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Spatial variation of cardiovascular mortality in Cali, Colombia, between 2010 and 2017
Luisa M Murillo1, Carolina Ramírez1, Mercedes Andrade-Bejarano1
1School of Statistics, Universidad del Valle, Calle 13 # 100-00, Edificio E56, Ciudad Universitaria Meléndez, Cali, Colombia.
Insights
Cardiovascular disease (CVD) mortality in Cali, Colombia, shows spatial patterns linked to socio-economic factors. Understanding these regional disparities is key for targeted public health interventions and reducing CVD deaths.
Area of Science:
- Public Health
- Epidemiology
- Spatial Analysis
Background:
- Cardiovascular disease (CVD) is a leading global and Colombian cause of death.
- CVD mortality is influenced by individual factors and broader contextual conditions.
- Regional analysis of CVD distribution aids targeted prevention and care.
Purpose of the Study:
- To analyze the spatial distribution and rates of CVD mortality in Cali, Colombia, from 2010-2017.
- To identify high-risk areas for CVD mortality based on socio-economic factors and spatial aggregation.
- To inform public health strategies by considering local contextual conditions.
Main Methods:
- Utilized the national mortality register for standardized CVD mortality rates and spatial distribution analysis.
- Employed Geary's C test to assess global and local spatial aggregation.
- Estimated smoothed standardized mortality ratios using Bayesian empirical methods for each district.
Main Results:
- CVD accounted for 23.8% of total deaths in Cali, with hypertensive diseases, ischemic heart diseases, and stroke as primary causes.
- High CVD mortality risk was observed in specific districts with both low and high socio-economic strata, particularly those on the city's periphery.
- Spatial autocorrelation was detected, with significant spatial associations in several districts, indicating clustering of CVD mortality.
Conclusions:
- CVD mortality risk is unevenly distributed across Cali's districts, with elevated risks in peripheral areas across different socio-economic strata.
- The identified global spatial aggregation suggests that contextual factors, potentially related to location and socio-economic conditions, influence CVD mortality.
- Local conditions must be considered in developing strategies to prevent and manage CVD mortality effectively.
Background:
Cardiovascular disease (CVD) is the leading cause of mortality worldwide and in Colombia. The analysis of CVD mortality has been mainly relied on individual factors and rates, but occurrence is also related to contextual conditions. Understanding the distribution of CVD in a region will contribute to implement more focused-preventive and care interventions.
Methods:
Using the national mortality register established by the Department of National Statistics, standardized rates and spatial distribution of CVD mortality were estimated for Cali, Colombia, between 2010-2017. Global and local spatial aggregation was assessed using the Geary's C test and for each district standardized mortality ratios smoothed by the Bayesian empirical were estimated.
Results:
Over the period, CVD was the main cause of mortality with 28,804 deaths accounting for 23,8% of total deaths. The global CVD mortality rate varied from 235.9 to 257.4 per 100.000 habitants, with an average increase of 9.1% in the percentage change. The main cause of mortality were hypertensive diseases following by ischemic heart diseases and stroke. The standardized mortality ratios smoothed by the Bayesian empirical method showed that the districts 7, 13, 14, 15 and 16 located at the eastern area with the lowest socio-economic strata and the district 22 at the south of the city with the highest socio-economic strata had the high risks of CVD mortality. All these areas were at the boundary of the city. The the lowest risk was observed in districts 1 and 2 at the northwest area with the upper socio-economic strata. Over the study period, a spatial autocorrelation was found in the districts 1,9 10, 11, 12, 13, 14, 15, 19, and 21 by using the Geary's C test. The highest significant spatial association was found in the districts 1 and 21.
Conclusion:
Of 22 districts in Cali, the highest risk of CVD mortality was found in three at the lowest and one in the upper socio-economic strata between 2013 and 2017. Over the period a global spatial aggregation was identified due mainly to districts peripherical located suggesting that there could be contextual conditions influencing the risk. Therefore, there is a need for considering local conditions to prevent CVD mortality.
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