Cross-sectional Ecological Study Research Articles

Mental Health Hospitalizations in Canadian Children, Adolescents, and Young Adults Over the COVID-19 Pandemic

The COVID-19 pandemic resulted in multiple socially restrictive public health measures and reported negative mental health impacts in youths. Few studies have evaluated incidence rates by sex, region, and social determinants across an entire population. To estimate the incidence of hospitalizations for mental health conditions, stratified by sex, region, and social determinants, in children and adolescents (hereinafter referred to as youths) and young adults comparing the prepandemic and pandemic-prevalent periods. This Canadian population-based repeated ecological cross-sectional study used health administrative data, extending from April 1, 2016, to March 31, 2023. All youths and young adults from 6 to 20 years of age in each of the Canadian provinces and territories were included. Data were provided by the Canadian Institute for Health Information for all provinces except Quebec; the Institut National d'Excellence en Santé et en Services Sociaux provided aggregate data for Quebec. The COVID-19-prevalent period, defined as April 1, 2020, to March 31, 2023. The main outcome measures were the prepandemic and COVID-19-prevalent incidence rates of hospitalizations for anxiety, mood disorders, eating disorders, schizophrenia or psychosis, personality disorders, substance-related disorders, and self-harm. Secondary measures included hospitalization differences by sex, age group, and deprivation as well as emergency department visits for the same mental health conditions. Among Canadian youths and young adults during the study period, there were 218 101 hospitalizations for mental health conditions (ages 6 to 11 years: 5.8%, 12 to 17 years: 66.9%, and 18 to 20 years: 27.3%; 66.0% female). The rate of mental health hospitalizations decreased from 51.6 to 47.9 per 10 000 person-years between the prepandemic and COVID-19-prevalent years. However, the pandemic was associated with a rise in hospitalizations for anxiety (incidence rate ratio [IRR], 1.11; 95% CI, 1.08-1.14), personality disorders (IRR, 1.21; 95% CI, 1.16-1.25), suicide and self-harm (IRR, 1.10; 95% CI, 1.07-1.13), and eating disorders (IRR, 1.66; 95% CI, 1.60-1.73) in females and for eating disorders (IRR, 1.47; 95% CI, 1.31-1.67) in males. In both sexes, there was a decrease in hospitalizations for mood disorders (IRR, 0.84; 95% CI, 0.83-0.86), substance-related disorders (IRR, 0.83; 95% CI, 0.81-0.86), and other mental health disorders (IRR, 0.78; 95% CI, 0.76-0.79). This cross-sectional study of Canadian youths and young adults found a rise in anxiety, personality disorders, and suicidality in females and a rise in eating disorders in both sexes in the COVID-19-prevalent period. These results suggest that in future pandemics, policymakers should support youths and young adults who are particularly vulnerable to deterioration in mental health conditions during public health restrictions, including eating disorders, anxiety, and suicidality.

Global Associations of the Traditional Japanese Diet Score with Hypertension Prevalence and Systolic Blood Pressure from 2009 to 2019: A Cross-Sectional and Longitudinal Ecological Study

Objective Prevention and improvement of hypertension is one of the most important health issues worldwide. The traditional Japanese diet contributes to the prevention of some non-communicable diseases associated with hypertension. However, whether traditional Japanese dietary patterns are associated with hypertension prevalence and systolic blood pressure (SBP) worldwide remains unknown. In this study, we aimed to investigate whether the traditional Japanese diet score (TJDS) is associated with hypertension prevalence and SBP. Methods This cross-sectional and longitudinal ecological study from 2009 to 2019 included 141 countries with a population of at least 1 million. All data used for analysis were obtained from internationally available databases. The TJDS was calculated using country-specific supplies of five foods commonly eaten in the traditional Japanese diet (rice, fish, soybean, vegetables, and egg) and three less commonly eaten foods (wheat, milk, and red meat). Hypertension was defined by SBP ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medications. The mean SBP was >25 age-standardized data. A general linear model was used for the cross-sectional model in 2009, and a linear mixed model was used for the longitudinal analysis from 2009 to 2019. The covariates included gross domestic product, percentage of population aged >65 years, years of education, smoking rate, average body mass index, physical activity, and energy supply. Results The TJDS was negatively associated with hypertension prevalence (β ± standard error: −0.861 ± 0.202, p < 0.001) and SBP (β ± standard error: −0.364 ± 0.154, p < 0.05) in the cross-sectional analysis. The TJDS was significantly negatively associated with hypertension prevalence (β ± standard error: −0.845 ± 0.200, p < 0.001) and SBP (β ± standard error: −0.312 ± 0.149, p < 0.05) in the 10-year longitudinal analysis controlled for full covariables. Conclusions Traditional Japanese dietary patterns are associated with lower hypertension prevalence and SBP worldwide.

