title: A spatial analysis of COPD prevalence, incidence, mortality and health service use in Ontario.
abstract: BACKGROUND
  Risk factors for chronic obstructive pulmonary disease (COPD) include smoking, occupational exposure and air pollution, which vary geographically, but relatively little is known about how COPD varies spatially.
  
  
  METHODS
  This population-based ecological analysis examines physician-diagnosed COPD prevalence, incidence, mortality, and health care services use in Ontario over a 10-year period. Data were mapped and analyzed at the sub-Local Health Integration Network level (n = 141). Comparative morbidity figures were calculated and analyzed for local clusters of high and low rates of COPD health and health service use outcomes.
  
  
  RESULTS
  A total of 722,494 individuals were identified as having COPD over the study period. Clusters of high rates in health outcomes and in most indicators of health service use emerged in northern parts of Ontario and in industrial and more rural agricultural areas. Clusters of low rates were centered on major urban and suburban areas. An exception was COPD-specific physician visits, which were lower in northern areas suggesting greater reliance on acute care.
  
  
  CONCLUSIONS
  This study highlights the need for research focused on explaining the spatial patterns identified here.
authors.affiliation: University of Ottawa, Ottawa, Ontario.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Crighton
authors.affiliation: University of Ottawa, Ottawa, Ontario.
authors.forename: Rosalind
authors.initials: R
authors.lastname: Ragetlie
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Jin
authors.initials: J
authors.lastname: Luo
authors.affiliation: The Hospital for Sick Children, Toronto, Ontario.
authors.forename: Teresa
authors.initials: T
authors.lastname: To
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gershon
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000401:mortality; D012111:Residence Characteristics; D012307:Risk Factors; D012737:Sex Factors; D062206:Spatial Analysis
keywords: Administrative data; COPD; public health surveillance; spatial analysis