Geographic accessibility and risk of hospitalization and mortality among patients with chronic respiratory diseases

• Main Author: Ghaderi, Gelareh
• Format: Thesis
• Language: English
• Published: Memorial University of Newfoundland 2019
• Subjects: Newfoundland
• Online Access: https://research.library.mun.ca/14269/; https://research.library.mun.ca/14269/1/thesis.pdf

Spatial differences exist in hospitalization and mortality among patients with Chronic Obstructive Pulmonary Disease (COPD) and asthma. Objective: Examine the association between geographic accessibility, hospitalization, and mortality among COPD and asthma patients in Newfoundland and Labrador (NL). Methods: A retrospective cohort of adults diagnosed with COPD and asthma were followed from diagnosis until hospitalization, death or end of the study. Geographic accessibility was defined using accessibility-remoteness index. Multivariate and geospatial analyses were performed. Result: We identified 44876 (43.8% inaccessible) COPD patients and 28316 asthma patients (37.4% inaccessible). Living in inaccessible areas increased hospitalization incidence for COPD (OR=2.57, 95% CI 1.54-4.25, P<0.00136) and asthma (OR=12.38, 95% CI:6.28-24.46, P<0.001). Mortality was associated with geographic accessibility only for COPD (OR=10.73, 95% CI; 2.27-44.77, P=0.002). COPD hospitalization (MI=0.034, p<0.03), mortality (MI=0.047, p<0.011) and asthma hospitalization (MI=0.065, p<0.001) were spatially autocorrelated. Conclusion: Living with chronic respiratory diseases in NL remote areas increases risk of hospitalization.