Key result
Panama CVD mortality disparities link to social determinants, with education showing a ~0.92 socioeconomic correlation.
Why the study?
The study was conducted to determine the geographic and time variation of social determinants of health and cardiovascular disease mortality in Panama from 2012 to 2016, and to identify which determinant most strongly correlates with a socioeconomic index.
Observational (n=154,019)
Effect estimate: correlation coefficient 0.9205
There are significant geographical and temporal disparities in social determinants of health and cardiovascular mortality rates in Panama, highlighting the need for targeted public health interventions in high-risk provinces.
Regional CVD disparities in Panama merit enhanced surveillance; leaves open whether education-focused policies reduce mortality.
BACKGROUND: The aims of this study were to determine the geographic and time variation of social determinants of health (SDH) and cardiovascular disease (CVD) mortality in Panama from 2012 to 2016, and to identify which of the SDH has the strongest correlation with a socioeconomic index (SEI). METHODS: We conducted an ecological study obtaining mortality from the National Mortality Register and socioeconomic variables derived from the National Household Survey (NHS). The International Classification of Diseases 10th revision codes I20-I25 and I60-I69 were used for ischemic heart disease (IHD) and stroke, respectively. Standardized age-adjusted mortality rates were calculated by direct method. Mortality rates and socioeconomic variables were evaluated together in a panel data model. A SEI was developed from factorial analysis by principal components with a polychoric correlation matrix. Provinces and regions were categorized in tertiles according to median value of the SEI score. RESULTS: The NHS evaluated an average of 15,919 households per year. The mean of age throughout the study period was 41 years. The average monthly income increased, from US$ (SD) 331.94 (5.38) in 2012, to 406.24 (5.81) in 2016, whereas the social security health coverage remained in a range of 57-58%. The mean number of school years was twelve. Significant geographical and temporal variations in social determinants and mortality rates were observed throughout the country. Colon, categorized in the middle tertile according to the SEI, presented higher IHD mortality rates. Darién (in the lowest SEI tertile) Colón and Herrera had higher stroke mortality rates. The SEI categorized indigenous territories in the lowest tertile. Total years of education was the strongest correlated variable with the SEI, when we excluded the population living in indigenous territories. However, when this population was included, social security coverage had the strongest correlation with the SEI. CONCLUSION: We observed geographical and temporal disparities in SDH and CVD mortality rates. Further epidemiological studies are warranted in the provinces of Colón, Darien, Herrera and Los Santos to explore in-depth the higher CVD mortality rates observed in these provinces.
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Quiel et al. (2019) conducted an observational in Cardiovascular disease mortality (n=154,019). Social determinants of health (years of education, social security coverage, monthly income) was evaluated on Correlation with socioeconomic index (SEI) (correlation coefficient 0.9205). Significant geographical and temporal disparities in social determinants and cardiovascular disease mortality were observed in Panama, with years of education showing the strongest correlation with the socioeconomic index (correlation 0.9205).
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