Joint modelling of potentially avoidable hospitalisation for five diseases accounting for spatiotemporal effects: A case study in New South Wales, Australia

PLoS One. 2017 Aug 30;12(8):e0183653. doi: 10.1371/journal.pone.0183653. eCollection 2017.

Abstract

Background: Three variant formulations of a spatiotemporal shared component model are proposed that allow examination of changes in shared underlying factors over time.

Methods: Models are evaluated within the context of a case study examining hospitalisation rates for five chronic diseases for residents of a regional area in New South Wales: type II diabetes mellitus (DMII), chronic obstructive pulmonary disease (COPD), coronary arterial disease (CAD), hypertension (HT) and congestive heart failure (CHF) between 2001-2006. These represent ambulatory care sensitive (ACS) conditions, often used as a proxy for avoidable hospitalisations. Using a selected model, the effects of socio-economic status (SES) as a shared component are estimated and temporal patterns in the influence of the residual shared spatial component are examined.

Results: Choice of model depends upon the application. In the featured application, a model allowing for changing influence of the shared spatial component over time was found to have the best fit and was selected for further analyses. Hospitalisation rates were found to be increasing for COPD and DMII, decreasing for CHF and stable for CAD and HT. SES was substantively associated with hospitalisation rates, with differing degrees of influence for each disease. In general, most of the spatial variation in hospitalisation rates was explained by disease-specific spatial components, followed by the residual shared spatial component.

Conclusion: Appropriate selection of a joint disease model allows for the examination of temporal patterns of disease outcomes and shared underlying spatial factors, and distinction between different shared spatial factors.

MeSH terms

  • Algorithms*
  • Ambulatory Care / statistics & numerical data
  • Chronic Disease / classification
  • Chronic Disease / therapy*
  • Coronary Artery Disease / therapy
  • Data Collection / methods
  • Data Collection / statistics & numerical data
  • Diabetes Mellitus, Type 2 / therapy
  • Heart Failure / therapy
  • Hospitalization / statistics & numerical data*
  • Humans
  • Hypertension / therapy
  • Models, Theoretical*
  • New South Wales
  • Patient Admission / statistics & numerical data
  • Pulmonary Disease, Chronic Obstructive / therapy
  • Spatio-Temporal Analysis

Grants and funding

The authors were financially supported in this work by the Cooperative Research Centre for Spatial Information, whose activities are funded by the Australian Commonwealth’s Cooperative Research Centres Programme. The funding source had no involvement in study design, in the collection, analysis or interpretation of data, in the writing of the report and in the decision to submit this article for publication.