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Spatial-temporal analysis of cerebral infarction mortality in Hokkaido, Japan : an ecological study using a conditional autoregressive model

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Title: Spatial-temporal analysis of cerebral infarction mortality in Hokkaido, Japan : an ecological study using a conditional autoregressive model
Authors: Ohashi, Kazuki Browse this author →KAKEN DB
Osanai, Toshiya Browse this author →KAKEN DB
Fujiwara, Kensuke Browse this author
Tanikawa, Takumi Browse this author →KAKEN DB
Tani, Yuji Browse this author →KAKEN DB
Takamiya, Soichiro Browse this author
Sato, Hirotaka Browse this author
Morii, Yasuhiro Browse this author →KAKEN DB
Bando, Kyohei Browse this author
Ogasawara, Katsuhiko Browse this author →KAKEN DB
Keywords: Conditional autoregressive model
Cerebral infarction
Bayesian inference
Spatial-temporal analysis
Healthcare accessibility
Issue Date: 31-Oct-2022
Publisher: BioMed Central
Journal Title: International Journal of Health Geographics
Volume: 21
Issue: 1
Start Page: 16
Publisher DOI: 10.1186/s12942-022-00316-1
PMID: 36316770
Abstract: Background: Accessibility to stroke treatments is a challenge that depends on the place of residence. However, recent advances in medical technology have improved health outcomes. Nevertheless, the geographic heterogeneity of medical resources may increase regional disparities. Therefore, evaluating spatial and temporal influences of the medical system on regional outcomes and advanced treatment of cerebral infarction are important from a health policy perspective. This spatial and temporal study aims to identify factors associated with mortality and to clarify regional disparities in cerebral infarction mortality at municipality level. Methods: This ecological study used public data between 2010 and 2020 from municipalities in Hokkaido, Japan. We applied spatial and temporal condition autoregression analysis in a Bayesian setting, with inference based on the Markov chain Monte Carlo simulation. The response variable was the number of deaths due to cerebral infarction (ICD-10 code: I63). The explanatory variables were healthcare accessibility and socioeconomic status. Results: The large number of emergency hospitals per 10,000 people (relative risk (RR) = 0.906, credible interval (Cr) = 0.861 to 0.954) was associated with low mortality. On the other hand, the large number of general hospitals per 10,000 people (RR = 1.123, Cr = 1.068 to 1.178) and longer distance to primary stroke centers (RR = 1.064, Cr = 1.014 to 1.110) were associated with high mortality. The standardized mortality ratio decreased from 2010 to 2020 in Hokkaido by approximately 44%. Regional disparity in mortality remained at the same level from 2010 to 2015, after which it narrowed by approximately 5% to 2020. After mapping, we identified municipalities with high mortality rates that emerged in Hokkaido's central and northeastern parts. Conclusion: Cerebral infarction mortality rates and the disparity in Hokkaido improved during the study period (2010-2020). This study emphasized that healthcare accessibility through places such as emergency hospitals and primary stroke centers was important in determining cerebral infarction mortality at the municipality level. In addition, this study identified municipalities with high mortality rates that require healthcare policy changes. The impact of socioeconomic factors on stroke is a global challenge, and improving access to healthcare may reduce disparities in outcomes.
Type: article
Appears in Collections:保健科学院・保健科学研究院 (Graduate School of Health Sciences / Faculty of Health Sciences) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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