Joint Mapping of Cardiovascular Diseases: Comparing the Geographic Patterns in Incident Acute Myocardial Infarction, Stroke and Atrial Fibrillation, a Danish Register-based Cohort Study 2014-15

Overview

Journal Int J Health Geogr

Publisher Biomed Central

Specialties Health Services
Public Health

Date 2021 Aug 31

PMID 34461900

Citations 3

Authors

Kristine Bihrmann

Gunnar Gislason

Mogens Lytken Larsen

Annette Kjaer Ersboll

Affiliations

Soon will be listed here.

Abstract

Background: Disease mapping aims at identifying geographic patterns in disease. This may provide a better understanding of disease aetiology and risk factors as well as enable targeted prevention and allocation of resources. Joint mapping of multiple diseases may lead to improved insights since e.g. similarities and differences between geographic patterns may reflect shared and disease-specific determinants of disease. The objective of this study was to compare the geographic patterns in incident acute myocardial infarction (AMI), stroke and atrial fibrillation (AF) using the unique, population-based Danish register data.

Methods: Incident AMI, stroke and AF was modelled by a multivariate Poisson model including a disease-specific random effect of municipality modelled by a multivariate conditionally autoregressive (MCAR) structure. Analyses were adjusted for age, sex and income.

Results: The study included 3.5 million adults contributing 6.8 million person-years. In total, 18,349 incident cases of AMI, 28,006 incident cases of stroke, and 39,040 incident cases of AF occurred. Estimated municipality-specific standardized incidence rates ranged from 0.76 to 1.35 for AMI, from 0.79 to 1.38 for stroke, and from 0.85 to 1.24 for AF. In all diseases, geographic variation with clusters of high or low risk of disease after adjustment was seen. The geographic patterns displayed overall similarities between the diseases, with stroke and AF having the strongest resemblances. The most notable difference was observed in Copenhagen (high risk of stroke and AF, low risk of AMI). AF showed the least geographic variation.

Conclusion: Using multiple-disease mapping, this study adds to the results of previous studies by enabling joint evaluation and comparison of the geographic patterns in AMI, stroke and AF. The simultaneous mapping of diseases displayed similarities and differences in occurrence that are non-assessable in traditional single-disease mapping studies. In addition to reflecting the fact that AF is a strong risk factor for stroke, the results suggested that AMI, stroke and AF share some, but not all environmental risk factors after accounting for age, sex and income (indicator of lifestyle and health behaviour).

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References

Naderi S, Wang Y, Miller A, Rodriguez F, Chung M, Radford M . The impact of age on the epidemiology of atrial fibrillation hospitalizations. Am J Med. 2013; 127(2):158.e1-7. PMC: 4436031. DOI: 10.1016/j.amjmed.2013.10.005. View

Madsen M, Davidsen M, Rasmussen S, Abildstrom S, Osler M . The validity of the diagnosis of acute myocardial infarction in routine statistics: a comparison of mortality and hospital discharge data with the Danish MONICA registry. J Clin Epidemiol. 2003; 56(2):124-30. DOI: 10.1016/s0895-4356(02)00591-7. View

Thorvaldsen P, Davidsen M, Bronnum-Hansen H, Schroll M . Stable stroke occurrence despite incidence reduction in an aging population: stroke trends in the danish monitoring trends and determinants in cardiovascular disease (MONICA) population. Stroke. 1999; 30(12):2529-34. DOI: 10.1161/01.str.30.12.2529. View

Ersboll A, Kjaerulff T, Bihrmann K, Schipperijn J, Gislason G, Larsen M . Geographical variation in a fatal outcome of acute myocardial infarction and association with contact to a general practitioner. Spat Spatiotemporal Epidemiol. 2016; 19:60-69. DOI: 10.1016/j.sste.2016.06.001. View

Soliman E, Safford M, Muntner P, Khodneva Y, Dawood F, Zakai N . Atrial fibrillation and the risk of myocardial infarction. JAMA Intern Med. 2013; 174(1):107-14. PMC: 4115282. DOI: 10.1001/jamainternmed.2013.11912. View

