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Introdução à Medicina II Class13 Adviser: Armando Teixeira Pinto, PhD

Faculdade de Medicina da Universidade do Porto Mestrado Integrado em Medicina 2009/2010. Geographical Distribution of Incidence and Fatality of Coronary Heart Disease Hospital Admissions in Portugal. Introdução à Medicina II Class13 Adviser: Armando Teixeira Pinto, PhD. TABLE OF CONTENTS.

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Introdução à Medicina II Class13 Adviser: Armando Teixeira Pinto, PhD

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  1. Faculdade de Medicina da Universidade do Porto Mestrado Integrado em Medicina 2009/2010 Geographical Distribution of Incidence and Fatality of Coronary Heart Disease Hospital Admissions in Portugal Introdução à Medicina II Class13 Adviser: Armando Teixeira Pinto, PhD

  2. TABLE OF CONTENTS • INTRODUCTION • AIM • PARTICIPANTS AND METHODS • RESULTS • DISCUSSION • REFERENCES

  3. TABLE OF CONTENTS • INTRODUCTION • AIM • PARTICIPANTS AND METHODS • RESULTS • DISCUSSION • REFERENCES

  4. INTRODUCTIONImportance Cardiovascular diseases are the most common cause of death in Europe. [1] Among them, coronary heart disease (CHD) is the most frequent. [1] Two million Europeans die from CHD each year, 21% men and 22% women. [2] Regional variations in cardiovascular mortality have been observed both between and within countries in Europe. [3] [1]World Health Organization <http://www.who.int/mediacentre/factsheets/fs310/en/index.html> [2] The Women’s Health Resource< http://www.imaginis.com/heart-disease/cad_ov.asp> [3] Tu J V, Nardi L, Willich S N. “An update on regional variation in cardiovascular mortality within Europe”. Heart J., May 2, 2008,

  5. INTRODUCTIONImportance In Portugal Stroke and ischemic heart disease are the leading causes of hospitalization and death, as well as of morbidity, disability, low quality of life and decrease in life expectancy. [4] The analysis of regional variance in CHD is important for the classification of regions in high- and low- risk regions. [3] [4] Direcção geral de saúde. Actualização do Programa Nacional de Prevenção e Controlo das Doenças Cardiovasculares. 2006. [3] Tu J V, Nardi L, Willich S N. “An update on regional variation in cardiovascular mortality within Europe”. Heart J., May 2, 2008,

  6. INTRODUCTIONCoronary Disease [5] NATIONAL HEART, LUNG, AND BLOOD INSTITUTE - Coronary Artery Disease. < http://www.nlm.nih.gov/medlineplus/coronaryarterydisease.html>

  7. TABLE OF CONTENTS • INTRODUCTION • AIM • PARTICIPANTS AND METHODS • RESULTS • DISCUSSION • REFERENCES

  8. AIM Analyze the variation in the CHD hospital admissions’ Fatality and Incidence in Portugal (continental) both on a national and on a regional level throughout the 2000-2007 year period.

  9. TABLE OF CONTENTS • INTRODUCTION • AIM • PARTICIPANTS AND METHODS • RESULTS • DISCUSSION • REFERENCES

  10. PARTICIPANTS AND METHODSStudy design

  11. PARTICIPANTS AND METHODSData collection Database Data from all Portuguese Public Hospitals, from 2000 to 2007. Extract of the GDH Database variables

  12. PARTICIPANTS AND METHODSStudy variables

  13. PARTICIPANTS AND METHODSStudy variables NUTS II distribution performed in the study

  14. Exclusion criteria Ages above 112 Admissions from Açores and Madeira Hospitalization Period (days) <1 (Patients with HP inferior to 1 day in case of death or transference to the hospital unit or discharge on personal demand were not excluded) Admissions with undefined sex

  15. PARTICIPANTS AND METHODSStatistical analysis What did we study? Geographical distribution of incidence and fatality of CHD (hospital admissions). Evolution of incidence and fatality of CHD (hospital admissions) along the 2000-2007 period.

  16. PARTICIPANTS AND METHODSStatistical analysis INCIDENCE = number of hospital admissions from CHD number of habitants FATALITY = number of hospital deaths from CHD number of hospital admissions from CHD

  17. PARTICIPANTS AND METHODSStatistical analysis Maps construction of geographical distribution for incidence and fatality – R Statistical analysis tool – SPSS Statistics 17.0

  18. PARTICIPANTS AND METHODSStatistical analysis SIR = Number of expected admissions by CHD Number of observed admissions by CHD Incidence adjusted rate = SIR * Incidence crude rate

  19. PARTICIPANTS AND METHODSStatistical analysis • SFR = Number of expected deaths by CHD • Number of observed deaths by CHD • Fatality adjusted rate = SFR * Fatality crude rate

  20. PARTICIPANTS AND METHODSStatistical analysis Importance of standardization Table 1: Comparison on age- and gender- standardized incidence rates (SIR) and crude incidence rates (CIR).