Global Associations of the Traditional Japanese Diet Score with Hypertension Prevalence and Systolic Blood Pressure from 2009 to 2019: A Cross-Sectional and Longitudinal Ecological Study

Objective Prevention and improvement of hypertension is one of the most important health issues worldwide. The traditional Japanese diet contributes to the prevention of some non-communicable diseases associated with hypertension. However, whether traditional Japanese dietary patterns are associated with hypertension prevalence and systolic blood pressure (SBP) worldwide remains unknown. In this study, we aimed to investigate whether the traditional Japanese diet score (TJDS) is associated with hypertension prevalence and SBP. Methods This cross-sectional and longitudinal ecological study from 2009 to 2019 included 141 countries with a population of at least 1 million. All data used for analysis were obtained from internationally available databases. The TJDS was calculated using country-specific supplies of five foods commonly eaten in the traditional Japanese diet (rice, fish, soybean, vegetables, and egg) and three less commonly eaten foods (wheat, milk, and red meat). Hypertension was defined by SBP ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medications. The mean SBP was >25 age-standardized data. A general linear model was used for the cross-sectional model in 2009, and a linear mixed model was used for the longitudinal analysis from 2009 to 2019. The covariates included gross domestic product, percentage of population aged >65 years, years of education, smoking rate, average body mass index, physical activity, and energy supply. Results The TJDS was negatively associated with hypertension prevalence (β ± standard error: −0.861 ± 0.202, p < 0.001) and SBP (β ± standard error: −0.364 ± 0.154, p < 0.05) in the cross-sectional analysis. The TJDS was significantly negatively associated with hypertension prevalence (β ± standard error: −0.845 ± 0.200, p < 0.001) and SBP (β ± standard error: −0.312 ± 0.149, p < 0.05) in the 10-year longitudinal analysis controlled for full covariables. Conclusions Traditional Japanese dietary patterns are associated with lower hypertension prevalence and SBP worldwide.

Inequity in access to digital public primary healthcare in Sweden: a cross-sectional study of the effects of urbanicity and socioeconomic status on utilization.

Social and geographical inequity in access to primary healthcare is an ongoing concern in Sweden. Digital care can potentially decrease geographical inequity. This study aimed to evaluate how urbanicity affects the utilization of a public digital primary healthcare service - PHC Online. We performed an ecological cross-sectional study of 4,482 PHC Online visits grouped by 83 public primary healthcare centers. Multiple linear regression analysis was performed with PHC Online visits per 1,000 registered patients as the dependent variable and urbanicity (municipalities grouped by number of inhabitants), socioeconomic status (Care Need Index), and morbidity (Adjusted Clinical Groups) per primary healthcare center as independent variables. Utilization of PHC Online was more common among those of a younger age (median 32 years) and among women (65%). Urbanicity did not affect utilization. Lower socioeconomic status and higher morbidity had negative effects on utilization (B -3.289, p = 0.001, B -7.728, p = 0.045). Geographical differences based on urbanicity do not seem to affect the utilization of PHC Online. Further studies are needed to clarify a possible association to geographical barriers in access to primary healthcare, specifically accounting for factors associated with urbanicity and distance to physical clinics, and how age and sex affect such an association. Lower utilization of PHC Online in low socioeconomic status and high morbidity populations raises questions on the effect of digital primary care on equitable access to primary healthcare.

Hospitalizations for Cardiovascular Diseases Sensitive to Primary Health Care in Paraná State, Brazil: A Bayesian Spatiotemporal Model.

To analyze spatiotemporal trends in hospitalizations for cardiovascular diseases (CVD) sensitive to primary health care (PHC) among individuals aged 50-69 years in Paraná State, Brazil, from 2014 to 2019 and investigate correlations between PHC services and the Social Development Index. We conducted a cross-sectional ecological study using publicly available secondary data to analyze the municipal incidence of hospitalizations for CVD sensitive to PHC and to estimate the risk of hospitalization for this group of diseases and associated factors using hierarchical Bayesian spatiotemporal modeling with Markov chain Monte Carlo simulation. There was a 5% decrease in the average rate of hospitalizations for PHC-sensitive CVD from 2014 to 2019. Regarding standardized hospitalization rate (SHR) according to population size, we found that no large municipality had an SHR >2. Likewise, a minority of these municipalities had SHR values of 1-2 (33%). However, many small and medium-sized municipalities had SHR values >2 (47% and 48%, respectively). A greater Social Development Index value served as a protective factor against hospitalizations, with a relative risk of 0.957 (95% credible interval, 0.929-0.984). The annual risk of hospitalization decreased over time; however, small municipalities had the greatest rates of hospitalization, indicating an increase in health inequity. The inverse association between social development and hospitalizations for CVD sensitive to PHC raises questions about intersectionality in health care.

