks and socioeconomic determinants of health (SDoH) is crucial more optimal targeting of efforts geared towards reducing cardiovascular health disparities and improving population health. The objectives of this study were to identify county-level SDoH of MI hospitalization risks, and to explore whether the associations between MI hospitalizations risks and its predictors varied with geographic location to determine if certain predictors are more important in specific geographic areas in Florida. Methodology: A multivariable global Negative Binomial Regression model (NBR) was used to identify county-level SDoH predictors of inpatient MI hospitalizations occurring in Florida between 2005 and 2014. A local Geographically Weighted Negative Binomial Regression model was then used to explore whether the associations between MI hospitalization risks and SDoH predictors identified in the global NBR model varied depending on geographic location in the state. The spatial distribution of MI hospitalization risks, significant SDoH predictors and non-stationary local regression coefficients were mapped using ArcGIS. Results: The risks of MI hospitalizations were significantly higher in counties with high proportions of residents with less than high school education (P < 0.0001) and divorced residents (P = 0.03). However, they were significantly lower in counties with high proportions of rural residents (P< 0.0001) and African Americans (P = 0.022), and marginally lower in counties with low rates of health insurance coverage (P = 0.056). The strength of associations between MI hospitalization risks and the proportion of population with less than high school education attainment and health uninsurance rate varied based on geographic location in Florida. Conclusion: Race, marital status, educational attainment, rurality and health insurance coverage were significant determinants of MI hospitalization risks in Florida. The strength of associations between MI hospitalization risks and education attainment and health insurance coverage were not constant across the state. These findings indicate that a one-size-fits-all approach is not appropriate for reducing the burden of MI and addressing geographic disparities in utilization of MI care in Florida. Rather, policies and interventions prioritizing identified SDoH factors should be tailored to location-specific community contexts to improve cardiovascular health in Florida.
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