Municipality Of Residence Research Articles

Knee replacement incidence and social deprivation: results from a French ecological study.

Temporal and geographic variations in knee osteoarthritis (OA) incidence occur worldwide. Regional variations also exist for socioeconomic status. We analyzed the association between socioeconomic deprivation (SED) and knee replacement (KR) incidence and assessed the proportion of KR associated with affluence. Patients aged 15 years and over hospitalized for KR in 2013 were included. We linked each patient to a municipality of residence. Municipalities were matched to the 2011 European Deprivation Index score for SED analysis. Poisson regression was performed to examine the association between KR incidence and EDI adjusted for age and sex. The Population Attributable Fraction (PAF) was measured to calculate the proportion of excess of KR associated with social affluence. We included 77 597 KR. KR incidence decreased with increasing SED index. The EDI was significantly associated with KR incidence (P < 0.0001). The risk of KR is 2.36 times higher for persons living in the most affluent area compared to those living in the most underprivileged area. The PAF was 28.3%. The French administrative municipalities with the highest SED have the lowest age- and sex-adjusted KR incidence. It cannot be excluded that patients living in more privileged areas are overtreated. Complementary studies are necessary to define all the individual factors that limit or increase the access to knee replacement.

Profile of hospitalizations in Pediatric Intensive Care Units of the Brazilian Unified Health System in the state of Pernambuco, Brazil.

In Brazil, the distribution of pediatric intensive care units (PICUs), causes of admission, costs incurred and how care is provided are still poorly understood. The objective was to describe the profile of hospitalizations in the PICUs of the Brazilian Unified Health System in the state of Pernambuco, in 2010. A cross-sectional study was performed, with 1,915 hospitalizations in the six PICUs, collected in the Hospital Information System. The variables were compared by age group. There was a predominance of male hospitalizations (58.1%), an age range of between one and four years old (32.5%), the use of philanthropic units (64.1%) and type III PICUs (59.2%) and admissions due to neoplasms (28.9%). The mean hospital stay was 14.4 days, and the mean cost was BRL 6,674.80. The mean distance between the municipality of residence and the PICU ranged from 8.7 to 486.5 km. There were 207 deaths (10.8/100 admissions), of which 30% were due to infectious and parasitic diseases. Differences were identified between the age groups (p < 0.05), except regarding gender. In conclusion, admissions to PICUs in Pernambuco show differences in geographical access and sociodemographic characteristics, admissions, and causes of hospitalization and death among age groups.

First incidence and associated factors of overweight and obesity from preschool to primary school: longitudinal analysis of a national cohort in Japan.

To assess longitudinal changes in the first incidence of overweight and obesity and associated factors from preschool to primary school age in Japan. We obtained individual-level data from the "Longitudinal Survey of Newborns in the 21st Century" on children born in Japan in 2001. This analysis included 15,427 children (7951 boys and 7476 girls) with complete anthropometric data reported annually from age 42 months to 12 years. We followed the criteria of the International Obesity Task Force to define overweight and obesity. We assessed annual and cumulative incidence proportions and estimated odds ratios for the first incidence at preschool age (42-66 months) and primary school age (7-12 years), using multivariable logistic regression. The annual incidence of overweight and obesity combined was 3.8% at age 54 months (3.5% in boys, 4.2% in girls), and 1.2% at age 12 years (1.6% in boys, 0.7% in girls). The cumulative incidence was 19.7% at age 12 years (21.9% in boys, 17.3% in girls). Odds ratios (95% confidence intervals) of incidence for girls compared with boys were 1.28 (1.12-1.46) at preschool age and 0.62 (0.55-0.68) at primary school age. Other associated factors at preschool age included birth month, birthweight, gestational length, region and municipality of residence, living with grandparents, and behavioral factors (bedtime hours, television viewing time, and skipping breakfast). These associations persisted at primary school age except birthweight and gestational length and associated factors covered maternal education, living without siblings, and school travel mode. The first incidence decreases from preschool to primary school age and follows different age trajectories for boys and girls in a high-income population with low levels of childhood overweight and obesity. Policy-makers should consider such age-based changes in incidence and associated factors to target appropriate groups for primary prevention.