Firearm-Related Lead Exposure and Child Lead Levels in the United States, 2012-2018

ObjectiveTo determine if firearm ownership is positively related to elevated child lead levels at a state-level, even when accounting for other sources of lead. Study designFor this cross-sectional ecological study, we investigated whether household firearm ownership rates (a proxy for firearm-related lead exposure) was associated with the prevalence of elevated child blood lead levels in 44 US States between 2012 and 2018. To account for potential confounding, we adjusted for other known lead exposures, poverty rate, population density, race, and calendar year. To address missing data, we used multiple imputation by chained equations. ResultsPrevalence of elevated child blood lead positively correlated with household firearm ownership and established predictors of lead exposure. In fully adjusted negative binomial regression models, child blood lead was positively associated with household firearm ownership and older housing; each interquartile range (14%) increase in household firearm ownership rate was associated with a 41% higher prevalence of childhood elevated blood lead (prevalence ratio: 1.41, 95% CI: 1.11-1.79). ConclusionThese data provide state-level evidence that firearms may be an important source of child lead exposure. More research is needed to substantiate this relationship and identify modifiable pathways of exposure at the individual level.

Examining the Role of Social Determinants of Health and COVID-19 Risk in 28 African Countries

While the impact of the pandemic has varied between and within countries, there are few published data on the relationship between social determinants of health (SDoH) and COVID-19 in Africa. This ecological cross-sectional study examines the relationship between COVID-19 risk and SDoH among 28 African countries. Included were countries with a recent demographic and health survey (years 2010 to 2018). The response variables were COVID-19 case rates and death rates (reported as of 15 August 2020); and the covariates comprised eight broad topics common to multiple SDoH frameworks aggregated to the country level: geography (urban residence), wealth index, education, employment, crowding, and access to information. A negative binomial regression was used to assess the association between aspects of SDoH and COVID-19 outcomes. Our analysis indicated that 1 in 4 (25.1%) households in study countries are without safe and clean water and a space for handwashing. The odds of COVID-19 morbidity and deaths were higher in countries with a high proportion of households without access to safe and clean water. Having a high proportional of educated women (1.003: 95% CI, 1.001–1.005) and living in a less crowded home (0.959: 95% CI, 0.920–1.000) were negatively associated with COVID-19 deaths, while being insured and owning a mobile phone predicted illness. Overall, aspects of SDoH contribute either negatively or positively to COVID-19 outcomes. Thus, addressing economic and environmental SDoH is critical for mitigating the spread of COVID-19 and re-emerging diseases on the African continent.

Analysis of the access of pregnant women to the first programmatic dental appointment: an ecological study.

To plan and evaluate public health policies, it is important to understand the influence of social factors on the quality and access to dental care. This study aimed to verify the potential association between the indicators of pregnant women receiving dental care and the social and health care indicators of cities in the Brazilian state of Minas Gerais. A cross-sectional ecological study was performed with secondary data from the Brazilian Institute of Geography and Statistics and the Health Care Department of the Ministry of Health regarding the cities of Minas Gerais. The study analyzed three health care indicators (such as more than six prenatal, the proportion of syphilis and human immunodeficiency virus tests, and oral health coverage) and four social indicators (average monthly wage, illiteracy rate, proportion of employed population, and rate of adequate sanitary sewerage). Bivariate analysis (Mann-Whitney test) and logistic regression were performed using Jamovi software. All of the indicators analyzed were associated with the access of pregnant women to dental care. However, in the regression models, only health care indicators remained statistically significant. Thus, although social indicators are associated with the access of pregnant women to dental appointments, access to primary health care and the teamwork of primary health care teams may overcome social inequality in the access of pregnant women to dental care.

