The Spatio-Temporal Information System on Myocardial Infarction

(SIST-IM)

GEOIDE Annual ConferenceMay 2003

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• SIST-IM* (Vanasse et al.)– Acute Coronary Syndrome (ACS)– Provincial Level

• SIST-OS* (Vanasse et al.)– Osteoporosis– Provincial Level

• SIST-STAT* (Niyonsenga et al.)– Spatial Statistics– Fundamental Research

SIST Program

* Financed by: GEOIDE networks and Merck Frosst Canada Ltd

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Geomatics and health

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SIST Program

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Partners

Principal investigatorA. Vanasse M.D. Ph.D.

Co-researchersT. Niyonsenga Ph.D.G. Bénié Ph.D.J.-P. Grégoire Ph.D.K. Goïta Ph.D.C. Dean Ph.D.P. Dagenais M.D. FRCP Ph.D.A. Ciampi Ph.D.

Research AssistantsJ. Courteau Ph.D.A. Hemiari Ph.D. M. Yergeau M.Sc.

StudentsM. Pomerleau M.Sc. (c)J. Loslier M.D. M.Sc. (c)J. Autmizguine

SIST-IM Project

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SIST-IM Objectives

• For patients hospitalized for ACS in Quebec between 1991 and 2001: – Describe and compare the profile of

revascularization and the profile of mortality/morbidity

– Describe and compare short and long term treatments for patients aged 65 and older

– Identify possible factors explaining spatio-temporal heterogeneity

• Ethical considerations– Approved by the ethical committee of CHUS and CAI

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Aspatial Database

MSSS

Inclusion criteria

Cohort constitution

NAM RAMQ

ExtractionMED-ECHOVital statistics

Patient ID number=

ExtractionPharmaceutical services

GEOMEDUS GEOMEDUS

Patient ID number

MSSS

Inclusion criteria

Cohort constitution

NAM RAMQ

ExtractionMED-ECHOVital statistics

Patient ID number=

ExtractionPharmaceutical services

GEOMEDUS GEOMEDUS

Patient ID number

Codes ICD-9: 410-4141991-2001

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Variables

VARIABLES 1. Patient ID number 2. Cause of death 3. Date of death

VARIABLES 1. Patient ID number 2. Age 3. Gender 4. Postal code 5. RSS-DSC-CLSC of patient 6. Type of establishment 7. RSS-DSC-CLSC of establishment 8. Admission date 9. Principal diagnosis (410 - 411) 10. Secondary diagnoses 11. Treatment code 12. Death type 13. Death 48 hours 14. Discharge date 15. Length of stay 16. Destination type 17. Destination code

MED-ECHO (MSSS) Vital Statistics (MSSS)

Pharmaceutical Services (RAMQ)

VARIABLES 1. Patient ID number 2. Drug identification number (DIN) 3. Common denomination code 4. AHF class 5. Quantity of drug 6. Duration of treatment 7. Code of renewal 8. Specialty of prescribing physician 9. Date of claim

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Specific Question

• For patients hospitalized for ACS in year 2000:– Can we observe a regional variation in

standardized revascularization ratios?

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Conceptual model

DA1.5

Region

DA1.12

Discharge date

DA1.6

Admission date

DA1.2

Date of Birth

DA1.3

Gender

DA1.1

Patient I D number

DI1.1

Revascularisation (0/1)

DI1.2

Age/sex category

DI2.1

Number revascularizations byage/sex and region

DI2.2

Number hospitalizations byage/sex and region

DI3.1

Number revasc. by region

DI3.2

Number revasc. by age/sex

f6f5

f2f1

f4

DI3.3

Number hospitalizations byage/sex

f7

DI5.1

Expected number ofrevascularizations

f8

DT1.1

Standardizedrevascularization ratios

f9

Standardized revascularizationratios by region

C1

DA1.9

Treatment code

f3

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RevascularizationStandardized revascularization ratios and 95%-confidence intervals

Bas-Saint-Laurent 0.589Saguenay-LacSt-Jean 1.067

Québec 0.883Mauricie,Centre-Qc 1.000

Estrie 0.924Montréal-centre 1.334

Outaouais 1.094Abitibi-Témisc 0.608

Côte-Nord 0.593Nord-du-Québec 0.691

Gaspésie, îles 0.483Chaudière-Appalaches 0.511

Laval 1.222Lanaudière 1.091Laurentides 0.877Montérégie 1.030

2,01,51,0,50,0

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Thresholding: standardized ratios

Dendrogram: Standardized revascularization ratios

Outaouais 7 Lanaudière 14 Saguenay-Lac St-Jean 2 Mauricie, Centre-du-Québec 4 Montérégie 16 Québec 3 Laurentides 15 Estrie 5 Montréal-Centre 6 Laval 13 Gaspésie, Îles-madeleine 11 Chaudière-Appalaches 12 Bas-St-Laurent 1 Côte-Nord 9 Abitibi-Témiscamingue 8 Nord-du-Québec 10

4 groups

1.043

0.892

1.314

0.549

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Discussion

• Is there any relation between access to tertiary cardiology centers and revascularization?

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Discussion

YES NO

YES 5395 2159 7554

NO 7450 5157 12,607

12,845 7316 20,161

Revascula-rization

Access to tertiary cardiology center

Odds Ratio = 1.73p < 0.0001

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Discussion

• Other related works– Relation between meteorological extreme

conditions and myocardial infarction (Michel Pomerleau)

– Relation between rural areas and myocardial infarction (Julie Loslier)