Analytical study of the breast cancer patient flow network in Brazil from 2014 to 2016

This study aims to analyze the flow of breast cancer patients treated outside of their municipality of residence, based on hospital admissions and chemotherapy and radiotherapy in the Brazilian Unified National Health System (SUS) from 2014 to 2016. Network analysis was used, considering the municipality of residence and of treatment as nodes in a graph, thus consisting of a "health system organizational network study". In addition, highway distances and travel time were estimated via the best feasible route according to the Open Street Maps highway project. According to the results, 51.34% of breast cancer patients in Brazil were treated outside their municipality of residence, following regionalized flows that respect state borders, generally towards the state capital or other large cities. The results also point to specific exceptions, where some municipalities occupy outstanding positions that extrapolate state borders. Median travel time from the municipality of residence to the municipality of care was nearly 3 hours, and 75% of trips totaled 324km for chemotherapy, 287km for radiotherapy, and 282km for hospitalizations. These results are indicative of the difficulties in access to oncology services, potentially aggravating the illness experience with cancer in terms of impact on the individuals and their families.

Case-fatality after a hospitalization for acute coronary syndrome in 2015: A national study

Previous study described acute myocardial infarction case fatality in France in cardiac care unit but no recent study analyzed all hospitalized acute coronary syndrome with one year follow-up. The objectives of this study were to analyze very early to late case fatality rates in patients hospitalized for ACS in 2015 in France, their determinants and time-trends between 2010 and 2015. Data were extracted from the national health insurance information system. Hospitalisation for ACS were collected by using ICD-10 codes as primary discharge diagnosis for ST-elevation myocardial infarction (STEMI), other MI and unstable angina (UA). Multivariate Cox models adjusted for age, comorbidities, sex, previous ACS, social deprivation of the municipality of residence, invasive procedures and pharmacological treatment refund were used to assess determinants of case-fatality respectively at 3 day after hospital admission, 4–30 day and 31–365 day after excluding dead patients of the preceding periods. In 2015, 84,202 persons were hospitalized for ACS with 34.9% for STEMI, 20.5% for other MI and 44.7% for UA. Mean age were 65.2, 69.1 and 68.1 respectively. Cumulative 3-day, 30-day and 1-year case-fatality were 3.9%, 8.4% and 13.8% for STEMI, 2.7%, 6.5% and 14.4% for other MI, and 0.4%, 2.0% and 7.2% for UA. In multivariate analysis, female sex was associated with higher 3-day case-fatality among STEMI only, particularly < 65 years of age [HR = 1.47(1.30–1.68)]. Social deprivation was associated with an increase of all case-fatality outcomes. Additional adjustment for hospital management and medication delivery did not change the results. Case-fatality up to 1 year after a hospitalization for ACS remained non-negligible. Women seemed to be at particular risk of very early case-fatality. Social inequalities independently impacted all period outcomes. No significant change in ACS case fatality were found between 2010 and 2015.

Las acciones educativas para la prevención de la violencia de género desde la percepción de estudiantes adolescentes de Andalucía

Resumen:Los estudios actuales muestran que existen necesidades formativas en materia de igualdad y prevención de la violencia de género entre adolescentes y desvelan una falta de acciones efectivas que las mitiguen. Nos interesa saber qué piensa el alumnado sobre las acciones educativas relacionadas con la igualdad y en contra de la violencia de género, conocer su percepción sobre el machismo en su centro educativo y saber si hay diferencias significativas en función del sexo y la edad en la valoración de estas acciones. Se realiza un estudio descriptivo tipo encuesta sobre una muestra representativa de 875 estudiantes de entre 14 y 19 años de Andalucía siguiendo un muestreo estratificado por afijación simple en función del tamaño de los municipios de residencia, la edad y el género. Los resultados indican que hay un porcentaje relevante de estudiantes que se muestran indiferentes hacia estas intervenciones, dejando entrever que o no las identifican como tales o no se han realizado de una manera significativa para ellos/as. Un notable porcentaje piensa que existe machismo en el centro educativo. Se observan diferencias en función del sexo y la edad en las valoraciones de las acciones. El estudio revela el papel de las acciones formativas y su repercusión para los estudiantes andaluces. También muestra la necesidad de hacer más visible a los estudiantes, el sentido que tienen y su relevancia. Las intervenciones se han de plantear de forma que resulten significativas para sus momentos vitales e impacten en su conciencia de género, debiendo ser específicas y diferenciadas para hombres y mujeres.