Public Benefit Programs and Differential Associations With Child Maltreatment by Race and Ethnicity

Public benefit programs, including state spending on local, state, and federal-state partnership programs, have consistently been associated with overall reductions in child protective services (CPS) involvement. Inequities in eligibility and access to benefit programs may contribute to varying associations by race and ethnicity. To determine whether associations between state spending on benefit programs and rates of CPS investigations differ by race and ethnicity. This cross-sectional ecological study used repeated state-level measures of child maltreatment from the National Child Abuse and Neglect Data System and population estimates from the US Census Bureau for all Black, Hispanic, and White children. All 50 US states from October 1, 2009, through September 30, 2019 (fiscal years 2010-2019), were included. Data were collected and analyzed from May 13, 2022, to March 2, 2023. Annual state spending on benefit programs per person living below the federal poverty limit, total and by the following subcategories: (1) cash, housing, and in-kind; (2) housing infrastructure; (3) child care assistance; (4) refundable earned income tax credit; and (5) medical assistance programs. Race- and ethnicity-specific rates of CPS investigations. Generalized estimating equations, with repeated measures of states, an interaction between race and spending, and estimated incidence rate ratios (IRRs) and 95% CIs for incremental changes in spending of US $1000 per person living below the federal poverty limit were calculated after adjustment for federal spending, race- and ethnicity-specific child poverty rate, and year. A total of 493 state-year observations were included in the analysis. The association between total spending and CPS investigations differed significantly by race and ethnicity: there was an inverse association between total state spending and CPS investigations for White children (IRR, 0.94 [95% CI, 0.91-0.98]) but not for Black children (IRR, 0.98 [95% CI, 0.94-1.02]) or Hispanic children (IRR, 0.99 [95% CI, 0.95-1.03]) (P = .02 for interaction). Likewise, inverse associations were present for only White children with respect to all subcategories of state spending and differed significantly from Black and Hispanic children for all subcategories except the refundable earned income tax credit (eg, IRR for medical assistance programs for White children, 0.89 [95% CI, 0.82-0.96]; P = .005 for race and spending interaction term). These results raise concerns that benefit programs may add relative advantages for White children compared with Black and Hispanic children and contribute to racial and ethnic disparities in CPS investigations. States' eligibility criteria and distribution practices should be examined to promote equitable effects on adverse child outcomes.

Abstract 15662: Age-Adjusted Premature Cardiac Mortality Rate Among United States Counties by Social Vulnerability Index From 2018 to 2021

Background: Considerable differences in premature cardiovascular disease (CVD) mortality rates exist across counties in the United States. Ecological examination and the association with county-level social vulnerability Indices (SVI) are limited. Aims: This study provides an updated analysis of age-adjusted premature CVD mortality rates and association with county-level SVI from 2018 to 2021. Methods: In this ecological cross-sectional study, we used United States county-level CVD mortality data from the Centers for Disease Control and Prevention (CDC) WONDER database (2018-2021) for non-elderly adults (&lt;65 years) and CDC SVI classified into quartiles (1st least vulnerable and 4th most vulnerable). We calculated age-adjusted CVD mortality rates per 100,000 persons including Ischemic heart disease (IHD), stroke, heart failure, and hypertension ICD-10 codes: I20-I25, I60-I69, I50 and I10-I13, I15 respectively. A multivariable mixed negative binomial regression model with county intercept examined the association between SVI and CVD mortality rate adjusted for gender, and ethnicity. Results: Overall, the age-adjusted CVD mortality rate per 100,000 persons was 111.0 (IHD 68.1 (95% CI:67.8-68.4), stroke 8 (95% CI: 7.9-8.0), heart failure 3.7 (95% CI:3.6-3.8), and hypertension 26.3 (95% CI 26.1-26.5)), increasing in a stepwise manner from the 1st to 4th SVI quartile. Counties in the 4th quartile had significantly higher mortality compared to the 1st quartile for CVD IRR=2.5 (IHD IRR=2.27 (95% CI:1.65-3.11), stroke IRR=2.72 (95% CI: 1.84-4.02), heart failure IRR=2.84 (95% CI:1.74-4.62), and hypertension IRR=2.83 (95% CI 1.79-4.45)). Conclusions: We observed a higher premature CVD mortality rate in the most vulnerable compared to the least vulnerable counties, adjusting for demographic characteristics. Targeted public health interventions are needed to effectively mitigate the growing burden of premature CVD in vulnerable populations.

The impact of socioeconomic vulnerability on the incidence of COVID-19 in school students

