Modeling Respiratory Disease Clusters in Central Appalachia

1. Matt Laurin - Morehead State University E-mail: mrlaur01@morehead-st.edu Aaron Pierce - Morehead State UniversityE-mail: anpierce@moreheadstate.edu Modeling Respiratory Disease Clusters in Central Appalachia Timothy S. Hare IRAPP, MSU 414C Bert Combs Building Tel. 606-783-9436 E-mail: t.hare@morehead-st.edu 1

2. Study Area

3. Mortality Rates - All Causes

4. LISA Cluster Map – Mortality - All Causes – Moran’s I 0.520***

5. Age-Adjusted Mortality for All Causes

6. LISA Cluster Map of Mortality for All Causes

7. Research Questions • Are mortality rates due to major respiratory conditions distributed evenly across central Appalachia? • What factors are associated with elevated mortality rates due to major respiratory conditions? 7

8. Key Tasks • Identify meaningful clusters of high mortality rates. • Use techniques of ESDA to characterize associated factors. • Examine the effects of factors on spatial clusters of high mortality rates. 8

9. Data & Methods Data • SeerStat • Health Care Services • AHA Annual Survey • Additional surveys & questionnaires • Area Resource File • Socioeconomic Data - Census • Travel – Kentucky State Transportation Model (KYSTM) Methods • Spatial Aggregation • County-level (598) • Mortality Rates • Temporal Aggregation • Direct Standardization • Age-Adjusted Rates • Year 2000 U.S. Standard Population • Travel time calculations 9

10. Analysis Techniques • Map visualization • Univariate & Bivariate Moran’s I • Local Indicators of Spatial Autocorrelation • Spatial Regression (lag & error models) • Geographically Weighted Regression 10

11. Research Question 1 • Are mortality rates due to lung cancer distributed evenly across central Appalachia? • Are Mortality rates due to COPD distributed evenly across central Appalachia? 11

12. Age-Adjusted Mortality for Lung Cancer

13. LISA Cluster Map of Lung Cancer Mortality

14. Age-Adjusted Mortality for Lung Cancer by Sex

15. LISA Cluster Map of Lung Cancer Mortality by Sex

16. Age-Adjusted Mortality for COPD

17. LISA Cluster Map of COPD Mortality

18. Age-Adjusted Mortality for COPD by Sex

19. LISA Cluster Map of COPD Mortality by Sex

20. Female vs. Male Lung Cancer Mortality Multivariate LISA Cluster Map Moran’s I = 0.3700 p < 0.001

21. Female vs. Male COPD Mortality Multivariate LISA Cluster Map Moran’s I = 0.3368 p < 0.001

22. Spatial Autocorrelation: Moran’s I Note: *** P < 0.001, ** P < 0.01, * P < 0.05

23. Research Question 1 • Are mortality rates due to lung cancer distributed evenly across central Appalachia? - No • Are Mortality rates due to COPD distributed evenly across central Appalachia? - No 23

24. Research Questions 2 • What factors are associated with elevated mortality rates due to Lung Cancer? • What factors are associated with elevated mortality rates due to Lung Cancer? 24

25. Population Density (people/mile2) 25

26. Median Household Income

27. LISA Cluster Map – Median Income – Moran’s I 0.681***

28. % with High School Education

29. LISA Cluster Map – High School – Moran’s I 0.582***

30. LISA Cluster Map – College – Moran’s I 0.532***

31. Total Household Health Care Expenditures

32. LISA Cluster Map - Household Health Care – Moran’s I 0.579***

33. Health Care Spending (% of Total Household Spending)

34. Health Insurance Spending

35. LISA Cluster Map - Insurance – Moran’s I 0.589***

36. Health Insurance Spending (% of Total Expenditures)

37. Total Household Education Spending

38. LISA Cluster Map – Total Education – Moran’s I 0.680***

39. Persistent Pattern: Rx Drug Spending

40. LISA Cluster Map - Rx Drug Spending – Moran’s I 0.419***

41. Bivariate Moran’s I vs. Total Mortality for Lung Cancer Note: *** P < 0.001, ** P < 0.01, * P < 0.05

42. Bivariate Moran’s I vs. Total Mortality for COPD Note: *** P < 0.001, ** P < 0.01, * P < 0.05

43. OLS Regression Model 1 Adjusted R-squared:    0.328321 Akaike info criterion:     4677.76 Note: *** P < 0.001, ** P < 0.01, * P < 0.05

44. Spatial Regression Model 1 (Lag) R-squared:    0.49796    Akaike info criterion:     4575.46 Note: *** P < 0.001, ** P < 0.01, * P < 0.05

45. Comparison of OLS & Spatial Lag Regression R-squared:    0.49796    Akaike info criterion:     4575.46 Adjusted R-squared:    0.328321 Akaike info criterion:     4677.76 Note: *** P < 0.001, ** P < 0.01, * P < 0.05

46. Results • Mortality rates due to major respiratory conditions are not distributed evenly across central Appalachia. • All examined factors are associated with elevated mortality rates due to major respiratory conditions. 46

47. Future Investigations • Further explore differences by sex • Deal with multicollinearity • Create composite deprivation index • Examine service utilization patterns • Examine • Tobacco use • Air quality 47

48. Questions?! 48

49. Thank You Thanks to: TheNational Center for Health Statistics for the mortality data. This Research is supported in part by: An MSU Faculty Research Grant KBRIN-NIH Research Grant The Institute for Regional Analysis and Public Policy Booth Endowment Research Grant Institute for Regional Analysis and Public Policy (IRAPP) Center of Excellence, MSU AKentucky Program of Distinction http://irapp.morehead-st.edu 49