Dying at home for terminal cancer patients: differences by level of education and municipality of residence in Spain

ObjectiveTo measure and assess differences by educational level in the place of death for cancer patients, and to determine whether patterns of geographical disparities are associated with access to palliative care services in the municipality of residence. MethodWe analysed the death certificates of adults (older than 24) who died of cancer (ICD-10 C00 to C97) in Spain during 2015, either at home, in hospital or in a long-term care centre. Of the 105,758 individuals included in the study population, 75.2% lived in one of the 746 identifiable municipalities (more than 10,000 inhabitants). This individual database was combined with three economic databases at municipal level and with a directory of palliative care resources published by the Sociedad Española de Cuidados Paliativos. Multilevel models were estimated to predict the place of death according to individual characteristics. Generalised least squares regression models were then applied to the municipal effects estimated in the first stage. ResultsThe probability of dying in long-term care centre decreases as levels of education increase; the probability of dying at home, rather than in hospital, is higher for patients with higher education. Dying in hospital is an urban phenomenon. There are large differences between Spanish regions. Access to palliative services is only of marginal significance in accounting for the systematic differences observed between municipalities. ConclusionsDeveloping specific plans for palliative care, with an active role being played by primary care teams, may help improve end-of-life care in Spain.

Therapeutic itinerary and access to health services in cases of oral cancer deaths

ABSTRACT Objective: to characterize the therapeutic itinerary followed by individuals who died from oral cancer in one area in the northeastern of Brazil, measuring the distances and average time spent in the searching for diagnosis and treatment service. Methods: this is an epidemiological, cross-sectional, retrospective study, where the key informants were interviewed and the points of residence and services were geo-referenced. The variables related to the location of diagnosis, the distance traveled and the time spent for the diagnostic sites, treatment and place of death, services used during the therapeutic course and the main access difficulties were studied. Percent differences were tested using Fisher's exact test, with α = 5%. To evaluate the behavior and the identification of hot areas for this mortality, the Kernel density estimator technique was used. Results: of the 18 cases of death due to oral cancer, 94.4 % were diagnosed in reference centers; 83.3% were diagnosed and treated for up to 60 days; 77.8% were diagnosed and died in less than one year, and in 72.2 %, financials reasons were identified as an obstacle to access to a health care provider. The average distance traveled to the diagnoses sites was 7,364.7 meters, with an average time spent of 32.67 min and for treatment, it was 6,987.5 meters and 33.68 min. Conclusion: the study showed that the diagnosis of the injury occurred predominantly outside the municipality of residence, although , people walked a fairly small distance to the health services, spending about half an hour for this displacement.

Lower youth steps/day values observed at both high and low population density areas: a cross-sectional study in metropolitan Tokyo

BackgroundPhysical activity among children and adolescents (collectively, youth) is important to ensure adult health. Population density is a factor that affects physical activity via various environmental factors. However, the relationship between population density and physical activity among youth is not fully understood, especially in extremely high density area. The aim of this study was to examine the relationship between population density and physical activity of youth using pedometer-determined step data.MethodsA total of 13,688 youth between 6 to 15 years of age were identified from the 2011 Tokyo Metropolitan Survey of Physical Fitness, Physical Activity and Lifestyle. Participants were divided into five subgroups according to the population density of their municipality of residence. The population density’s fixed effects on in-school, out-of-school, and daily total step count adjusted for gender and school grade were estimated.ResultsThe lowest (< 2500 people/km2) and highest (> 10,000 people/km2) population density subgroups had significantly lower daily total step count and out-of-school step count than those of the reference population (5000–7500 people/km2). In contrast, in-school step count did not significantly differ according to population density.ConclusionsBoth low population density and also high population density were related to lower step count. Low physical activity in high density areas has not been well documented in previous research. Considering population growth in urbanized area globally, these results suggest the importance of continued research of physical activity determinants in high population density areas.

