Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil
Objective The aim of this observational cross-sectional study was to analyse the spatial distribution of major lower limb amputation (MLLA) rates and associate them to socioeconomic, demographic and public healthcare access-related variables in the State of Paraná, Brazil, from 2012 to 2017.Method D...
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BMJ Publishing Group
2020-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/12/e038980.full |
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| author | Catherine Staton Sergio Quilici Belczak Joao Vissoci Rogério do Lago Franco Pedro Henrique Iora Amanda Carvalho Dutra Luciano Andrade |
| author_facet | Catherine Staton Sergio Quilici Belczak Joao Vissoci Rogério do Lago Franco Pedro Henrique Iora Amanda Carvalho Dutra Luciano Andrade |
| author_sort | Catherine Staton |
| collection | DOAJ |
| description | Objective The aim of this observational cross-sectional study was to analyse the spatial distribution of major lower limb amputation (MLLA) rates and associate them to socioeconomic, demographic and public healthcare access-related variables in the State of Paraná, Brazil, from 2012 to 2017.Method Data on MLLA, revascularisation surgeries, diagnostic exams and healthcare coverage were obtained from the Brazilian Public Hospital Information System. Socioeconomic data were obtained from the Brazilian Institute of Geography and Statistics. Spatial autocorrelation of the MLLA rates was tested using Moran’s I method. Multivariate spatial regression models using ordinary least squares regression (OLS) and geographically weighted regression (GWR) were used to identify the variables significantly correlated with MLLA.Results A total of 5270 MLLA were included in the analysis. Mean MLLA rates were 24.32 (±18.22)/100 000 inhabitants, showing a positive global spatial autocorrelation (Moran’s I=0.66; p<0.001). Queen contiguity matrix demonstrates that MLLA rates ranged from 7.6 to 46.6/100 000 with five large clusters of high MLLA rates. OLS showed that four of the nine studied variables presented significant spatial correlation with MLLA rates. Colour Doppler ultrasound showed a negative association (p<0.001), while revascularisation surgeries and illiteracy showed a positive correlation (p<0.01). GWR presented the best model (adjusted R2=0.77) showing that the predictors differentially affect the MLLA rates geographically.Conclusion The high MLLA rates in some regions of the state are influenced by the high rate of illiteracy and low utilisation rate of colour Doppler, indicating a social problem and difficulty in accessing health. On the other hand, the high rates of revascularisation surgeries are related to higher MLLA rates, possibly due to delayed access to specialised hospitals. This indicates that attention must be given to population access to public healthcare in the State of Paraná in order to ensure proper and timely medical attention. |
| format | Article |
| id | doaj-art-09975b4d04a448068088e87ddbf358e4 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-09975b4d04a448068088e87ddbf358e42025-08-20T02:26:35ZengBMJ Publishing GroupBMJ Open2044-60552020-12-01101210.1136/bmjopen-2020-038980Spatial inequalities of major lower limb amputation rates in Paraná state, BrazilCatherine Staton0Sergio Quilici Belczak1Joao Vissoci2Rogério do Lago Franco3Pedro Henrique Iora4Amanda Carvalho Dutra5Luciano Andrade61Duke Global Health InstituteMedicine Department, Centro Universitário São Camilo, Sao Paulo, BrazilDuke University Global Health Institute, Duke University, Durham, North Carolina, USAMedicine Department, Universidade Estadual de Maringa, Maringa, BrazilMedicine Department, Universidade Estadual de Maringa, Maringa, BrazilCentro de Ciencias da Saude, Universidade Estadual de Maringa, Maringa, BrazilMedicine Department, Universidade Estadual de Maringa, Maringa, BrazilObjective The aim of this observational cross-sectional study was to analyse the spatial distribution of major lower limb amputation (MLLA) rates and associate them to socioeconomic, demographic and public healthcare access-related variables in the State of Paraná, Brazil, from 2012 to 2017.Method Data on MLLA, revascularisation surgeries, diagnostic exams and healthcare coverage were obtained from the Brazilian Public Hospital Information System. Socioeconomic data were obtained from the Brazilian Institute of Geography and Statistics. Spatial autocorrelation of the MLLA rates was tested using Moran’s I method. Multivariate spatial regression models using ordinary least squares regression (OLS) and geographically weighted regression (GWR) were used to identify the variables significantly correlated with MLLA.Results A total of 5270 MLLA were included in the analysis. Mean MLLA rates were 24.32 (±18.22)/100 000 inhabitants, showing a positive global spatial autocorrelation (Moran’s I=0.66; p<0.001). Queen contiguity matrix demonstrates that MLLA rates ranged from 7.6 to 46.6/100 000 with five large clusters of high MLLA rates. OLS showed that four of the nine studied variables presented significant spatial correlation with MLLA rates. Colour Doppler ultrasound showed a negative association (p<0.001), while revascularisation surgeries and illiteracy showed a positive correlation (p<0.01). GWR presented the best model (adjusted R2=0.77) showing that the predictors differentially affect the MLLA rates geographically.Conclusion The high MLLA rates in some regions of the state are influenced by the high rate of illiteracy and low utilisation rate of colour Doppler, indicating a social problem and difficulty in accessing health. On the other hand, the high rates of revascularisation surgeries are related to higher MLLA rates, possibly due to delayed access to specialised hospitals. This indicates that attention must be given to population access to public healthcare in the State of Paraná in order to ensure proper and timely medical attention.https://bmjopen.bmj.com/content/10/12/e038980.full |
| spellingShingle | Catherine Staton Sergio Quilici Belczak Joao Vissoci Rogério do Lago Franco Pedro Henrique Iora Amanda Carvalho Dutra Luciano Andrade Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil BMJ Open |
| title | Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil |
| title_full | Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil |
| title_fullStr | Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil |
| title_full_unstemmed | Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil |
| title_short | Spatial inequalities of major lower limb amputation rates in Paraná state, Brazil |
| title_sort | spatial inequalities of major lower limb amputation rates in parana state brazil |
| url | https://bmjopen.bmj.com/content/10/12/e038980.full |
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