  21. TABLE OF CONTENTS • INTRODUCTION • AIM • PARTICIPANTS AND METHODS • RESULTS • DISCUSSION • REFERENCES

  22. RESULTSGeographical distribution of SIR by NUTS II 2000

  23. RESULTSGeographical distribution of SIR by NUTS II 2001

  24. RESULTSGeographical distribution of SIR by NUTS II 2002

  25. RESULTSGeographical distribution of SIR by NUTS II 2003

  26. RESULTSGeographical distribution of SIR by NUTS II 2004

  27. RESULTSGeographical distribution of SIR by NUTS II 2005

  28. RESULTSGeographical distribution of SIR by NUTS II 2006

  29. RESULTSGeographical distribution of SIR by NUTS II 2007

  30. RESULTSGeographical distribution of SIR by NUTS II 2000 2007

  31. RESULTSGeographical distribution of SFR by NUTS II 2000

  32. RESULTSGeographical distribution of SFR by NUTS II 2001

  33. RESULTSGeographical distribution of SFR by NUTS II 2002

  34. RESULTSGeographical distribution of SFR by NUTS II 2003

  35. RESULTSGeographical distribution of SFR by NUTS II 2004

  36. RESULTSGeographical distribution of SFR by NUTS II 2005

  37. RESULTSGeographical distribution of SFR by NUTS II 2006

  38. RESULTSGeographical distribution of SFR by NUTS II 2007

  39. RESULTSGeographical distribution of SFR by NUTS II 2000 2007

  40. RESULTSAdjusted incidence rate Figure 1: Age- and gender- adjusted rates of hospital admissions because of coronary heart disease per 100 000 population in Continental Portugal, 2000-2007.

  41. RESULTSAdjusted fatality rate Figure 2: Age- and gender- adjusted in-hospital case fatality rates among patients with coronary heart disease in Continental Portugal, 2000-2007.

  42. RESULTSAdjusted incidence rate VS Adjusted fatality rate Figure 3: Comparison on age- and gender- adjusted rates of hospital admissions because of coronary heart disease per 100 000 population and age- and gender- standardized in-hospital case fatality rates among patients with coronary heart disease in Continental Portugal, 2000-2007.

  43. TABLE OF CONTENTS • INTRODUCTION • AIM • PARTICIPANTS AND METHODS • RESULTS • DISCUSSION • REFERENCES

  44. DISCUSSION • There were regional differences on the distribution of the incidence of CHD Continental Portugal • Gender and age only were not responsible for the regional variation Lisboae Vale do Tejo • Highest incidence rate of CHD, but fatality rate similar to the other regions • decrease on the incidence rate of CHD in the 2004-2007 period of the study

  45. DISCUSSION Other regions The incidence and fatality of CHD in these regions were very similar. Centro presents the lowest incidence rate of CHD, but fatality rate similar to the other regions.

  46. RESULTSAdjusted incidence rate VS Adjusted fatality rate Figure 3: Comparison on age- and gender- adjusted rates of hospital admissions because of coronary heart disease per 100 000 population and age- and gender- standardized in-hospital case fatality rates among patients with coronary heart disease in Continental Portugal, 2000-2007.

  47. DISCUSSIONLimitations • Possible bias from errors in the database Missing values: admissions that don’t include address, gender, age or hospitalization cause Wrong data Several hospitalizations for the same person Hospital transferences Choosing the main diagnosis as the inclusion criteria may create unexpected bias Different data quality between regions Non-inclusion of private inpatients • Non-inclusion of individuals with CHD who haven’t been hospitalized

  48. DISCUSSIONValue Better classification of regions into high- and low- risk incidence and fatality of CHD Improvement of healthcare at regional levels, decreasing incidence and fatality of CHD Better use of available resources Adoption of more preventive measures Stimulation for further analysis and studies

  49. DISCUSSION Further Studies Risk factors Cultural factors Lifestyles Preventive measures of CHD Evaluation of CHD treatment efficiency

  50. TABLE OF CONTENTS • INTRODUCTION • AIM • PARTICIPANTS AND METHODS • RESULTS • DISCUSSION • REFERENCES

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