Spatial Association of Social Determinants of Health and Health Care Access Markers to Acute Coronary Syndromes Mortality in Brazil

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2021

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Introduction: Acute coronary syndromes (ACS) result in significant morbidity and mortality in low-and-middle-income countries (LMICs). Fifty percent of deaths in this region are from a cardiac etiology. Not much is known about the epidemiology of ACS in Brazil. Our aim was to describe the correlation between social determinants of health and access-to-care markers as related to ACS mortality and its geographic distribution in the country. Methods: Using the Brazilian National Health Database (DATASUS) and other nationally aggregated data sources, socioeconomic (SE) parameters, cardiovascular risk (CV) factors and an accessibility index for high complexity cardiac care centers (with hemodynamic monitoring and cardiac interventions) were obtained. To account for spatial dependency, geographic weighted regression (GWR) analysis was performed for all the predictor variables with respect to the outcome of deaths. Results: There were 776,449 ACS-related deaths from 2012 to 2018. The highest ACS mortality rate was in the South region of Brazil (104.7 per 100,000 population). The GWR analysis showed regional variability of socioeconomic factors as correlated with ACS mortality. A low accessibility-index in the North and Northeast regions of Brazil was strongly associated with ACS deaths. Conclusions: Spatial analysis allows for estimation of the local heterogeneity in the relationship between SE components, CV risk factors and access-to-care markers as related to ACS mortality. Such analyses allow for improved understanding of the burden of ACS in Brazil.

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Akhter, Mohammed Waseem (2021). Spatial Association of Social Determinants of Health and Health Care Access Markers to Acute Coronary Syndromes Mortality in Brazil. Master's thesis, Duke University. Retrieved from https://hdl.handle.net/10161/23175.

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