Linking surveillance and climate data to combat malaria

IntroductionMalaria is an infectious disease that affected nearly 215 million individuals in 2015. In Brazil, there are various information systems targeted to store data from disease notification, including malaria surveillance. However, these databases are identified and difficult to be accessed by researchers due to privacy restrictions.&#x0D; Objectives and ApproachOur goal is to integrate data from two different malaria surveillance systems, as well climate, hydrographics and socioeconomic data, to support ecological and cohort-based analyzes on malaria recurrence, parasitic classification assisted by machine learning methods and epidemics forecasting.&#x0D; Our approach so far was to generate data sets organized by municipality of residence and by municipality of infection and the disposal of these data sets with information aggregated on monthly and annual basis. We expect these databases can be freely used by any researcher intending to conduct studies on malaria using governmental data.&#x0D; ResultsOur current results comprise data sets with information aggregated by municipality of residence, for all municipalities within the Amazonian region (n=772), and by municipalities of infection with active transmission (n=613). For both case, we added variables referring to demographic, socioeconomic, climatological and hydrological data for the period 2010 to 2015 in an annual and monthly form.&#x0D; We also performed a machine learning-based classification to group notifications according to the type of parasite into P. vivax, P. falciparum and mixed cases. Our goal is to identify similar and different characteristics among such groups that can be used to correctly assess recurrence, as well support epidemic forecasting.&#x0D; Conclusion/ImplicationsFrom the databases we created, it will be possible to implement an indexing structure with related metadata, as well publicize these databases to allow for free access by researchers. Currently, we are also running different predictive analytics methods (including visualisation) targeted to generate a forecast model for malaria epidemics.

Spatiotemporal diffusion of influenza A (H1N1): Starting point and risk factors.

Influenza constitutes a major challenge to world health authorities due to high transmissibility and the capacity to generate large epidemics. This study aimed to characterize the diffusion process of influenza A (H1N1) by identifying the starting point of the epidemic as well as climatic and sociodemographic factors associated with the occurrence and intensity of transmission of the disease. The study was carried out in the Brazilian state of Paraná, where H1N1 caused the largest impact. The units of spatial and temporal analysis were the municipality of residence of the cases and the epidemiological weeks of the year 2009, respectively. Under the Bayesian paradigm, parametric inference was performed through a two-part spatiotemporal model and the integrated nested Laplace approximation (INLA) algorithm. We identified the most likely starting points through the effective distance measure based on mobility networks. The proposed estimation methodology allowed for rapid and efficient implementation of the spatiotemporal model, and provided evidence of different patterns for chance of occurrence and risk of influenza throughout the epidemiological weeks. The results indicate the capital city of Curitiba as the probable starting point, and showed that the interventions that focus on municipalities with greater migration and density of people, especially those with higher Human Development Indexes (HDIs) and the presence of municipal air and road transport, could play an important role in mitigation of effects of future influenza pandemics on public health. These results provide important information on the process of introduction and spread of influenza, and could contribute to the identification of priority areas for surveillance as well as establishment of strategic measures for disease prevention and control. The proposed model also allows identification of epidemiological weeks with high chance of influenza occurrence, which can be used as a reference criterion for creating an immunization campaign schedule.