Abstract Inequalities have been observed in the spread of COVID-19 due to higher incidence rates in environments with greater socioeconomic deprivation. The objective of this study was to analyse the relationship between socioeconomic level and the incidence of COVID-19 in students of schools in the city of Barcelona, in different epidemic waves. Cross-sectional ecological study on compulsory education students (N = 176,390). Unit of analysis: the 780 schools in the city. Study period: second (autumn 2020), third (winter 2020-21) and sixth epidemic waves (winter 2021-22). Dependent variable: Cumulative Incidence (CI) of COVID-19 among school students. Independent variables: complexity and ownership of the school, indexes in quartiles (being Q4 the most disadvantaged) of vulnerable students of the school and the Available Family Income (AFI) of the neighbourhood of the school. Stratified by sex and educational stage (Primary/Secondary). A bivariate and multivariate analysis was performed using Poisson regression to calculate crude Relative Risks and adjusted (aRR). As an impact measure, the Population Attributable Risk was calculated. In the second wave, 41% of the CI in primary boys was attributed to the vulnerability of the school (Q4: aRR=1.96 [1.10-3.50]), and 36% to a lower AFI in the neighbourhood of the school in secondary boys (Q4: aRR=3.18 [1.25-8.13]). Instead, in the sixth wave, taking Q4 as a reference, 35% of the CI in primary girls was attributed to lower vulnerability indices of the school (Q1: aRR=1.82 [1.52-2.20]), and 38% higher AFI from the neighbourhood of the school in secondary girls (Q1: aRR=1.99 [1.33-2.98]). In the third wave, the results are mixed and less significant in the models. The results obtained show that there was an inversion of the impact of social inequalities in the CI of COVID-19 in the second wave compared to the sixth. This reflects the need to delve into the contextual factors that favour the spread of communicable diseases. Key messages • The socioeconomic vulnerability of school students has been associated with a higher Cumulative Incidence of COVID-19 in the second wave, but this pattern has been reversed in the sixth wave. • Between 18 and 41% - depending on gender, educational level and epidemic wave- of the Cumulative Incidence of COVID-19 in Barcelona schools can be attributed to factors of socioeconomic deprivation.

Mortalidade infantil por causas evitáveis

Infant mortality refers to deaths of children under one year of age, subdivided into neonatal mortality (early and late neonatal) and post-neonatal mortality, being considered an indicator for assessing the population's health situation. The study aimed at describing the infant mortality rates due to preventable causes, in children under one year of age and in the state of Alagoas, during 2017. A descriptive and cross-sectional ecological study was carried out, with a quantitative approach on mortality rates in the age group of children under one year old, based on secondary data available in the Mortality Information System, by the Informatics Department of the Unified Health System (Departamento de Informática do Sistema Único de Saúde, [DATASUS]). This study was carried out from November to December 2019. During this period, in the state of Alagoas, 793 deaths due to preventable causes among children under five years of age were recorded in the Informatics Department of the Unified Health System. 83.98% (n=666) of these deaths corresponded to children under one year of age, with death cases in the early neonatal period being the most prevalent, followed by deaths in the post-neonatal and late neonatal periods. Among the cities in Alagoas, Maceió ranks first and Arapiraca is in second place in relation to the infant mortality rate.

Does shortage of GPs matter? A cross-sectional study of practice population life expectancy.

There are not enough GPs in England. Access to general practice and continuity of care are declining. To investigate whether practice characteristics are associated with life expectancy of practice populations. A cross-sectional ecological study of patient life expectancy from 2015-2019. Selection of independent variables was based on conceptual frameworks describing general practice's influence on outcomes. Sixteen non-correlated variables were entered into multivariable weighted regression models: population characteristics (Index of Multiple Deprivation, region, % White ethnicity, and % on diabetes register); practice organisation (total NHS payments to practices expressed as payment per registered patient, full-time equivalent fully qualified GPs, GP registrars, advanced nurse practitioners, other nurses, and receptionists per 1000 patients); access (% seen on the same day); clinical performance (% aged ≥45 years with blood pressure checked, % with chronic obstructive pulmonary disease vaccinated against flu, % with diabetes in glycaemic control, and % with coronary heart disease on antiplatelet therapy); and the therapeutic relationship (% continuity). Deprivation was strongly negatively associated with life expectancy. Regions outside London and White ethnicity were associated with lower life expectancy. Higher payment per patient, full-time equivalent fully qualified GPs per 1000 patients, continuity, % with chronic obstructive pulmonary disease having the flu vaccination, and % with diabetes with glycaemic control were associated with higher life expectancy; the % being seen on the same day was associated with higher life expectancy in males only. The variable aged ≥45 years with blood pressure checked was a negative predictor in females. The number of GPs, continuity of care, and access in England are declining, and it is worrying that these features of general practice were positively associated with life expectancy.

Young, Black/African American, and Latino communities are left behind despite legislative efforts in California to reduce HIV/STI disparities.

