Variations in cardiovascular disease under-diagnosis in England: national cross-sectional spatial analysis.
Variations in cardiovascular disease under-diagnosis in England: national cross-sectional spatial analysis.
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DOI：
10.1186/1471-2261-11-12
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发表时间：
2011-03-17
影响因子：
2.1
通讯作者：
Majeed A
中科院分区：
文献类型：
--
作者：
Soljak M;Samarasundera E;Indulkar T;Walford H;Majeed A
英国人口中心血管疾病（CVD）的诊断不足，尽管有财政激励措施鼓励全科诊所登记新病例。我们比较了三种心血管疾病的建模（预期）和诊断（观察）患病率-冠心病（CHD），高血压和中风-在当地水平，其地理变化，以及可能影响诊断的人口和医疗保健预测因素。在所有英国地方当局（351）和全科诊所（8，372）中进行的横断面观察性研究，比较了基于模型的预期患病率与实践疾病登记册上的诊断患病率。空间分析被用来确定地理集群和回归关系的变化。共有9，682，176例患者进行了实践CHD、卒中和短暂性脑缺血发作以及高血压登记。所有这三种疾病的观察到的预期流行率存在很大的空间差异，在某些地区，诊断出的预期病例不到5%。伦敦及周边地区的观察到的患病率与预期的患病率之比在统计学上存在显著差异，观察到的患病率远低于流行病学模型的预测。增加全科医生的供应作为一个变量，产生了更强的回归结果，所有三个条件。尽管几乎普遍获得免费的初级卫生保健，但英格兰各地可能存在显著且高度可变的心血管疾病诊断不足，这可以部分解释为GP供应的持续不平等。疾病管理研究应考虑诊断不足对人群健康结果的可能影响。与经典的回归模型相比，空间分析技术可以提供有关诊断不足风险因素的额外信息，并可以建议最需要医疗资源的地方。
There is under-diagnosis of cardiovascular disease (CVD) in the English population, despite financial incentives to encourage general practices to register new cases. We compared the modelled (expected) and diagnosed (observed) prevalence of three cardiovascular conditions- coronary heart disease (CHD), hypertension and stroke- at local level, their geographical variation, and population and healthcare predictors which might influence diagnosis. Cross-sectional observational study in all English local authorities (351) and general practices (8,372) comparing model-based expected prevalence with diagnosed prevalence on practice disease registers. Spatial analyses were used to identify geographic clusters and variation in regression relationships. A total of 9,682,176 patients were on practice CHD, stroke and transient ischaemic attack, and hypertension registers. There was wide spatial variation in observed: expected prevalence ratios for all three diseases, with less than five per cent of expected cases diagnosed in some areas. London and the surrounding area showed statistically significant discrepancies in observed: expected prevalence ratios, with observed prevalence much lower than the epidemiological models predicted. The addition of general practitioner supply as a variable yielded stronger regression results for all three conditions. Despite almost universal access to free primary healthcare, there may be significant and highly variable under-diagnosis of CVD across England, which can be partially explained by persistent inequity in GP supply. Disease management studies should consider the possible impact of under-diagnosis on population health outcomes. Compared to classical regression modelling, spatial analytic techniques can provide additional information on risk factors for under-diagnosis, and can suggest where healthcare resources may be most needed.
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影响因子：
105.7
作者：
Gray, J;Majeed, A;Rowlands, G
通讯作者：
Rowlands, G
DOI：
10.1111/1467-9884.00145
发表时间：
1998-01-01
期刊：
JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES D-THE STATISTICIAN
影响因子：
--
作者：
Brunsdon, C;Fotheringham, S;Charlton, M
通讯作者：
Charlton, M
影响因子：
8.3
作者：
Hajat, C;Tilling, K;Wolfe, CDA
通讯作者：
Wolfe, CDA
影响因子：
7.2
作者：
Lampe, FC;Walker, M;Ebrahim, S
通讯作者：
Ebrahim, S
影响因子：
8.3
作者：
McFadden, Emily;Luben, Robert;Khaw, Kay-Tee
通讯作者：
Khaw, Kay-Tee