Examination of spatial inequalities in access to health care according to mortality data of acute myocardial infarction

Abstract

Introduction: An improving tendency of cardiovascular mortality such as mortality from ischemic heart disease and infarction can be experienced in the last 15 years in the member states of the European Union, but this improvement is the most moderated in Hungary. The country is significantly lagging behind the most developed European countries, in spite of the improving tendency since the first years after 2000. The aim of this paper is to study the changes and spatial differences of acute myocardial infarction (AMI) in Hungary, in order to analyse this paradox. This can help in defining the Hungarian health inequalities and the difficulties in access to health care because a quick diagnosis, timely interventions and efficient rehabilitation can increase the survival chances of AMI.Methods: Our applied statistical methods are based on the examination of AMI mortality data (ICD I21-23) and its spatial inequalities between 2005 and 2015 at the level of counties and districts, by gender. Description of inequalities was based on selected inequality indicators. The neighbouring impact was examined by spatial autocorrelation, while spatial impact was analyzed by spatial autoregressive lagged model (SAR Lag) estimation.Results: There are significant differences among the different parts of the country according to AMI mortality and its spatial inequalities based on the total distribution of AMI mortality data. The scale of these inequalities was influenced by changes in time, spatial distribution and gender balance. There has been a remarkable improvement in AMI mortality in Hungary since 2005, but it is associated with increased inequality, which is especially true for female AMI mortality.Conclusions:Reducing spatial inequalities in socioeconomic determinants, such as health consciousness and labour market position, can result in declining inequalities in access to AMI care in the future. Rising spatial inequalities in AMI mortality raises the issue of defining socio-economic determinants which influence or hinder access to AMI care. Analysing these determinants is not part of this paper but they should be examined in the future, especially by local case studies. It is also worth studying the relationship between rising inequalities in female AMI mortality and the long term effects of the latest economic crisis.