Exploratory Temporal and Spatial Analysis of Myocardial Infarction Hospitalizations in Calgary, Canada.

Xiaoxiao Liu,Stefania Bertazzon

doi:10.3390/ijerph14121555

Abstract

Spatial and temporal analyses are critical to understand the pattern of myocardial infarction (MI) hospitalizations over space and time, and to identify their underlying determinants. In this paper, we analyze MI hospitalizations in Calgary from 2004 to 2013, stratified by age and gender. First, a seasonal trend decomposition analyzes the seasonality; then a linear regression models the trend component. Moran’s I and hot spot analyses explore the spatial pattern. Though exploratory, results show that most age and gender groups feature a statistically significant decline over the 10 years, consistent with previous studies in Canada. Decline rates vary across ages and genders, with the slowest decline observed for younger males. Each gender exhibits a seasonal pattern with peaks in both winter and summer. Spatially, MI hot spots are identified in older communities, and in socioeconomically and environmentally disadvantaged communities. In the older communities, higher MI rates appear to be more highly associated with demographics. Conversely, worse air quality appears to be locally associated with higher MI incidence in younger age groups. The study helps identify areas of concern, where MI hot spots are identified for younger age groups, suggesting the need for localized public health policies to target local risk factors.

Highlights

It is well known that cardiovascular disease is a leading public health concern, contributing to 30% of global mortality [1,2]
With kernel density analysis and clustering methods, Majlund et al 2016 examined the geographical patterns of acute myocardial infarction in Denmark and found that people who lived in the identified Myocardial infarction (MI) clusters featured a markedly lower socioeconomic status than those living outside the clusters [6]
Our results indicate that when the population is disaggregated by age and gender, the southern area exhibits only minor and less significant hotspots of older males, yet highly significant hot spots of MI in younger males occur in the industrial eastern communities, home to working class families, characterized by lower socioeconomic status, and higher industrial pollution

Summary

Introduction

It is well known that cardiovascular disease is a leading public health concern, contributing to 30% of global mortality [1,2]. It is one of the top two leading causes of death in Canada [3]. Among 17 million deaths caused by cardiovascular disease by 2015, as many as 7.6 million were attributed to coronary heart disease [4]. Myocardial infarction (MI), commonly known as heart attack, is one of the five main manifestations of coronary heart disease [1]. Spatial analysis in myocardial infarction provides a strategy to address spatially varying incidence patterns and to investigate the contextual factors surrounding it. A study conducted in Quebec, Canada, reported the existence of spatial variability of hospitalization rates due to ischemic heart disease for both men and women [5]. Most of the Canadian studies analyzing MI spatial

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