本期为大家推荐的内容为论文《Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018》（2007-2018年北京地区人群急性心肌梗死死亡率的地理差异及其与医疗设施可达性的关联），发表在 Journal of the American Heart Association 期刊，欢迎大家学习与交流。
背景
在快速发展的特大城市中，小区域尺度急性心肌梗死(AMI)死亡率的地理差异及医疗设施可达性变化与AMI死亡率变化的关联尚不清楚。
方法和结果
在这项生态学研究中，我们纳入了2007-2018年北京心血管疾病监测系统中的94106例AMI死亡数据。采用贝叶斯空间模型估计了每3年乡镇/街道水平的AMI死亡率。使用两部移动搜索模型测度乡镇/街道医疗设施可达性。利用线性回归模型分析医疗设施可达性和AMI死亡率的关联。2007-2018年，乡镇/街道水平中位AMI死亡率从86.3/10万人 (95% CI,34.2-173.8)降至49.4/10万人(95% CI, 30.5-73.7)。AMI死亡率下降较多的乡镇/街道，其医疗设施可达性上升也较多。使用乡镇/街道水平90分位数和10分位数AMI死亡率的比值定义地理不平等，发现AMI死亡率的地理不平等从3.4增加到3.8。研究期间，86.3% (265/307)的乡镇/街道医疗设施可达性上升。医疗设施可达性每增加10%与AMI死亡率降低0.71% (95%CI, -1.08%- -0.33%)显著相关。
结论
北京乡镇/街道水平AMI死亡率的地理差异很大，并在不断增加。乡镇/街道水平医疗设施可达性的相对增加与AMI死亡率的相对降低相关。在AMI死亡率高的地区，针对性地改善医疗设施可达性可能有助于减轻AMI疾病负担，并改善特大城市的AMI地理不平等。
题目：Geographic Variation in Mortality of Acute Myocardial Infarction and Association With Health Care Accessibility in Beijing, 2007 to 2018
（2007-2018年北京地区人群急性心肌梗死死亡率的地理差异及其与医疗设施可达性的关联）
作者：
Jie Chang*, Qiuju Deng, Piaopiao Hu, Moning Guo, Feng Lu, Yuwei Su, Jiayi Sun, Yue Qi , Ying Long and Jing Liu
发表刊物：
Journal of the American Heart Association
DOI:
https://doi.org/10.1161/JAHA.123.029769
URL:
https://www.ahajournals.org/doi/10.1161/JAHA.123.029769
Little is known about geographic variation in acute myocardial infarction (AMI) mortality within fast‐developing megacities and whether changes in health care accessibility correspond to changes in AMI mortality at the small‐area level.
We included data of 94 106 AMI deaths during 2007 to 2018 from the Beijing Cardiovascular Disease Surveillance System in this ecological study. We estimated AMI mortality for 307 townships during consecutive 3‐year periods with a Bayesian spatial model. Township‐level health care accessibility was measured using an enhanced 2‐step floating catchment area method. Linear regression models were used to examine the association between health care accessibility and AMI mortality. During 2007 to 2018, median AMI mortality in townships declined from 86.3 (95% CI, 34.2–173.8) to 49.4 (95% CI, 30.5–73.7) per 100 000 population. The decrease in AMI mortality was larger in townships where health care accessibility increased more rapidly. Geographic inequality, defined as the ratio of the 90th to 10th percentile of mortality in townships, increased from 3.4 to 3.8. In total, 86.3% (265/307) of townships had an increase in health care accessibility. Each 10% increase in health care accessibility was associated with a −0.71% (95% CI, −1.08% to −0.33%) change in AMI mortality.
Geographic disparities in AMI mortality among Beijing townships are large and increasing. A relative increase in township‐level health care accessibility is associated with a relative decrease in AMI mortality. Targeted improvement of health care accessibility in areas with high AMI mortality may help reduce AMI burden and improve its geographic inequality in megacities.
研究全文以及更多相关的研究工作详见BCL的【Healthy Cities】单元链接：
https://www.beijingcitylab.com/projects-1/34-healthy-cities/
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BCL北京城市实验室“健康城市” （Healthy Cities）项目还包括《北京地区急性心肌梗死患者到最近可行经皮冠状动脉介入术医院的驾驶时间与病死风险的关联研究》、《利用出租车轨迹数据回溯就医可达性:以北京急性心肌梗死患者就医为例》、《社区基础设施相关的风险因素对慢性非传染性疾病的影响：系统性元综述》等研究内容，欢迎探索。
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原文始发于微信公众号（北京城市实验室BCL）：论文推荐 | 2007-2018年北京地区人群急性心肌梗死死亡率的地理差异及其与医疗设施可达性的关联
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