Movilidad habitual y concentración territorial de la población inmigrante: el caso de la Región Metropolitana de Barcelona

The recent arrival of thousands of foreign immigrants has modified the labor market of the Metropolitan Region of Barcelona. This paper studies immigrant commuting behavior, especially those displacements produced between workplace and residence. Commuting characteristics will first be analyzed from a descriptive perspective, to then focus on the effects of territorial distribution over mobility. Results show that immigrants need more time for their displacements, and a greater intensity in public transport use. At the same time, they tend to work less outside their municipality of residence. If analyzed by gender, these patterns particularly affect women. Additionally, a clear concentration effect is also noticed, reinforced by location: A metropolitan center effect is observed, while peripheries penalize daily mobility.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

BACKGROUND CONTEXT Lumbar disc herniation (LDH) is associated with great morbidity and significant socio-economic impact in many parts of the world, as the majority of the patients are of working age. The patients' ability to return to the workforce following an illness depends on the person's workload, strength of social relationships, level of education and length of sick leave. PURPOSE The purpose of this study is to determine if the duration of preoperative sick leave is predictive of return to work following discectomy. STUDY DESIGN/SETTING A retrospective study of prospectively collected data from the Danish Spine database (DaneSpine) and the Danish Ministry of Employment's national register of public sickness benefits (DREAM database). PATIENT SAMPLE The study population comprised of a consecutive cohort of patients aged between 17 and 62years at the time of operation, treated at a single spine specialty center due to LDH during the period from 1 June 2010 to 31 May 2013. All patients had magnetic resonance imaging demonstrating lumbar disc herniation at the level and side corresponding with the patient's symptoms. OUTCOME MEASURES Number of weeks on sick leave post-operatively. METHODS Data available from the DREAM database included weekly public transfer payments to the patients two years prior to the date of operation and two years postoperative. As work force attachment is a cyclically sensitive parameter, a control cohort was also made available. The control cohort was matched to the LDH cases based on date of birth, sex and municipality of residence on the week of surgery. After linking data from DaneSpine and the DREAM register the surgical and vocational record for each person was established. We examined the weekly status of any type of transfer income in each of the weeks two years prior and after the date of surgery to describe the socio-economical history for each person before and after the surgery. RESULTS A total of 1,134 consecutive patients operated due to herniated lumbar disc and 3,402 age and sex matched controls were included in the study. The mean age in both cohorts was 48.16±14.75. One year postoperative the employment rate for cases was fairly constant, at 15 % below the controls. There was a strong association between the duration of preoperative sick leave and postoperative sick leave, with a correlation coefficient of 0.832 (p CONCLUSIONS Denmark has a public and free health care system, which minimizes socio-economic differences in the access to health care, thus reducing the risk of bias in the present study. Due to free health care socio-economic factors should not affect the duration of preoperative sick leave. The study indicated a need to address the patients with sick leave exceeding 3 months due to LDH to avoid long-term sick leave, risk of developing chronic pain syndromes and risk of early retirement.

Vigilância das síndromes neurológicas notificadas no HFSE em um contexto de epidemia de Zika, chikungunya e dengue

Justificativa e Objetivos: a ocorrência de manifestações neurológicas no contexto da circulação dos vírus da dengue(DENV), Zika(ZIKV) e chikungunya(CHIKV) no Brasil é um desafio para a vigilância epidemiológica. Objetivo: descrever o perfil clínico-epidemiológico dos pacientes notificados no HFSE com síndromes neurológicas potencialmente associadas ao DENV, CHIKV e ZIKV, em 2015 e 2016. &#x0D; Métodos: estudo observacional, com análise de bases secundárias e coleta de dados em prontuários e fichas de investigação epidemiológica do HFSE. Incluídos todos os casos notificados em 2015 e 2016, que atendessem aos critérios: a) síndrome neurológica de origem indeterminada e registro de infecção viral prévia até 60 dias antes do início do quadro neurológico, confirmados laboratorialmente ou não; b) síndrome neurológica sem registro de infecção viral prévia até 60 dias antes do início do quadro neurológico, com confirmação laboratorial para DENV, CHIKV e ZIKV em líquor, soro ou urina. Variáveis analisadas: sexo, idade, raça/cor, escolaridade, município de residência, sinais e sintomas, diagnóstico sindrômico e etiológico do quadro neurológico, local/tempo de internação e evolução. &#x0D; Resultados: 72 casos notificados: 61,1% homens, idade mediana 37 anos, quadro neurológico com síndrome de Guillain-Barré(SGB) 34,7% e meningoencefalite 31,9%. Foram classificados como associados a arboviroses 39 casos (54,1%), dos quais 14 pelo critério laboratorial (3 ZIKV, 6 CHIKV, 4 DENV, 1 DENV+ CHIKV) e 25 por critério clínico-epidemiológico. Nos laboratorialmente confirmados o percentual de meningoencefalite (57,1%) ultrapassou SGB (35,7%). &#x0D; Conclusão: o diagnóstico diferencial entre as arboviroses nesse contexto é um desafio para a vigilância epidemiológica, destacando-se o predomínio da SGB e das meningoencefalites.&#x0D; PALAVRAS-CHAVE: infecção por arbovírus; manifestações neurológicas; Epidemiologia.

