The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access
Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality. Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calc...
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| creator | Hertz, Julian T Fu, Tommy Vissoci, Joao Ricardo Rocha, Thiago Augusto Hernandes Carvalho, Elias Flanagan, Brendan de Andrade, Luciano Limkakeng, Alex T Staton, Catherine A |
| description | Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality.
Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables.
The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country. |
| doi_str_mv | 10.1371/journal.pone.0210502 |
| format | Article |
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Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables.
The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0210502</identifier><identifier>PMID: 30629670</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acute coronary syndrome ; Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - epidemiology ; Acute Coronary Syndrome - mortality ; Acute coronary syndromes ; Adult ; Aged ; Biology and Life Sciences ; Blood pressure ; Brazil - epidemiology ; Cardiology ; Cardiovascular disease ; Cardiovascular tests ; Catheterization ; Coronary vessels ; Cross-Sectional Studies ; Diagnosis ; Diagnostic systems ; Diagnostic tests ; Earth Sciences ; Echocardiography ; EKG ; Electrocardiography - economics ; Emergency medical care ; Female ; Health care ; Health Services Accessibility ; Heart ; Heart attacks ; Heterogeneity ; Humans ; Hypertension ; Income ; Intubation ; Male ; Medical diagnosis ; Medicine ; Medicine and Health Sciences ; Methods ; Middle Aged ; Mortality ; Municipalities ; Patient outcomes ; Patients ; People and places ; Regression analysis ; Regression models ; Research and Analysis Methods ; Scintigraphy ; Social Sciences ; Socioeconomic Factors ; Spatial distribution ; Stress ; Studies ; Surgery ; Tobacco ; Trends ; Urban areas ; Urban environments ; Young Adult</subject><ispartof>PloS one, 2019-01, Vol.14 (1), p.e0210502-e0210502</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Hertz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Hertz et al 2019 Hertz et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-cdd7374d2252ae0a8e7eea848d5468f3212246153168dcd9849748b4b659b54b3</citedby><cites>FETCH-LOGICAL-c692t-cdd7374d2252ae0a8e7eea848d5468f3212246153168dcd9849748b4b659b54b3</cites><orcidid>0000-0002-7396-4789</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328143/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6328143/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30629670$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Shah, Tayyab Ikram</contributor><creatorcontrib>Hertz, Julian T</creatorcontrib><creatorcontrib>Fu, Tommy</creatorcontrib><creatorcontrib>Vissoci, Joao Ricardo</creatorcontrib><creatorcontrib>Rocha, Thiago Augusto Hernandes</creatorcontrib><creatorcontrib>Carvalho, Elias</creatorcontrib><creatorcontrib>Flanagan, Brendan</creatorcontrib><creatorcontrib>de Andrade, Luciano</creatorcontrib><creatorcontrib>Limkakeng, Alex T</creatorcontrib><creatorcontrib>Staton, Catherine A</creatorcontrib><title>The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality.
Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables.
The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.</description><subject>Acute coronary syndrome</subject><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - epidemiology</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute coronary syndromes</subject><subject>Adult</subject><subject>Aged</subject><subject>Biology and Life Sciences</subject><subject>Blood pressure</subject><subject>Brazil - epidemiology</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular tests</subject><subject>Catheterization</subject><subject>Coronary vessels</subject><subject>Cross-Sectional Studies</subject><subject>Diagnosis</subject><subject>Diagnostic systems</subject><subject>Diagnostic tests</subject><subject>Earth Sciences</subject><subject>Echocardiography</subject><subject>EKG</subject><subject>Electrocardiography - economics</subject><subject>Emergency medical care</subject><subject>Female</subject><subject>Health care</subject><subject>Health Services Accessibility</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Income</subject><subject>Intubation</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Municipalities</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>People and places</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Research and Analysis Methods</subject><subject>Scintigraphy</subject><subject>Social Sciences</subject><subject>Socioeconomic Factors</subject><subject>Spatial distribution</subject><subject>Stress</subject><subject>Studies</subject><subject>Surgery</subject><subject>Tobacco</subject><subject>Trends</subject><subject>Urban areas</subject><subject>Urban environments</subject><subject>Young 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distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access</title><author>Hertz, Julian T ; Fu, Tommy ; Vissoci, Joao Ricardo ; Rocha, Thiago Augusto Hernandes ; Carvalho, Elias ; Flanagan, Brendan ; de Andrade, Luciano ; Limkakeng, Alex T ; Staton, Catherine A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-cdd7374d2252ae0a8e7eea848d5468f3212246153168dcd9849748b4b659b54b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acute coronary syndrome</topic><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - epidemiology</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute coronary syndromes</topic><topic>Adult</topic><topic>Aged</topic><topic>Biology and Life Sciences</topic><topic>Blood pressure</topic><topic>Brazil - 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Catherine A</au><au>Shah, Tayyab Ikram</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-01-10</date><risdate>2019</risdate><volume>14</volume><issue>1</issue><spage>e0210502</spage><epage>e0210502</epage><pages>e0210502-e0210502</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality.
Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables.
The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>30629670</pmid><doi>10.1371/journal.pone.0210502</doi><tpages>e0210502</tpages><orcidid>https://orcid.org/0000-0002-7396-4789</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | PubMed Central Free; MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS) Journals Open Access; Free Full-Text Journals in Chemistry |
| subjects | Acute coronary syndrome Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - epidemiology Acute Coronary Syndrome - mortality Acute coronary syndromes Adult Aged Biology and Life Sciences Blood pressure Brazil - epidemiology Cardiology Cardiovascular disease Cardiovascular tests Catheterization Coronary vessels Cross-Sectional Studies Diagnosis Diagnostic systems Diagnostic tests Earth Sciences Echocardiography EKG Electrocardiography - economics Emergency medical care Female Health care Health Services Accessibility Heart Heart attacks Heterogeneity Humans Hypertension Income Intubation Male Medical diagnosis Medicine Medicine and Health Sciences Methods Middle Aged Mortality Municipalities Patient outcomes Patients People and places Regression analysis Regression models Research and Analysis Methods Scintigraphy Social Sciences Socioeconomic Factors Spatial distribution Stress Studies Surgery Tobacco Trends Urban areas Urban environments Young Adult |
| title | The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access |
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