Kjaerulff T, Bihrmann K, Zhao J, Exeter D, Gislason G, Larsen M . Acute myocardial infarction: Does survival depend on geographical location and social background?. Eur J Prev Cardiol. 2019; 26(17):1828-1839. DOI: 10.1177/2047487319852680. View

Labarthe D, Howard G, Safford M, Howard V, Judd S, Cushman M . Incidence and Case Fatality at the County Level as Contributors to Geographic Disparities in Stroke Mortality. Neuroepidemiology. 2016; 47(2):96-102. PMC: 5121010. DOI: 10.1159/000449102. View

Wodschow K, Bihrmann K, Larsen M, Gislason G, Ersboll A . Geographical variation and clustering are found in atrial fibrillation beyond socioeconomic differences: a Danish cohort study, 1987-2015. Int J Health Geogr. 2021; 20(1):11. PMC: 7923319. DOI: 10.1186/s12942-021-00264-2. View

Gelfand A, Vounatsou P . Proper multivariate conditional autoregressive models for spatial data analysis. Biostatistics. 2003; 4(1):11-25. DOI: 10.1093/biostatistics/4.1.11. View

10.

MacNab Y . Linear models of coregionalization for multivariate lattice data: a general framework for coregionalized multivariate CAR models. Stat Med. 2016; 35(21):3827-50. DOI: 10.1002/sim.6955. View

11.

Jin X, Banerjee S, Carlin B . Order-free co-regionalized areal data models with application to multiple-disease mapping. J R Stat Soc Series B Stat Methodol. 2010; 69(5):817-838. PMC: 2963450. DOI: 10.1111/j.1467-9868.2007.00612.x. View

12.

Havulinna A, Paakkonen R, Karvonen M, Salomaa V . Geographic patterns of incidence of ischemic stroke and acute myocardial infarction in Finland during 1991-2003. Ann Epidemiol. 2008; 18(3):206-13. DOI: 10.1016/j.annepidem.2007.10.008. View

13.

Jack E, Lee D, Dean N . Estimating the changing nature of Scotland's health inequalities by using a multivariate spatiotemporal model. J R Stat Soc Ser A Stat Soc. 2019; 182(3):1061-1080. PMC: 6563432. DOI: 10.1111/rssa.12447. View

14.

Kjaerulff T, Bihrmann K, Andersen I, Gislason G, Larsen M, Ersboll A . Geographical inequalities in acute myocardial infarction beyond neighbourhood-level and individual-level sociodemographic characteristics: a Danish 10-year nationwide population-based cohort study. BMJ Open. 2019; 9(2):e024207. PMC: 6398745. DOI: 10.1136/bmjopen-2018-024207. View

15.

Benjamin E, Levy D, Vaziri S, DAgostino R, Belanger A, Wolf P . Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994; 271(11):840-4. View

16.

Virani S, Alonso A, Benjamin E, Bittencourt M, Callaway C, Carson A . Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020; 141(9):e139-e596. DOI: 10.1161/CIR.0000000000000757. View

17.

Rix T, Riahi S, Overvad K, Lundbye-Christensen S, Schmidt E, Joensen A . Validity of the diagnoses atrial fibrillation and atrial flutter in a Danish patient registry. Scand Cardiovasc J. 2012; 46(3):149-53. DOI: 10.3109/14017431.2012.673728. View

18.

Luhdorf P, Overvad K, Schmidt E, Johnsen S, Bach F . Predictive value of stroke discharge diagnoses in the Danish National Patient Register. Scand J Public Health. 2017; 45(6):630-636. DOI: 10.1177/1403494817716582. View

19.

Wolf P, Abbott R, Kannel W . Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22(8):983-8. DOI: 10.1161/01.str.22.8.983. View

20.

Lynge E, Sandegaard J, Rebolj M . The Danish National Patient Register. Scand J Public Health. 2011; 39(7 Suppl):30-3. DOI: 10.1177/1403494811401482. View