Abstract
Knowledge of geographical disparities in myocardial infarction (MI) is critical for guiding health planning and resource allocation. The objectives of this study were to identify geographic disparities in MI hospitalization risks in Florida and assess temporal changes in these disparities between 2005 and 2014. This study used retrospective data on MI hospitalizations that occurred among Florida residents between 2005 and 2014. We identified spatial clusters of hospitalization risks using Kulldorff’s circular and Tango’s flexible spatial scan statistics. Counties with persistently high or low MI hospitalization risks were identified. There was a 20% decline in hospitalization risks during the study period. However, we found persistent clustering of high risks in the Big Bend region, South Central and southeast Florida, and persistent clustering of low risks primarily in the South. Risks decreased by 7%–21% in high-risk clusters and by 9%–28% in low-risk clusters. The risk decreased in the high-risk cluster in the southeast but increased in the Big Bend area during the last four years of the study. Overall, risks in low-risk clusters were ahead those for high-risk clusters by at least 10 years. Despite MI risk declining over the study period, disparities in MI risks persist. Eliminating/reducing those disparities will require prioritizing high-risk clusters for interventions.
Highlights
myocardial infarction (MI) hospitalization risks decreased by 20% overall during the 10-year study period
We found modest declines in MI hospitalization risks in Florida overall and in patients stratified by age, sex, race, and ethnicity
MI hospitalization risks declined modestly in all clusters, but there were disparities in the rates of decline amongst clusters, with the slowest declines occurring in high-risk clusters in northern Florida, and more rapid declines occurring in clusters in southern Florida
Summary
Preventive and control strategies for acute myocardial infarction (MI), or heart attack, have resulted in substantial reductions in the incidence and overall burden of MI hospitalizations in the U.S [1,2].MI remains a leading cause of hospital admissions in the U.S [3], accounting for 608,800 hospital discharges/stays in 2014. [4] the burden is projected to get worse as major MI risk factors such as diabetes mellitus (DM), obesity and population aging [5,6,7] become increasingly prevalent in the future [8], making MI prevention a continuing public health priority.Despite the overall decline in the burden of MI hospitalizations in the U.S over time, the rates have been shown to vary widely across the country. Preventive and control strategies for acute myocardial infarction (MI), or heart attack, have resulted in substantial reductions in the incidence and overall burden of MI hospitalizations in the U.S [1,2]. [4] the burden is projected to get worse as major MI risk factors such as diabetes mellitus (DM), obesity and population aging [5,6,7] become increasingly prevalent in the future [8], making MI prevention a continuing public health priority. County-level MI hospitalization rates for individuals aged 35 years and older decreased by at least 20% for 19 out of 20 states in the Centers for Disease Control and Prevention (CDC) Tracking Network between 2000 and 2008. Public Health 2019, 16, 4734; doi:10.3390/ijerph16234734 www.mdpi.com/journal/ijerph
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