Sexually transmitted infections (STI) have been on the rise in the United States with racial/ethnic minority groups, gay and bisexual men, and youth experiencing the highest STI and HIV infection rates. In 2022, California became the first state in the nation to pass legislation, Senate Bill 306 (SB 306), requiring health care plans to cover the costs of home test kits for STIs, including HIV. This study examines provisions within SB 306 and its potential to reduce STI and HIV disparities among key demographic groups and geographic regions within California. Ecological cross-sectional study involving 58 California counties. Descriptive statistics and choropleth maps compared HIV/STI prevalence rates, uninsured rates, demographic composition, and healthcare provider coverage across California counties. Three geographically weighted Poisson regression analyses were conducted to separately examine the association between proportion of uninsured and HIV, gonorrhea, and chlamydia prevalence rates. HIV/STI rates were significantly and positively associated with the proportion of uninsured residents in Central and Southern California counties. These counties had a higher proportion of demographic groups vulnerable to HIV/STI including a large Latino, Black/African American, and younger (age 15-24) population but had a lower rate of healthcare providers with prescription authority for home testing kits, which is a requirement under SB 306. Cutting-edge solutions are needed to stem the rising tide of new STI and HIV infections. While SB 306 is novel and innovative in intent, its coverage gaps will increase disparities and inequities among historically underserved populations.

Access to mechanical thrombectomy and ischemic stroke mortality in Japan: a spatial ecological study.

Advances in stroke treatment have greatly improved outcomes; however, disparities in access to treatment might increase. Achieving equitable access to stroke treatment is a health policy challenge, as rapid treatment is essential for positive outcomes. This ecological cross-sectional study aimed to determine the relationship between the disparities in spatial accessibility to mechanical thrombectomy (SAMT) and stroke mortality rates in Japan, hypothesizing that disparities in SAMT may increase the differences in stroke mortality between regions. We used the average number of ischemic stroke (IS) deaths between 2020 and 2021 as the response variable; and SAMT, medical resources, and socioeconomic characteristics of each municipality as explanatory variables. A conditional autoregressive model was used to examine the association between the risk of stroke mortality and SAMT. The standardized mortality ratio (SMR) was mapped to understand the nationwide disparities in stroke mortality risk. The median number of IS deaths was 17.5 persons per year in the municipalities (2020 to 2021). The study also found that municipalities with low SAMT were located in the northern part of Japan. The non-spatial regression model results indicated that poor accessibility, a small proportion of bachelor's degrees or higher, and a high proportion of workers in secondary industries were related to high IS mortality. Three models were evaluated using spatial analysis; Model 1 with accessibility indicators alone, Model 2 with medical resources added to Model 1, and Model 3 with socioeconomic characteristics added to Model 2. In Models 1 and 2, the population-weighted spatial accessibility index (PWSAI) showed a significant negative relationship with stroke mortality. However, this was not evident in Model 3. Mapping using Model 3 showed that the high-risk areas were predominantly located in northern Japan, excluding Hokkaido. Access to mechanical thrombectomy was estimated, and regional differences were observed. The relationship between accessibility and IS mortality is unknown; however, regardless of accessibility, municipalities with a high proportion of workers in secondary industries and a small proportion with bachelor's degrees or above are at risk of death from stroke.

Relationship between meteorological factors and mortality in patients with coronavirus disease 2019: A cross-sectional study

BackgroundRecent studies on COVID-19 have demonstrated that poverty, comorbidities, race/ethnicity, population density, mobility, hygiene and use of masks are some of the important correlates of COVID-19 outcomes. In fact, weather conditions also play an important role in enhancing or eradicating health issues. Based on Chinese experience, the development of SARS and COVID-19 is partially associated with alterations in climate that align with the seasonal shifts of the “24 solar terms.” However, the applicability of this pattern to other countries, particularly the United States, which has the highest global incidence and mortality rates, remains subject to ongoing investigation. We need to find more evidence to in the U.S. states verify the relationship between meteorological factors and COVID-19 outcomes to provide epidemiological and environmental support for the COVID-19 pandemic prevention and resource preservation. ObjectiveTo evaluate the relationship between meteorological factors and Coronavirus Disease 2019 (COVID-19) mortality. MethodsWe conducted an ecological cross-sectional study to evaluate the relationship between meteorological factors (maximum temperature, minimum temperature, humidity, wind speed, precipitation, atmospheric pressure) and COVID-19 mortality. This retrospective observational study examines mortality rates among COVID-19 patients in the three US states, California, Texas, and New York, with the highest fatality numbers, between March 7, 2020 and March 7, 2021. The study draws upon data sourced from the publicly accessible Dryad database. The daily corresponding meteorological conditions were retrieved from the National Oceanic and Atmospheric Administration Global Meteorological website (https://www.ncei.noaa.gov/maps/hourly/). This study employed multivariate linear regression analysis to assess the correlation between six meteorological factors and COVID-19 mortality. Gaussian distribution models were utilized to generate smooth curves for examining the linear association between maximum or minimum temperature and mortality. Additionally, breakpoint analysis was conducted to evaluate the threshold effect of temperature. ResultsWe found that the death toll of patients with COVID-19 decreased with an increase in the highest and lowest ambient temperatures (p < 0.001). In our study, we observed a seasonal difference in mortality rates, with a higher number of deaths occurring during winter months, particularly in January and February. However, mortality rates decreased significantly in March. Notably, we found no statistically significant correlation between relative humidity, average precipitation, and average wind speed with COVID-19 mortality (all p > 0.05). Daily COVID-19 death was negatively correlated with the maximum temperature (β = −22, 95% CI, −26.2 to −17.79 –, p < 0.01), while the maximum temperature was below 30 °C. Similarly, the number of deaths was negatively correlated with the minimum temperature (β = −27.46, 95% CI, −31.48 to −23.45, p < 0.01), when the minimum temperature was below 8 °C. Our study found a significant association between temperature and COVID-19 mortality, with every 1 °C increase in maximum or minimum temperature resulting in a decrease of 22 and 27 deceased cases, respectively. The relationship between atmospheric pressure and COVID-19 mortality was not fully elucidated due to its complex interaction with maximum temperature. ConclusionsThis empirical study adds to the existing body of research on the impact of climate factors on COVID-19 prevention and resource allocation. Policymakers and health scientists may find these findings useful in conjunction with other social factors when making decisions related to COVID-19 prevention and resource allocation.

