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The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access.

Publication ,  Journal Article
Hertz, JT; Fu, T; Vissoci, JR; Rocha, TAH; Carvalho, E; Flanagan, B; de Andrade, L; Limkakeng, AT; Staton, CA
Published in: PLoS One
2019

BACKGROUND: Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality. METHODS AND RESULTS: Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables. CONCLUSIONS: The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2019

Volume

14

Issue

1

Start / End Page

e0210502

Location

United States

Related Subject Headings

  • Young Adult
  • Socioeconomic Factors
  • Middle Aged
  • Male
  • Humans
  • Health Services Accessibility
  • General Science & Technology
  • Female
  • Electrocardiography
  • Cross-Sectional Studies
 

Citation

APA
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Hertz, J. T., Fu, T., Vissoci, J. R., Rocha, T. A. H., Carvalho, E., Flanagan, B., … Staton, C. A. (2019). The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access. PLoS One, 14(1), e0210502. https://doi.org/10.1371/journal.pone.0210502
Hertz, Julian T., Tommy Fu, Joao Ricardo Vissoci, Thiago Augusto Hernandes Rocha, Elias Carvalho, Brendan Flanagan, Luciano de Andrade, Alex T. Limkakeng, and Catherine A. Staton. “The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access.PLoS One 14, no. 1 (2019): e0210502. https://doi.org/10.1371/journal.pone.0210502.
Hertz, Julian T., et al. “The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access.PLoS One, vol. 14, no. 1, 2019, p. e0210502. Pubmed, doi:10.1371/journal.pone.0210502.
Hertz JT, Fu T, Vissoci JR, Rocha TAH, Carvalho E, Flanagan B, de Andrade L, Limkakeng AT, Staton CA. The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access. PLoS One. 2019;14(1):e0210502.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2019

Volume

14

Issue

1

Start / End Page

e0210502

Location

United States

Related Subject Headings

  • Young Adult
  • Socioeconomic Factors
  • Middle Aged
  • Male
  • Humans
  • Health Services Accessibility
  • General Science & Technology
  • Female
  • Electrocardiography
  • Cross-Sectional Studies