title: Regional disparities in mortality after ischemic heart disease in a Brazilian state from 2006 to 2010.
abstract: BACKGROUND
  High technology in the field of interventional cardiology applied in tertiary hospitals has brought enormous benefits in the treatment of ischemic heart disease (IHD). However, IHD mortality rates remain high. We analyzed the relationship between IHD mortality rate and the socioeconomic, demographic, and geographic conditions in 399 cities in Parana state, Brazil, from 2006 to 2010.
  
  
  RESULTS
  Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics and evaluated through Exploratory Spatial Data Analysis. GeoDa™ was used to analyze 29.351 deaths across 399 cities. We found a positive spatial autocorrelation regarding IHD mortality (I = 0.5913, p = 0.001). There was a significant positive association between each of three socioeconomic and demographic indicators and IHD mortality rate: Population Elderly Index (I = 0.3436), Illiteracy Rate (I = 0.1873) and City Development Index (I = 0.0900). In addition, two indicators presented significant negative association with IHD mortality rate: Adjusted Population Size (I = -0.1216) and Gross Domestic Product (I = -0.0864). We also found a positive association between IHD mortality rates and the geographic distances between patients' city of residence and their corresponding regional referral centers in interventional cardiology (I = 0.3368). Cities located within Regional Health Units with Reference Interventional Cardiology Center presented a significantly lower average specific mortality rate by IHD. The high mortality rate by IHD within the Regional Health Units was not restricted to socioeconomic and demographic variables, but dependent on the distance between each city and their reference interventional cardiology center.
  
  
  CONCLUSIONS
  We conclude that geographic factors play a significant role in IHD mortality within cities. These findings have important policy implications regarding the geographic distribution of cardiac health care networks in Latin America and in other emerging countries.
authors.affiliation: Department of Nursing, State University of the West of Parana, Foz do Iguaçu, Parana, Brazil.
authors.forename: Luciano
authors.initials: L
authors.lastname: de Andrade
authors.forename: Vanessa
authors.initials: V
authors.lastname: Zanini
authors.forename: Adelia Portero
authors.initials: AP
authors.lastname: Batilana
authors.forename: Elias Cesar Araujo
authors.initials: EC
authors.lastname: de Carvalho
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Oscar Kenji
authors.initials: OK
authors.lastname: Nihei
authors.forename: Maria Dalva
authors.initials: MD
authors.lastname: de Barros Carvalho
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002947:Cities; D003430:Cross-Sectional Studies; D003710:Demography; D005843:Geography; D049674:History, 21st Century; D006801:Humans; D017202:Myocardial Ischemia / Q000266:history / Q000401:mortality*; D011156:Population Density; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric