title: Spatial prevalence and associations among respiratory diseases in Maine.
abstract: Chronic respiratory diseases rank among the leading global disease burdens. Maine's respiratory disease prevalence exceeds the US average, despite limited urbanization/industrialization. To provide insight into potential etiologic factors among this unique, rural population, we analyzed the spatial distributions of, and potential associations among asthma, COPD, pneumonia, and URI adult outpatient data (n=47,099) from all outpatient transactions (n=5,052,900) in 2009 for Maine hospitals and affiliate clinics, using spatial scan statistic, geographic weighted regression (GWR), and a Delaunay graph algorithm. Non-random high prevalence regions were identified, the majority of which (84% of the population underlying all regions) exhibited clusters for all four respiratory diseases. GWR provided further evidence of spatial correlation (R(2)=0.991) between the communicable and noncommunicable diseases under investigation, suggesting spatial interdependence in risk. Sensitivity analyses of known respiratory disease risks did not fully explain our results. Prospective epidemiology studies are needed to clarify all contributors to risk.
authors.affiliation: Maine Institute for Human Genetics and Health, Brewer, ME, United States; The Polis Center and the Center for Health Geographics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States. Electronic address: chriscfarah@gmail.com.
authors.forename: Christopher
authors.initials: C
authors.lastname: Farah
authors.affiliation: Department of Epidemiology and Population Health, Division of Epidemiology, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: H Dean
authors.initials: HD
authors.lastname: Hosgood
authors.affiliation: Maine Institute for Human Genetics and Health, Brewer, ME, United States; The Polis Center and the Center for Health Geographics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Hock
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000453:epidemiology*; D008281:Maine / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D062206:Spatial Analysis; D055815:Young Adult
keywords: Environmental health; Health disparities; Respiratory disease; Spatial epidemiology; Spatial statistics