Judicialização do Acesso aos Serviços de Saúde: análise de caso da Secretaria de Saúde de Pernambuco

Objetivo: Este artigo objetivou analisar a judicialização do acesso aos serviços de saúde na Secretaria Estadual de Saúde de Pernambuco no ano de 2016. Métodos: Tratou-se de estudo transversal, quantitativo e analítico com dados do Núcleo de Ações Judiciais da Secretaria Estadual de Saúde de Pernambuco em 2016. As variáveis foram: o produto; o estabelecimento de atendimento; CID-10; municípios da comarca; município de residência; sexo; grupo do produto e condutor da ação. Resultados: Dos 2.560 processos, os medicamentos corresponderam a 63,5% das ações. 42% das demandas concentraram-se na 1a Região de Saúde; 39,3% e 31,5% foram provenientes de unidades públicas de saúde e filantrópicas, respectivamente. Os dados corroboram com achados da literatura quanto ao item mais demandado judicialmente e à tendência de concentração em regiões metropolitanas. Difere quanto à natureza do órgão demandante por ter sido neste caso o próprio poder público e as unidades de saúde pública. Conclusões: Incorporar os objetos das demandas judiciais na oferta regular dos serviços de saúde pode contribuir para a redução de processos e aumentar o acesso dos cidadãos aos direitos legais. Em alguns casos, garantir o cumprimento das normas já editadas favorece a tendência de diminuição da judicialização, sendo necessário para esta análise os estudos longitudinais.

Place of registration and place of residence: the non-linear detrimental impact of transportation cost on electoral participation

The French case offers a very valuable opportunity for testing the impact of transportation costs on the individual decision of turnout, because in France, voters can be registered in a municipality other than their residential municipality. Voters with a non-residential registration have to travel great distances in order to cast their ballots compared to voters with a residential registration. Our empirical analysis, based on a unique dataset extracted from the French Census database, uses a selection model to estimate the probability of voting of an individual voter with a non-residential electoral registration and assesses the impact of the distance to the voting municipality on this probability. The analysis shows that distance and in fine the cost of voting have a highly significant impact on electoral turnout: at the median distance (22 km), a 1% increase in distance induces a reduction of 0.01% in turnout in the first round of the 2012 French presidential election and 0.007% in the second round. Moreover, the impact of distance is non-linear: an increase in distance for voters with a short distance to travel is more detrimental to turnout than the same increase for voters who travel great distances. The results are robust to several checks, ranging from analyzing other elections to changes in the estimation method. This analysis provides new insights in the issue of voting cost and its impact on electoral turnout.

Exploring variation in human papillomavirus vaccination uptake in Switzerland: a multilevel spatial analysis of a national vaccination coverage survey

ObjectiveUnderstanding the factors that influence human papillomavirus (HPV) vaccination uptake is critically important to the design of effective vaccination programmes. In Switzerland, HPV vaccination uptake (≥1 dose) by age 16...

Sociodemographic determinants of attrition in the HIV continuum of care in Brazil, in 2016.

