title: Using spatial analysis to predict health care use at the local level: a case study of type 2 diabetes medication use and its association with demographic change and socioeconomic status.
abstract: Local health status and health care use may be negatively influenced by low local socio-economic profile, population decline and population ageing. To support the need for targeted local health care, we explored spatial patterns of type 2 diabetes mellitus (T2DM) drug use at local level and determined its association with local demographic, socio-economic and access to care variables. We assessed spatial variability in these associations. We estimated the five-year prevalence of T2DM drug use (2005-2009) in persons aged 45 years and older at four-digit postal code level using the University of Groningen pharmacy database IADB.nl. Statistics Netherlands supplied data on potential predictor variables. We assessed spatial clustering, correlations and estimated a multiple linear regression model and a geographically weighted regression (GWR) model. Prevalence of T2DM medicine use ranged from 2.0% to 25.4%. The regression model included the extent of population ageing, proportion of social welfare/benefits, proportion of low incomes and proportion of pensioners, all significant positive predictors of local T2DM drug use. The GWR model demonstrated considerable spatial variability in the association between T2DM drug use and above predictors and was more accurate. The findings demonstrate the added value of spatial analysis in predicting health care use at local level.
authors.affiliation: Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
authors.forename: Aletta
authors.initials: A
authors.lastname: Dijkstra
authors.forename: Fanny
authors.initials: F
authors.lastname: Janssen
authors.forename: Marinus
authors.initials: M
authors.lastname: De Bakker
authors.forename: Jens
authors.initials: J
authors.lastname: Bos
authors.forename: René
authors.initials: R
authors.lastname: Lub
authors.forename: Leo J G
authors.initials: LJ
authors.lastname: Van Wissen
authors.forename: Eelko
authors.initials: E
authors.lastname: Hak
mesh_terms: D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology*; D005843:Geography; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012044:Regression Analysis; D012923:Social Class; D062206:Spatial Analysis
chemical_list: D007004:Hypoglycemic Agents
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