Exploring regional disparities in lung cancer mortality in a Brazilian state: A cross-sectional ecological study.

Lung cancer (LC) is one of the main causes of mortality in Brazil; geographic, cultural, socioeconomic and health access factors can affect the development of the disease. We explored the geospatial distribution of LC mortality, and associated factors, between 2015 and 2019, in Parana state, Brazil. We obtained mortality (from the Brazilian Health Informatics Department) and population rates (from the Brazilian Institute of Geography and Statistics [IBGE]) in people over 40 years old, accessibility of oncology centers by municipality, disease diagnosis rate (from Brazilian Ministry of Health), the tobacco production rate (IBGE) and Parana Municipal Performance Index (IPDM) (from Parana Institute for Economic and Social Development). Global Moran's Index and Local Indicators of Spatial Association were performed to evaluate the spatial distribution of LC mortality in Parana state. Ordinary Least Squares Regression and Geographically Weighted Regression were used to verify spatial association between LC mortality and socioeconomic indicators and health service coverage. A strong spatial autocorrelation of LC mortality was observed, with the detection of a large cluster of high LC mortality in the South of Parana state. Spatial regression analysis showed that all independent variables analyzed were directly related to LC mortality by municipality in Paraná. There is a disparity in the LC mortality in Parana state, and inequality of socioeconomic and accessibility to health care services could be associated with it. Our findings may help health managers to intensify actions in regions with vulnerability in the detection and treatment of LC.

Spatio-Temporal Analysis of Leptospirosis Hotspot Areas and Its Association With Hydroclimatic Factors in Selangor, Malaysia: Protocol for an Ecological Cross-sectional Study

Leptospirosis is considered a neglected zoonotic disease in temperate regions but an endemic disease in countries with tropical climates such as South America, Southern Asia, and Southeast Asia. There has been an increase in leptospirosis incidence in Malaysia from 1.45 to 25.94 cases per 100,000 population between 2005 and 2014. With increasing incidence in Selangor, Malaysia, and frequent climate change dynamics, a study on the disease hotspot areas and their association with the hydroclimatic factors would further enhance disease surveillance and public health interventions. This study aims to examine the association between the spatio-temporal distribution of leptospirosis hotspot areas from 2011 to 2019 with the hydroclimatic factors in Selangor using the geographical information system and remote sensing techniques to develop a leptospirosis hotspot predictive model. This will be an ecological cross-sectional study with geographical information system and remote sensing mapping and analysis concerning leptospirosis using secondary data. Leptospirosis cases in Selangor from January 2011 to December 2019 shall be obtained from the Selangor State Health Department. Laboratory-confirmed cases with data on the possible source of infection would be identified and georeferenced according to their longitude and latitudes. Topographic data consisting of subdistrict boundaries and the distribution of rivers in Selangor will be obtained from the Department of Survey and Mapping. The ArcGIS Pro software will be used to evaluate the clustering of the cases and mapped using the Getis-Ord Gi* tool. The satellite images for rainfall and land surface temperature will be acquired from the Giovanni National Aeronautics and Space Administration EarthData website and processed to obtain the average monthly values in millimeters and degrees Celsius. Meanwhile, the average monthly river hydrometric levels will be obtained from the Department of Drainage and Irrigation. Data are then inputted as thematic layers and in the ArcGIS software for further analysis. The artificial neural network analysis in artificial intelligence Phyton software will then be used to obtain the leptospirosis hotspot predictive model. This research was funded as of November 2022. Data collection, processing, and analysis commenced in December 2022, and the results of the study are expected to be published by the end of 2024. The leptospirosis distribution and clusters may be significantly associated with the hydroclimatic factors of rainfall, land surface temperature, and the river hydrometric level. This study will explore the associations of leptospirosis hotspot areas with the hydroclimatic factors in Selangor and subsequently the development of a leptospirosis predictive model. The constructed predictive model could potentially be used to design and enhance public health initiatives for disease prevention. PRR1-10.2196/43712.

Association of Food Deserts and Food Swamps With Obesity-Related Cancer Mortality in the US

Obesity-related cancers account for 40% of all cancers in the US. Healthy food consumption is a modifiable factor shown to reduce obesity-related cancer mortality, but residing in areas with less access to grocery stores (food deserts) or higher access to fast food (food swamps) reduces healthy food access and has been understudied. To analyze the association of food deserts and food swamps with obesity-related cancer mortality in the US. This cross-sectional ecologic study used US Department of Agriculture Food Environment Atlas data from 2012, 2014, 2015, 2017, and 2020 and Centers for Disease Control and Prevention mortality data from 2010 to 2020. A total of 3038 US counties or county equivalents with complete information on food environment scores and obesity-related cancer mortality data were included. An age-adjusted, generalized, mixed-effects regression model was performed for the association of food desert and food swamp scores with obesity-related cancer mortality rates. Data were analyzed from September 9, 2022, to September 30, 2022. Food swamp score was calculated as the ratio of fast-food and convenience stores to grocery stores and farmers markets. Higher food swamp and food desert scores (20.0 to ≥58.0) indicated counties with fewer healthy food resources. Obesity-related cancer (based on the International Agency for Research on Cancer evidence between obesity and 13 types of cancer) mortality rates were categorized as high (≥71.8 per 100 000 population) vs low (<71.8 per 100 000 population) per county. A total of 3038 counties or county equivalents with high obesity-related cancer mortality rates had a higher percentage of non-Hispanic Black residents (3.26% [IQR, 0.47%-26.35%] vs 1.77% [IQR, 0.43%-8.48%]), higher percentage of persons older than 65 years (15.71% [IQR, 13.73%-18.00%] vs 15.40% [IQR, 12.82%-18.09%]), higher poverty rates (19.00% [IQR, 14.20%-23.70%] vs 14.40% [IQR, 11.00%-18.50%]), higher adult obesity rates (33.00% [IQR, 32.00%-35.00%] vs 32.10% [IQR, 29.30%-33.20%]), and higher adult diabetes rates (12.50% [IQR, 11.00%-14.20%] vs 10.70% [IQR, 9.30%-12.40%]) compared with counties or county equivalents with low obesity-related cancer mortality. There was a 77% increased odds of having high obesity-related cancer mortality rates among US counties or county equivalents with high food swamp scores (adjusted odds ratio, 1.77; 95% CI, 1.43-2.19). A positive dose-response relationship among 3 levels of food desert and food swamp scores and obesity-related cancer mortality was also observed. The findings of this cross-sectional ecologic study suggest that policy makers, funding agencies, and community stakeholders should implement sustainable approaches to combating obesity and cancer and establishing access to healthier food, such as creating more walkable neighborhoods and community gardens.

Socio-demographic and Epidemiological Characterisation of Leprosy in the Population of Pará, Amazon, from 2016 to 2020

Objective: To describe the sociodemographic and epidemiological characteristics of the population with leprosy in the State of Pará from 2016 to 2020.&#x0D; Methodology: Cross-sectional ecological study, based on data from the Disease Information and Notification System (SINAN). The study was conductedin 144 municipalities in Pará, Amazon. The data were organised and distributed by 12 integration Regions.&#x0D; Results and Discussion: In the analysed data, a total of 11,687 cases of leprosy were verified in Pará from 2016 to 2020. Sociodemographic data showed a predominance in the male population, in the brown race, and in those with low education, this study demonstrated that leprosy is prevalent in vulnerable populations with low socioeconomic status, highlighting social inequalities. Conclusion: Monitoring epidemiological and operational indicators of leprosy is essential for evaluating programs and planning public health policies to contribute to epidemiological surveillance.