The aim of this study was to identify sociodemographic factors associated with attrition in the 3 steps of the HIV continuum of care related to the 90-90-90 targets – access to diagnosis, treatment initiation, and virologic suppression, in Brazilian adults (15 years or older), in 2016.Programmatic data were obtained from 2 information systems from the Brazilian Ministry of Health, which register all antiretroviral therapy (ART) dispensations and all CD4+ and viral load counts (VL) performed within the country's public health system. The 3 attrition indicators were late presentation to care, defined as a first CD4 count <350 cells/mm3 among ART-naive individuals who performed a first CD4+ count in 2016; not being on ART, defined as having no recorded dispensation within the last 100 days of the year, among those who were linked to care in 2016; and not being virologically suppressed, defined as having the last recorded VL >200 copies/mL in 2016, among those with a recorded VL count who were on treatment for at least 6 months. Association of sociodemographic factors with these indicators was analyzed by unconditional logistic regression analysis.Lower educational level and black/brown/indigenous race/color were associated with worse outcomes in the 3 indicators. Environmental indicators, namely the region, size, and social vulnerability index of the municipality of residence, also played an important role in the models. Younger age was strongly associated with not being on ART and not showing virological suppression.Our findings help identify the barriers in the different stages of the HIV continuum of care, which need to be addressed in order to progress toward the achievement of the 90-90-90 targets.

Dimensão espacial do(s) risco(s) em Portugal continental e na área metropolitana do Porto: perceção dos alunos do 9.º ano de escolaridade

Neste estudo pretende-se aferir a perceção que os alunos do 9º ano de escolaridade têm sobre alguns conceitos fundamentais ligados à ciência do Risco e avaliar a respetiva capacidade em identificar e classificar os riscos naturais e mistos com maior probabilidade de ocorrência, tanto à escala nacional como na Área Metropolitana do Porto (AMP). Procedeu-se à aplicação de um inquérito, por questionário, e os resultados mostram que os discentes classificaram o risco de incêndio florestal como o de maior probabilidade de ocorrência, quer a nível nacional quer no conjunto dos concelhos da AMP, com uma classificação a variar entre elevada e moderada, respetivamente. A nível municipal, são destacar algumas diferenças no “ranking” definido para as diferentes tipologias de risco. O estudo sugere, ainda, que a maioria dos alunos tem dificuldade em identificar a génese, as consequências e as medidas de mitigação dos riscos por eles identificados como sendo os de maior probabilidade de manifestação no respetivo município de residência.

Exploring the small-scale spatial distribution of hypertension and its association to area deprivation based on health insurance claims in Northeastern Germany

BackgroundHypertension is one of the most frequently diagnosed chronic conditions in Germany. Targeted prevention strategies and allocation of general practitioners where they are needed most are necessary to prevent severe complications arising from high blood pressure. However, data on chronic diseases in Germany are mostly available through survey data, which do not only underestimate the actual prevalence but are also only available on coarse spatial scales. The discussion of including area deprivation for planning of healthcare is still relatively young in Germany, although previous studies have shown that area deprivation is associated with adverse health outcomes, irrespective of individual characteristics. The aim of this study is therefore to analyze the spatial distribution of hypertension at very fine geographic scales and to assess location-specific associations between hypertension, socio-demographic population characteristics and area deprivation based on health insurance claims of the AOK Nordost.MethodsTo visualize the spatial distribution of hypertension prevalence at very fine geographic scales, we used the conditional autoregressive Besag–York–Mollié (BYM) model. Geographically weighted regression modelling (GWR) was applied to analyze the location-specific association of hypertension to area deprivation and further socio-demographic population characteristics.ResultsThe sex- and age-adjusted prevalence of hypertension was 33.1% in 2012 and varied widely across northeastern Germany. The main risk factors for hypertension were proportions of insurants aged 45–64, 65 and older, area deprivation and proportion of persons commuting to work outside their residential municipality. The GWR model revealed important regional variations in the strength of the examined associations.ConclusionArea deprivation has only a significant and therefore direct influence in large parts of Mecklenburg-West Pomerania. However, the spatially varying strength of the association between demographic variables and hypertension indicates that there also exists an indirect effect of area deprivation on the prevalence of hypertension. It can therefore be expected that persons ageing in deprived areas will be at greater risk of hypertension, irrespective of their individual characteristics. The future planning and allocation of primary healthcare in northeastern Germany would therefore greatly benefit from considering the effect of area deprivation.